Significant strides have been made since the first cases of human immune-deficiency virus (HIV) were identified in the U.S. 43 years ago. Medications such as preexposure prophylaxis (PrEP), postexposure prophylaxis (PEP), and highly active antiretroviral treatments (HAART), are helping decrease new infections, showing a steady 12% decline in new infections from 2017 to 2021 (CDC, 2024).
These advancements should be recognized and honored, but in no way indicate that it’s time to take our foot off the gas. There continue to be barriers in addressing stigma, disparities and access to HIV prevention and treatment. Every physician providing preventive care services in the United States should be talking to their patients about HIV prevention.

The Basics
Nationwide, approximately 1.2 million people are currently living with HIV; 13% are unaware of their status (CDC, 2024; In 2021, Black/African American people accounted for 40% of all new HIV diagnoses, and Hispanic/Latino people accounted for 29% (CDC, 2024; Although the majority of people currently living with HIV in the United States are cisgender men, HIV infections are increasing almost four times faster among cisgender women; and HIV prevalence among transgender women is disproportionately high (CDC, 2024). Yet, women remain understudied, underreported and underdiagnosed (CDC, 2024; For Latinos, stigma is aggravated by the lack of information in their native language and communication that addresses religious and cultural barriers. While HIV disproportionately impacts these communities, improvements in stigma related to sexuality and status, discouragement of testing, and broken linkages to treatment should be addressed and curated for all communities.

Disparities exist in HIV prevalence and care across regions and populations. A universal truth is that HIV can affect anyone, anywhere; therefore, prevention and treatment must be accessible for everyone.
Barriers & Solutions
Accessing HIV prevention and testing services is difficult for some, especially in areas lacking these services, such as rural communities. One of the most common and prevalent barriers to access is stigma. Stigma manifests feelings of worthlessness, isolation, guilt, and shame, which can further deter people from seeking essential services (CDC, 2024; Bouabida et al., 2023). A solution to breaking this barrier is to create safe and stigma-free environments for testing and screening. Systemic barriers include lack of insurance, transportation, and financial resources. Health systems must work with communities and institutions to eliminate such barriers to support vulnerable groups and improve accessibility (Bouabida et al., 2023).

Integrating essential HIV services into primary care can increase access and improve health outcomes for people living with HIV. Both societal and clinical approaches to HIV prevention would benefit from a patient-centered, whole health model, rather than being based on an individual’s perceived “risk profile”. Patient-centered care enables clinicians to offer holistic, whole-person care (Edgman-Levitan & Schoenbaum, 2021).

Physicians and health care systems must embed HIV care into existing primary care delivery models, making HIV preventive care and treatment routinized and normalized. For instance, most PrEP and sexual health consultations can be completed when a person sees their primary care physician for a “well visit” or annual check-up, eliminating the burden, including cost, of seeking specialized HIV care for general preventive health services. Furthermore, siloing HIV preventive services and treatment to the domain of HIV specialists —rather than integrating these services into primary care— functionally results in “gatekeeping” information from the people who need it most (Sell et al., 2023; CDC, 2024; Hong et al., 2024). If physicians and systems shift siloed care models to a patient-centered model, this will in turn decrease stigma, discrimination, and the associated shame and trauma of seeking care (Sell et al., 2023; Hong et al., 2024).

Shifting Conversations
Risk for HIV does not define an individual and should not cast them as an “other”. It is imperative to understand that people need support and care, not fear or judgement, from the professionals licensed to help and heal. Sexual health education and wellness, and HIV/STI prevention and testing are for everyone — regardless of sex assigned at birth, gender identity, sexual preferences, race, ethnicity, age, or lifestyle. Empowering people and all clinical providers to engage in HIV preventive services and link people to care when necessary is paramount to expanding HIV care.

The American College of Preventive Medicine, HealthHIV, National Coalition for LGBTQ Health, National Hispanic Medical Association, George Washington University Milken Institute School of Public Health, and AIDS United -- all partners in the CDC's Let's Stop HIV Together initiative which aims to educate the public, including physicians, about tools to prevent and treat HIV -- call for expanding HIV prevention to everyone. We must think innovatively across specialties and institutions and leverage resources and knowledge to expand HIV prevention to everyone.  

Visit CDC HIV Data to learn more about national efforts towards Ending the HIV Epidemic. If you are a provider seeking free resources for yourself or your patients, visit Let's Stop HIV Together. If you are an individual seeking HIV services, use the CDC Find Services Locator.

Mira Agneshwar, MPH
Program Manager, Programs and Grants

Kate Shreve, MPH
Director of Programs and Grants
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