Nursing-Led HIV Prevention in Uzbekistan: Strategies, Stigma Reduction, and Pathways to Strengthening Vulnerable Population Outcomes

Nursing-Led HIV Prevention in Uzbekistan: Strategies, Stigma Reduction, and Pathways to Strengthening Vulnerable Population Outcomes | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Nursing-Led HIV Prevention in Uzbekistan: Strategies, Stigma Reduction, and Pathways to Strengthening Vulnerable Population Outcomes Sevara Mirkhamidova This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9614177/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: HIV infection remains a global public health challenge, with over 50,000 officially registered cases in Uzbekistan as of 2023. Nursing personnel occupy a unique frontline position within the healthcare system with substantial but underutilized potential for HIV prevention. Methods: A narrative review and comparative analysis of international guidelines, peer-reviewed literature, and national regulatory documents were conducted. Sources included World Health Organization (WHO) and UNAIDS publications, journals including The Lancet , Journal of Clinical Nursing , and BMC Public Health , as well as Uzbekistan Ministry of Health policy documents. A comparative survey of nursing attitudes toward HIV-positive patients was also conducted among two groups (main group: n = 614; control group: n = 74). Results: Nurses serve as primary points of contact in HIV prevention, counseling, voluntary testing, psychosocial support, and interdisciplinary collaboration. Comparative analysis demonstrated that higher HIV awareness correlated with reduced stigma: fear and hostility toward HIV-positive patients was reported by 25% of main group nurses versus 11% in the control group. Uzbekistan's nursing workforce is actively involved in educational campaigns and voluntary counseling and testing (VCT), but lacks access to harm reduction programs and pre-exposure prophylaxis (PrEP). Conclusion: Expanding nursing competencies, integrating international best practices, and addressing systemic barriers including stigma and resource limitations are essential to improving HIV prevention outcomes among vulnerable populations in Uzbekistan. HIV prevention nursing roles stigma reduction Uzbekistan vulnerable populations voluntary counseling and testing 1 Introduction HIV infection remains a significant global public health concern. Despite substantial advances in prevention, diagnosis, and treatment, the virus continues to spread, particularly among high-risk groups—including people who use drugs, sex workers, and men who have sex with men (MSM) [1, 3, 8, 11]. In Uzbekistan, the epidemic represents an ongoing public health priority. According to the Ministry of Health of the Republic of Uzbekistan, more than 50,000 cases of HIV infection had been officially registered as of 2023; however, actual prevalence may be higher due to limited screening coverage [1–5]. The predominant transmission routes remain sexual and parenteral (through injection drug use). A notable trend in recent years is the rising proportion of women among newly diagnosed cases, underscoring the need for targeted prevention efforts among women of reproductive age [9–11]. A significant barrier to effective HIV control in Uzbekistan is the pervasive stigmatization of people living with HIV (PLHIV), which deters timely healthcare access and undermines preventive interventions. In this context, nursing personnel occupy a strategic position: they are among the first points of contact within the healthcare system and are well-positioned to deliver information, conduct counseling, facilitate testing, and provide comprehensive patient support [1–8, 10–12]. Contemporary nursing practice extends well beyond conventional caregiving. Nurses actively participate in diagnosis, prevention, patient education, and rehabilitation. Examining their specific role in HIV prevention in Uzbekistan is therefore of particular scientific and practical relevance—not only for expanding preventive reach but also for reducing disease-related stigma and improving the quality of life of PLHIV. Aims and objectives. The present study aims to examine the role of nursing personnel in HIV prevention, identify the most effective strategies and interventions, and evaluate their impact on vulnerable population groups. Specific objectives were to: (1) analyze the current state of HIV in Uzbekistan and globally; (2) study core nursing functions related to HIV prevention; (3) assess educational, diagnostic, and counseling programs implemented by nurses; (4) identify barriers to working with vulnerable populations; and (5) develop evidence-based recommendations for strengthening the nursing role in HIV prevention. 2 Methods 2.1 Study Design A two-part methodological approach was employed. First, a narrative review and comparative analysis of international and national regulatory documents and peer-reviewed scientific publications was conducted. Second, a comparative cross-sectional survey was administered to assess HIV stigma levels among nursing personnel in Uzbekistan. 2.2 Literature Review Peer-reviewed articles were identified through systematic searches of PubMed, Scopus, and Google Scholar databases using terms including "HIV prevention," "nursing role," "stigma," "Uzbekistan," "vulnerable populations," and "antiretroviral therapy." International guidelines consulted included the WHO Consolidated Guidelines on HIV Prevention, Diagnosis, Treatment and Care (2023) and relevant UNAIDS reports. National regulatory documents included the Law of the Republic of Uzbekistan "On Combating the Spread of the Disease Caused by the Human Immunodeficiency Virus (HIV Infection)" and Ministry of Health decrees governing VCT programs. 