Illustration by Sara Gironi Carnevale December 2021, ScientificAmerican.com 13
through too many hoops to get care. The first hoop is
finding a provider that they can trust. Imagine living in
a small town where everyone knows you and your fami-
ly or where the lab technician or pharmacist is also a
member of your church community. The shame and fear
associated with disclosing one’s sexual behavior prevent
many from seeking care face-to-face.One way to bring informed, nonjudgmental HIV prevention
to people is through telehealth, which allows them to reach out
to a medical provider any time, day or night, from their smart-
phones to request an HIV test or a prescription for PrEP—no look-
ing for a clinic, waiting for an appointment, taking time off from
work, or letting shame or stigma lead them to cancel their
appointment. At-home tests and PrEP medication then can be
sent to the patient’s door in discreet packaging, and communi-
cations with medical providers can happen in the comfort and
convenience of the person’s home.
But to fulfill the potential of telehealth, we need policy chang-
es. A step is to change laws that prohibit providers from offering
care across state lines. Acknowledging that medical profession-
als can effectively give preventive care to patients across states
or time zones will improve access to the best HIV care (often con-
centrated in cities) for those who need it most (those in poor,
rural areas). During the pandemic, those in-state requirements
were waived, dramatically reducing the burden on clinics and
keeping patients at home when that was the safest place to be.
Another way to make this lifesaving and cost-saving care
more accessible is to improve telehealth reimbursements. State
laws requiring that care begin in person or that a patient have
a prior relationship with a medical provider before telehealth
can be used or reimbursed create an often insurmountable bar-
rier to access for populations that need it most, face stigma and
in many cases are at greater risk of contracting HIV.
The city of San Francisco has had low rates of COVID com-
pared with other dense cities. Its success has been attributed to
a public health infrastructure that learned hard lessons from the
AIDS epidemic and was prepared to sound the alarm early, test
people and trace contacts of infected individuals. Now let’s take
those lessons, alongside what the health system as a whole has
learned from COVID, and apply them to ending HIV in all com-
munities around the country.JOIN THE CONVERSATION ONLINE
Visit Scientific American on Facebook and Twitter
or send a letter to the editor: [email protected]Emily Rymland is director of clinical operations at Nurx and
is certified by the American Academy of HIV Medicine as an HIV
specialist. She also runs the Buseesa Community Development
Center, a small bush clinic in western Uganda.