2.3 Comparative Survey A structured questionnaire was administered to two groups of nurses employed in clinical settings in Tashkent. The main group comprised 614 nurses (predominantly younger, with less professional experience), and the control group comprised 74 nurses (predominantly more experienced, with 16 or more years of practice). The questionnaire addressed: (1) attitudes toward mandatory disclosure of HIV status, (2) willingness to perform clinical procedures for HIV-positive patients, (3) psychological reactions to learning a patient's HIV-positive status, and (4) behavioral attitudes regarding shared resources. Descriptive statistics and between-group comparisons were used to analyze responses. 2.4 Ethics Declaration The study was conducted in accordance with the principles of the Declaration of Helsinki. Participation was voluntary and anonymous. Formal ethics committee approval was not required as no patient data were collected and no clinical interventions were performed. 3 Results 3.1 Key Functions of Nurses in HIV Prevention Nursing personnel perform a broad spectrum of HIV prevention functions. These encompass five interrelated domains: Educational and preventive activities: Raising public awareness of HIV transmission routes, protective measures, and testing opportunities; organizing seminars and training sessions for diverse population groups; and informing high-risk communities about evidence-based safer practices. Early detection and testing: Engaging in voluntary counseling and testing (VCT) programs; providing pre- and post-test counseling; and referring individuals for further diagnosis and treatment. Medical care and adherence support: Supporting adherence to antiretroviral therapy (ART); monitoring health status and early complication detection; and collaborating with physicians and social workers for comprehensive, patient-centered care. Psychosocial support: Reducing stigma and discrimination through education and advocacy; providing individual and group counseling; and offering psychological assistance to PLHIV and their families. Interdisciplinary collaboration: Partnering with governmental and non-governmental organizations; supporting community outreach; contributing to policy development; and engaging in epidemiological research. 3.2 Comparative Analysis of HIV Prevention Strategies Across Countries Table 1 presents a comparison of HIV prevention strategies and nursing roles across selected countries and regions. In high-income settings (USA, EU), nurses participate in integrated programs including mobile testing units, PrEP administration, and community outreach. In sub-Saharan Africa (South Africa, Nigeria, Kenya), nursing efforts are focused on public education and prevention of mother-to-child transmission (PMTCT). In Russia and Kazakhstan, voluntary testing programs involve nursing staff, though legislative constraints limit broader harm reduction approaches. In Uzbekistan, nurses are actively engaged in educational campaigns and VCT programs; however, access to harm reduction programs, anonymous testing in rural areas, and PrEP/PEP remains limited. Table 1 Comparative analysis of HIV prevention strategies and nursing roles across selected regions Country/Region Main Prevention Focus Role of Nurses PrEP/PEP Access Harm Reduction USA, EU Comprehensive: testing, PrEP, education Patient management, testing, counseling, PrEP oversight Widely available Widely distributed Africa (South Africa, Nigeria, Kenya) Education, PMTCT Outreach, education, vaccination Limited Partially implemented Russia, Kazakhstan Testing, harm reduction for PWID Counseling, work with key groups Partially available Limited Uzbekistan Education, VCT Counseling, VCT participation Not available Limited PMTCT = prevention of mother-to-child transmission; PWID = people who inject drugs; PrEP = pre-exposure prophylaxis; PEP = post-exposure prophylaxis; VCT = voluntary counseling and testing. 3.3 Survey Results: HIV Stigma Among Nurses 3.3.1 Disclosure Attitudes and Communication Willingness Among control group nurses (n = 74), 68% agreed that patients should disclose their HIV-positive status during medical visits, compared to 59% in the main group (n = 614). Conversely, 80% of control group nurses believed that relatives did not need to be informed, compared to only 50% in the main group—suggesting a more strongly patient-centered and confidentiality-oriented approach among the more experienced group. 3.3.2 Readiness to Perform Clinical Procedures Willingness to conduct medical examinations was high in both groups (control: 96%; main: 89%). However, willingness to perform procedures such as injections and wound dressing was markedly lower in the main group (72%) compared to the control group (89%). Willingness to assist during childbirth was reported by 51% of control group nurses and 59% of the main group, though this difference may reflect specialty distribution rather than stigma alone. 3.3.3 Psychological Reactions and Fear A substantially higher proportion of nurses in the main group reported fear or hostility upon learning a patient's HIV-positive status (25%) compared to the control group (11%). Willingness to use a shared toilet with an HIV-positive patient was reported by 80% of control group nurses but only 49% of the main group. Similarly, 84% of control group nurses would purchase products from a seller who had previously had HIV, compared to 62% in the main group. These disparities are consistent with greater HIV-related misconceptions and stigmatizing attitudes in the main group. 3.4 Effectiveness of Existing HIV Prevention Programs Evidence from international literature supports the effectiveness of several program types relevant to nursing practice in Uzbekistan. Needle and syringe exchange programs can reduce HIV incidence among people who inject drugs by 30–40% [2]. PMTCT programs, when combined with ART, reduce vertical transmission to below 5% [9]. PrEP reduces HIV risk by up to 90% among high-risk individuals when taken consistently [6]. Educational campaigns and HIV testing programs that integrate nursing outreach—particularly through mobile and anonymous services—are associated with increased testing uptake among vulnerable groups including youth, MSM, and PWID [7, 10]. 4 Discussion 4.1 Demographic and Professional Influences on Stigma The survey data reveal that younger, less experienced nurses (main group) exhibited higher levels of HIV stigma—manifested as greater reluctance to perform clinical procedures, higher rates of fear, and more restrictive attitudes toward shared resources. This pattern likely reflects less cumulative exposure to HIV-positive patients and more limited targeted training. Conversely, the control group's experience may have fostered greater professional confidence and familiarity with infection control practices, as demonstrated in prior studies from sub-Saharan Africa and Central Asia [3, 8]. 4.2 Barriers to Effective HIV Prevention Nursing Multiple systemic barriers limit the effectiveness of nursing-led HIV prevention in Uzbekistan. Persistent stigma among healthcare workers reduces willingness to provide quality care and creates psychological barriers that discourage PLHIV from seeking services [3, 4]. Insufficient targeted training in HIV counseling, ethics, and communication diminishes nurses' confidence and skill. Resource constraints—particularly in rural and remote settings—restrict the reach of mobile testing units and harm reduction programs. Social and cultural norms, including taboos surrounding discussions of sexual health and drug use, further impede open communication between nurses and patients [5, 12]. Finally, limited integration of nurses into interdisciplinary teams reduces the comprehensiveness of care. 4.3 Prospects for Expanding Nursing Involvement International evidence clearly demonstrates that countries with expanded nursing roles achieve superior HIV prevention outcomes. In the USA and EU, nurse-led mobile clinics and PrEP programs have substantially broadened access to biomedical prevention [6, 10]. In sub-Saharan Africa, task-shifting toward nursing personnel for VCT and PMTCT has been associated with significant reductions in new infections [1]. Uzbekistan's healthcare system has a robust nursing workforce that remains underutilized for HIV prevention. Expanding nursing scope of practice—particularly for harm reduction, PrEP provision, and anonymous testing—alongside systematic professional development represents a high-impact, cost-effective strategy. The integration of digital health tools, including telemedicine platforms and mobile health applications for adherence monitoring, offers additional pathways to expand nursing reach, particularly in geographically isolated areas [10, 11]. Strengthening interdisciplinary collaboration—formally embedding nurses in HIV prevention teams alongside physicians, psychologists, and social workers—can further enhance the comprehensiveness and continuity of care. 5 Conclusions Nursing personnel are indispensable to effective HIV prevention in Uzbekistan. The study confirms that nurses' expanded involvement in education, voluntary counseling and testing, psychosocial support, and adherence facilitation is associated with improved prevention outcomes and reduced HIV stigma. However, significant gaps remain: nurses in the main survey group exhibited substantially higher levels of HIV-related fear and stigmatizing attitudes than their more experienced counterparts, underscoring the urgency of systematic, targeted professional development. To strengthen nursing-led HIV prevention in Uzbekistan, the following evidence-based recommendations are proposed: 1. Implement mandatory, continuing professional education for nurses covering HIV transmission, ethics, patient communication, and stigma reduction. 2. Expand nursing scope of practice to include harm reduction program leadership, PrEP/PEP counseling, and provision of anonymous HIV testing in rural and remote settings. 3. Integrate anti-stigma training into undergraduate nursing curricula and ensure regular refresher programs for practicing nurses. 4. Establish formally structured interdisciplinary HIV prevention teams in which nurses hold defined roles alongside physicians, psychologists, and social workers. 5. Develop mobile and digital health platforms for nurse-led outreach, remote counseling, and ART adherence monitoring among hard-to-reach populations. 6. Secure increased government funding and international partnership support for HIV prevention programs, with particular attention to resource equity across urban and rural settings. 7. Conduct further research to evaluate the effectiveness of nursing-specific interventions in reducing HIV incidence and stigma in Central Asian contexts. Enhancing the role of nursing staff through expanded competencies, continuous professional development, and integration of international best practices is essential for improving HIV prevention and rehabilitation outcomes among vulnerable populations in Uzbekistan. Declarations Funding: No funding was received for the preparation of this article. Conflict of Interest: The author declares no competing interests. Ethics Approval and Consent to Participate: Not applicable. The study involved an anonymous voluntary survey of healthcare professionals and did not involve patient data or clinical interventions. Consent for Publication: Not applicable. Data Availability: The survey data analyzed in this study are available from the corresponding author on reasonable request. Author Contribution: S.M.M. conceived and designed the study, conducted the literature review and data analysis, and wrote and revised the manuscript. Acknowledgements The author acknowledges the support of the Ministry of Health of the Republic of Uzbekistan and local healthcare providers in facilitating the survey component of this research. References Bekker LG, Alleyne G, Baral S, Cepeda J, Daskalakis D, Dowdy D, et al. Advancing global health and strengthening the HIV response in the era of the Sustainable Development Goals: The International AIDS Society–Lancet Commission. Lancet. 2018;392(10144):312–58. https://doi.org/10.1016/S0140-6736(18)31070-5 Dawson L, Copenhaver MM. HIV risk behavior interventions for people who inject drugs: a review of current evidence. Curr HIV/AIDS Rep. 2020;17(1):1–9. https://doi.org/10.1007/s11904-019-00471-6 Geter A, Herron AR, Sutton MY. HIV-related stigma by healthcare providers in the United States: a systematic review. AIDS Patient Care STDs. 2018;32(10):418–24. https://doi.org/10.1089/apc.2018.0114 Knettel BA, Minja L, Chumba LN, Oshosen M, Cichowitz C, Mmbaga BT, et al. Serostatus disclosure outcomes for HIV-infected adolescents in sub-Saharan Africa: a systematic review. J Int AIDS Soc. 2021;24(1):e25628. https://doi.org/10.1002/jia2.25628 Mirkhamidova SM. Analysis of HIV awareness in Tashkent city. Glob J Med Res. 2021;21(2):20–32. https://globaljournals.org/GJMR_Volume21/3-Analysis-of-HIV-Awareness-in-Tashkent.pdf Ojikutu BO, Bogart LM, Higgins-Biddle M, Dale SK, O'Cleirigh C, Mayer KH. Facilitators and barriers to pre-exposure prophylaxis (PrEP) use among Black individuals in the United States: results from the national survey on HIV in the Black community (NSHBC). AIDS Behav. 2018;22(11):3576–87. https://doi.org/10.1007/s10461-018-2062-2 Reif SS, Wilson E, McAllaster C, Pence BW, Legrand S, Whetten K. HIV/AIDS in the southern USA: a disproportionate epidemic. AIDS Care. 2019;31(6):726–35. https://doi.org/10.1080/09540121.2018.1533225 Mirkhamidova S, Rustamova H, Umarov B, Kamilova D, Pakhrudinova N. The role of nurses in organizing HIV prevention work in educational institutions. Ann RSCB. 2021;25(2):3079–91. ISSN: 1583-6258. UNAIDS. Global HIV & AIDS statistics – Fact Sheet. Joint United Nations Programme on HIV/AIDS; 2021. Available from: https://www.unaids.org/en/resources/fact-sheet Van Velthoven MH, Helms PJ. Digital health interventions for HIV care: a narrative review. Curr HIV/AIDS Rep. 2021;18(2):172–9. https://doi.org/10.1007/s11904-021-00550-x Wood SM, Dowshen N, Bauermeister JA. Social media, online peer engagement, and the prevention of HIV and other sexually transmitted infections among adolescents. Curr Opin HIV AIDS. 2017;12(5):490–7. https://doi.org/10.1097/COH.0000000000000400 Zarei N. Barriers to health care for women living with HIV in developing countries: a review article. Clin Pract Epidemiol Ment Health. 2018;14:173–82. https://doi.org/10.2174/1745017901814010173 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Despite substantial advances in prevention, diagnosis, and treatment, the virus continues to spread, particularly among high-risk groups—including people who use drugs, sex workers, and men who have sex with men (MSM) [1, 3, 8, 11]. In Uzbekistan, the epidemic represents an ongoing public health priority. According to the Ministry of Health of the Republic of Uzbekistan, more than 50,000 cases of HIV infection had been officially registered as of 2023; however, actual prevalence may be higher due to limited screening coverage [1–5]. The predominant transmission routes remain sexual and parenteral (through injection drug use). A notable trend in recent years is the rising proportion of women among newly diagnosed cases, underscoring the need for targeted prevention efforts among women of reproductive age [9–11].\u003c/p\u003e\n\u003cp\u003eA significant barrier to effective HIV control in Uzbekistan is the pervasive stigmatization of people living with HIV (PLHIV), which deters timely healthcare access and undermines preventive interventions. In this context, nursing personnel occupy a strategic position: they are among the first points of contact within the healthcare system and are well-positioned to deliver information, conduct counseling, facilitate testing, and provide comprehensive patient support [1–8, 10–12].\u003c/p\u003e\n\u003cp\u003eContemporary nursing practice extends well beyond conventional caregiving. Nurses actively participate in diagnosis, prevention, patient education, and rehabilitation. Examining their specific role in HIV prevention in Uzbekistan is therefore of particular scientific and practical relevance—not only for expanding preventive reach but also for reducing disease-related stigma and improving the quality of life of PLHIV.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAims and objectives.\u0026nbsp;\u003c/strong\u003eThe present study aims to examine the role of nursing personnel in HIV prevention, identify the most effective strategies and interventions, and evaluate their impact on vulnerable population groups. Specific objectives were to: (1) analyze the current state of HIV in Uzbekistan and globally; (2) study core nursing functions related to HIV prevention; (3) assess educational, diagnostic, and counseling programs implemented by nurses; (4) identify barriers to working with vulnerable populations; and (5) develop evidence-based recommendations for strengthening the nursing role in HIV prevention.\u003c/p\u003e"},{"header":"2 Methods","content":"\u003cp\u003e\u003cstrong\u003e2.1 \u0026nbsp;Study Design\u003c/strong\u003e\u003c/p\u003e\u003cp\u003eA two-part methodological approach was employed. First, a narrative review and comparative analysis of international and national regulatory documents and peer-reviewed scientific publications was conducted. Second, a comparative cross-sectional survey was administered to assess HIV stigma levels among nursing personnel in Uzbekistan.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003e2.2 \u0026nbsp;Literature Review\u003c/strong\u003e\u003c/p\u003e\u003cp\u003ePeer-reviewed articles were identified through systematic searches of PubMed, Scopus, and Google Scholar databases using terms including \"HIV prevention,\" \"nursing role,\" \"stigma,\" \"Uzbekistan,\" \"vulnerable populations,\" and \"antiretroviral therapy.\" International guidelines consulted included the WHO Consolidated Guidelines on HIV Prevention, Diagnosis, Treatment and Care (2023) and relevant UNAIDS reports. National regulatory documents included the Law of the Republic of Uzbekistan \"On Combating the Spread of the Disease Caused by the Human Immunodeficiency Virus (HIV Infection)\" and Ministry of Health decrees governing VCT programs.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003e2.3 \u0026nbsp;Comparative Survey\u003c/strong\u003e\u003c/p\u003e\u003cp\u003eA structured questionnaire was administered to two groups of nurses employed in clinical settings in Tashkent. The main group comprised 614 nurses (predominantly younger, with less professional experience), and the control group comprised 74 nurses (predominantly more experienced, with 16 or more years of practice). The questionnaire addressed: (1) attitudes toward mandatory disclosure of HIV status, (2) willingness to perform clinical procedures for HIV-positive patients, (3) psychological reactions to learning a patient's HIV-positive status, and (4) behavioral attitudes regarding shared resources. Descriptive statistics and between-group comparisons were used to analyze responses.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003e2.4 \u0026nbsp;Ethics Declaration\u003c/strong\u003e\u003c/p\u003e\u003cp\u003eThe study was conducted in accordance with the principles of the Declaration of Helsinki. Participation was voluntary and anonymous. Formal ethics committee approval was not required as no patient data were collected and no clinical interventions were performed.\u003c/p\u003e"},{"header":"3 Results","content":"\u003cp\u003e\u003cstrong\u003e3.1 \u0026nbsp;Key Functions of Nurses in HIV Prevention\u003c/strong\u003e\u003c/p\u003e\u003cp\u003eNursing personnel perform a broad spectrum of HIV prevention functions. These encompass five interrelated domains:\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eEducational and preventive activities:\u0026nbsp;\u003c/strong\u003eRaising public awareness of HIV transmission routes, protective measures, and testing opportunities; organizing seminars and training sessions for diverse population groups; and informing high-risk communities about evidence-based safer practices.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eEarly detection and testing:\u0026nbsp;\u003c/strong\u003eEngaging in voluntary counseling and testing (VCT) programs; providing pre- and post-test counseling; and referring individuals for further diagnosis and treatment.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eMedical care and adherence support:\u0026nbsp;\u003c/strong\u003eSupporting adherence to antiretroviral therapy (ART); monitoring health status and early complication detection; and collaborating with physicians and social workers for comprehensive, patient-centered care.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003ePsychosocial support:\u0026nbsp;\u003c/strong\u003eReducing stigma and discrimination through education and advocacy; providing individual and group counseling; and offering psychological assistance to PLHIV and their families.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eInterdisciplinary collaboration:\u0026nbsp;\u003c/strong\u003ePartnering with governmental and non-governmental organizations; supporting community outreach; contributing to policy development; and engaging in epidemiological research.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003e3.2 \u0026nbsp;Comparative Analysis of HIV Prevention Strategies Across Countries\u003c/strong\u003e\u003c/p\u003e\u003cp\u003eTable 1 presents a comparison of HIV prevention strategies and nursing roles across selected countries and regions. In high-income settings (USA, EU), nurses participate in integrated programs including mobile testing units, PrEP administration, and community outreach. In sub-Saharan Africa (South Africa, Nigeria, Kenya), nursing efforts are focused on public education and prevention of mother-to-child transmission (PMTCT). In Russia and Kazakhstan, voluntary testing programs involve nursing staff, though legislative constraints limit broader harm reduction approaches. In Uzbekistan, nurses are actively engaged in educational campaigns and VCT programs; however, access to harm reduction programs, anonymous testing in rural areas, and PrEP/PEP remains limited.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eTable 1\u0026nbsp;\u003c/strong\u003eComparative analysis of HIV prevention strategies and nursing roles across selected regions\u003c/p\u003e\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"576\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 16.6667%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCountry/Region\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMain Prevention Focus\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRole of Nurses\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.6667%;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePrEP/PEP Access\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.6667%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHarm Reduction\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 16.6667%;\"\u003e\n \u003cp\u003eUSA, EU\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25%;\"\u003e\n \u003cp\u003eComprehensive: testing, PrEP, education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25%;\"\u003e\n \u003cp\u003ePatient management, testing, counseling, PrEP oversight\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.6667%;\"\u003e\n \u003cp\u003eWidely available\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.6667%;\"\u003e\n \u003cp\u003eWidely distributed\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 16.6667%;\"\u003e\n \u003cp\u003eAfrica (South Africa, Nigeria, Kenya)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25%;\"\u003e\n \u003cp\u003eEducation, PMTCT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25%;\"\u003e\n \u003cp\u003eOutreach, education, vaccination\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.6667%;\"\u003e\n \u003cp\u003eLimited\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.6667%;\"\u003e\n \u003cp\u003ePartially implemented\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 16.6667%;\"\u003e\n \u003cp\u003eRussia, Kazakhstan\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25%;\"\u003e\n \u003cp\u003eTesting, harm reduction for PWID\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25%;\"\u003e\n \u003cp\u003eCounseling, work with key groups\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.6667%;\"\u003e\n \u003cp\u003ePartially available\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.6667%;\"\u003e\n \u003cp\u003eLimited\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 16.6667%;\"\u003e\n \u003cp\u003eUzbekistan\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25%;\"\u003e\n \u003cp\u003eEducation, VCT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25%;\"\u003e\n \u003cp\u003eCounseling, VCT participation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.6667%;\"\u003e\n \u003cp\u003eNot available\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.6667%;\"\u003e\n \u003cp\u003eLimited\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\u003cp\u003e\u003cem\u003ePMTCT = prevention of mother-to-child transmission; PWID = people who inject drugs; PrEP = pre-exposure prophylaxis; PEP = post-exposure prophylaxis; VCT = voluntary counseling and testing.\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003e3.3 \u0026nbsp;Survey Results: HIV Stigma Among Nurses\u003c/strong\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003e3.3.1 \u0026nbsp; Disclosure Attitudes and Communication Willingness\u003c/strong\u003e\u003c/p\u003e\u003cp\u003eAmong control group nurses (n = 74), 68% agreed that patients should disclose their HIV-positive status during medical visits, compared to 59% in the main group (n = 614). Conversely, 80% of control group nurses believed that relatives did not need to be informed, compared to only 50% in the main group—suggesting a more strongly patient-centered and confidentiality-oriented approach among the more experienced group.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003e3.3.2 \u0026nbsp;Readiness to Perform Clinical Procedures\u003c/strong\u003e\u003c/p\u003e\u003cp\u003eWillingness to conduct medical examinations was high in both groups (control: 96%; main: 89%). However, willingness to perform procedures such as injections and wound dressing was markedly lower in the main group (72%) compared to the control group (89%). Willingness to assist during childbirth was reported by 51% of control group nurses and 59% of the main group, though this difference may reflect specialty distribution rather than stigma alone.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003e3.3.3 \u0026nbsp; Psychological Reactions and Fear\u003c/strong\u003e\u003c/p\u003e\u003cp\u003eA substantially higher proportion of nurses in the main group reported fear or hostility upon learning a patient's HIV-positive status (25%) compared to the control group (11%). Willingness to use a shared toilet with an HIV-positive patient was reported by 80% of control group nurses but only 49% of the main group. Similarly, 84% of control group nurses would purchase products from a seller who had previously had HIV, compared to 62% in the main group. These disparities are consistent with greater HIV-related misconceptions and stigmatizing attitudes in the main group.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003e3.4 \u0026nbsp; Effectiveness of Existing HIV Prevention Programs\u003c/strong\u003e\u003c/p\u003e\u003cp\u003eEvidence from international literature supports the effectiveness of several program types relevant to nursing practice in Uzbekistan. Needle and syringe exchange programs can reduce HIV incidence among people who inject drugs by 30–40% [2]. PMTCT programs, when combined with ART, reduce vertical transmission to below 5% [9]. PrEP reduces HIV risk by up to 90% among high-risk individuals when taken consistently [6]. Educational campaigns and HIV testing programs that integrate nursing outreach—particularly through mobile and anonymous services—are associated with increased testing uptake among vulnerable groups including youth, MSM, and PWID [7, 10].\u003c/p\u003e"},{"header":"4 Discussion","content":"\u003cp\u003e\u003cstrong\u003e4.1 \u0026nbsp;Demographic and Professional Influences on Stigma\u003c/strong\u003e\u003c/p\u003e\u003cp\u003eThe survey data reveal that younger, less experienced nurses (main group) exhibited higher levels of HIV stigma—manifested as greater reluctance to perform clinical procedures, higher rates of fear, and more restrictive attitudes toward shared resources. This pattern likely reflects less cumulative exposure to HIV-positive patients and more limited targeted training. Conversely, the control group's experience may have fostered greater professional confidence and familiarity with infection control practices, as demonstrated in prior studies from sub-Saharan Africa and Central Asia [3, 8].\u003c/p\u003e\u003cp\u003e\u003cstrong\u003e4.2 \u0026nbsp;Barriers to Effective HIV Prevention Nursing\u003c/strong\u003e\u003c/p\u003e\u003cp\u003eMultiple systemic barriers limit the effectiveness of nursing-led HIV prevention in Uzbekistan. Persistent stigma among healthcare workers reduces willingness to provide quality care and creates psychological barriers that discourage PLHIV from seeking services [3, 4]. Insufficient targeted training in HIV counseling, ethics, and communication diminishes nurses' confidence and skill. Resource constraints—particularly in rural and remote settings—restrict the reach of mobile testing units and harm reduction programs. Social and cultural norms, including taboos surrounding discussions of sexual health and drug use, further impede open communication between nurses and patients [5, 12]. Finally, limited integration of nurses into interdisciplinary teams reduces the comprehensiveness of care.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003e4.3 \u0026nbsp;Prospects for Expanding Nursing Involvement\u003c/strong\u003e\u003c/p\u003e\u003cp\u003eInternational evidence clearly demonstrates that countries with expanded nursing roles achieve superior HIV prevention outcomes. In the USA and EU, nurse-led mobile clinics and PrEP programs have substantially broadened access to biomedical prevention [6, 10]. In sub-Saharan Africa, task-shifting toward nursing personnel for VCT and PMTCT has been associated with significant reductions in new infections [1]. Uzbekistan's healthcare system has a robust nursing workforce that remains underutilized for HIV prevention. Expanding nursing scope of practice—particularly for harm reduction, PrEP provision, and anonymous testing—alongside systematic professional development represents a high-impact, cost-effective strategy.\u003c/p\u003e\u003cp\u003eThe integration of digital health tools, including telemedicine platforms and mobile health applications for adherence monitoring, offers additional pathways to expand nursing reach, particularly in geographically isolated areas [10, 11]. Strengthening interdisciplinary collaboration—formally embedding nurses in HIV prevention teams alongside physicians, psychologists, and social workers—can further enhance the comprehensiveness and continuity of care.\u003c/p\u003e"},{"header":"5 Conclusions","content":"\u003cp\u003eNursing personnel are indispensable to effective HIV prevention in Uzbekistan. The study confirms that nurses' expanded involvement in education, voluntary counseling and testing, psychosocial support, and adherence facilitation is associated with improved prevention outcomes and reduced HIV stigma. However, significant gaps remain: nurses in the main survey group exhibited substantially higher levels of HIV-related fear and stigmatizing attitudes than their more experienced counterparts, underscoring the urgency of systematic, targeted professional development.\u003c/p\u003e\u003cp\u003eTo strengthen nursing-led HIV prevention in Uzbekistan, the following evidence-based recommendations are proposed:\u003c/p\u003e\u003cp\u003e\u003cstrong\u003e1.\u0026nbsp;\u003c/strong\u003eImplement mandatory, continuing professional education for nurses covering HIV transmission, ethics, patient communication, and stigma reduction.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003e2.\u0026nbsp;\u003c/strong\u003eExpand nursing scope of practice to include harm reduction program leadership, PrEP/PEP counseling, and provision of anonymous HIV testing in rural and remote settings.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003e3.\u0026nbsp;\u003c/strong\u003eIntegrate anti-stigma training into undergraduate nursing curricula and ensure regular refresher programs for practicing nurses.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003e4.\u0026nbsp;\u003c/strong\u003eEstablish formally structured interdisciplinary HIV prevention teams in which nurses hold defined roles alongside physicians, psychologists, and social workers.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003e5.\u0026nbsp;\u003c/strong\u003eDevelop mobile and digital health platforms for nurse-led outreach, remote counseling, and ART adherence monitoring among hard-to-reach populations.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003e6.\u0026nbsp;\u003c/strong\u003eSecure increased government funding and international partnership support for HIV prevention programs, with particular attention to resource equity across urban and rural settings.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003e7.\u0026nbsp;\u003c/strong\u003eConduct further research to evaluate the effectiveness of nursing-specific interventions in reducing HIV incidence and stigma in Central Asian contexts.\u003c/p\u003e\u003cp\u003eEnhancing the role of nursing staff through expanded competencies, continuous professional development, and integration of international best practices is essential for improving HIV prevention and rehabilitation outcomes among vulnerable populations in Uzbekistan.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eFunding:\u0026nbsp;\u003c/strong\u003eNo funding was received for the preparation of this article.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConflict of Interest:\u0026nbsp;\u003c/strong\u003eThe author declares no competing interests.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eEthics Approval and Consent to Participate:\u0026nbsp;\u003c/strong\u003eNot applicable. The study involved an anonymous voluntary survey of healthcare professionals and did not involve patient data or clinical interventions.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConsent for Publication:\u0026nbsp;\u003c/strong\u003eNot applicable.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eData Availability:\u0026nbsp;\u003c/strong\u003eThe survey data analyzed in this study are available from the corresponding author on reasonable request.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eAuthor Contribution:\u0026nbsp;\u003c/strong\u003eS.M.M. conceived and designed the study, conducted the literature review and data analysis, and wrote and revised the manuscript.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\u003cp\u003eThe author acknowledges the support of the Ministry of Health of the Republic of Uzbekistan and local healthcare providers in facilitating the survey component of this research.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eBekker LG, Alleyne G, Baral S, Cepeda J, Daskalakis D, Dowdy D, et al. Advancing global health and strengthening the HIV response in the era of the Sustainable Development Goals: The International AIDS Society–Lancet Commission. Lancet. 2018;392(10144):312–58. https://doi.org/10.1016/S0140-6736(18)31070-5\u003c/li\u003e\n \u003cli\u003eDawson L, Copenhaver MM. HIV risk behavior interventions for people who inject drugs: a review of current evidence. Curr HIV/AIDS Rep. 2020;17(1):1–9. https://doi.org/10.1007/s11904-019-00471-6\u003c/li\u003e\n \u003cli\u003eGeter A, Herron AR, Sutton MY. HIV-related stigma by healthcare providers in the United States: a systematic review. AIDS Patient Care STDs. 2018;32(10):418–24. https://doi.org/10.1089/apc.2018.0114\u003c/li\u003e\n \u003cli\u003eKnettel BA, Minja L, Chumba LN, Oshosen M, Cichowitz C, Mmbaga BT, et al. Serostatus disclosure outcomes for HIV-infected adolescents in sub-Saharan Africa: a systematic review. J Int AIDS Soc. 2021;24(1):e25628. https://doi.org/10.1002/jia2.25628\u003c/li\u003e\n \u003cli\u003eMirkhamidova SM. Analysis of HIV awareness in Tashkent city. Glob J Med Res. 2021;21(2):20–32. https://globaljournals.org/GJMR_Volume21/3-Analysis-of-HIV-Awareness-in-Tashkent.pdf\u003c/li\u003e\n \u003cli\u003eOjikutu BO, Bogart LM, Higgins-Biddle M, Dale SK, O'Cleirigh C, Mayer KH. Facilitators and barriers to pre-exposure prophylaxis (PrEP) use among Black individuals in the United States: results from the national survey on HIV in the Black community (NSHBC). AIDS Behav. 2018;22(11):3576–87. https://doi.org/10.1007/s10461-018-2062-2\u003c/li\u003e\n \u003cli\u003eReif SS, Wilson E, McAllaster C, Pence BW, Legrand S, Whetten K. HIV/AIDS in the southern USA: a disproportionate epidemic. AIDS Care. 2019;31(6):726–35. https://doi.org/10.1080/09540121.2018.1533225\u003c/li\u003e\n \u003cli\u003eMirkhamidova S, Rustamova H, Umarov B, Kamilova D, Pakhrudinova N. The role of nurses in organizing HIV prevention work in educational institutions. Ann RSCB. 2021;25(2):3079–91. ISSN: 1583-6258.\u003c/li\u003e\n \u003cli\u003eUNAIDS. Global HIV \u0026amp; AIDS statistics – Fact Sheet. Joint United Nations Programme on HIV/AIDS; 2021. Available from: https://www.unaids.org/en/resources/fact-sheet\u003c/li\u003e\n \u003cli\u003eVan Velthoven MH, Helms PJ. Digital health interventions for HIV care: a narrative review. Curr HIV/AIDS Rep. 2021;18(2):172–9. https://doi.org/10.1007/s11904-021-00550-x\u003c/li\u003e\n \u003cli\u003eWood SM, Dowshen N, Bauermeister JA. Social media, online peer engagement, and the prevention of HIV and other sexually transmitted infections among adolescents. Curr Opin HIV AIDS. 2017;12(5):490–7. https://doi.org/10.1097/COH.0000000000000400\u003c/li\u003e\n \u003cli\u003eZarei N. Barriers to health care for women living with HIV in developing countries: a review article. Clin Pract Epidemiol Ment Health. 2018;14:173–82. https://doi.org/10.2174/1745017901814010173\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"HIV prevention, nursing roles, stigma reduction, Uzbekistan, vulnerable populations, voluntary counseling and testing","lastPublishedDoi":"10.21203/rs.3.rs-9614177/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9614177/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eHIV infection remains a global public health challenge, with over 50,000 officially registered cases in Uzbekistan as of 2023. Nursing personnel occupy a unique frontline position within the healthcare system with substantial but underutilized potential for HIV prevention.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eA narrative review and comparative analysis of international guidelines, peer-reviewed literature, and national regulatory documents were conducted. Sources included World Health Organization (WHO) and UNAIDS publications, journals including \u003cem\u003eThe Lancet\u003c/em\u003e, \u003cem\u003eJournal of Clinical Nursing\u003c/em\u003e, and \u003cem\u003eBMC Public Health\u003c/em\u003e, as well as Uzbekistan Ministry of Health policy documents. A comparative survey of nursing attitudes toward HIV-positive patients was also conducted among two groups (main group: n = 614; control group: n = 74).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eNurses serve as primary points of contact in HIV prevention, counseling, voluntary testing, psychosocial support, and interdisciplinary collaboration. Comparative analysis demonstrated that higher HIV awareness correlated with reduced stigma: fear and hostility toward HIV-positive patients was reported by 25% of main group nurses versus 11% in the control group. Uzbekistan's nursing workforce is actively involved in educational campaigns and voluntary counseling and testing (VCT), but lacks access to harm reduction programs and pre-exposure prophylaxis (PrEP).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eExpanding nursing competencies, integrating international best practices, and addressing systemic barriers including stigma and resource limitations are essential to improving HIV prevention outcomes among vulnerable populations in Uzbekistan.\u003c/p\u003e","manuscriptTitle":"Nursing-Led HIV Prevention in Uzbekistan: Strategies, Stigma Reduction, and Pathways to Strengthening Vulnerable Population Outcomes","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-05-13 07:37:08","doi":"10.21203/rs.3.rs-9614177/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"ff880aa5-2617-4d22-8b3b-be6796cddce8","owner":[],"postedDate":"May 13th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-05-13T07:37:08+00:00","versionOfRecord":[],"versionCreatedAt":"2026-05-13 07:37:08","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9614177","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9614177","identity":"rs-9614177","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}