12 Scientific American, December 2021
FORUM
COMMENTARY ON SCIENCE IN
THE NEWS FROM THE EXPERTS
The COVID pandemic has taught America’s health-care system
a lot about fighting a highly contagious, deadly virus. There have
been victories and failures, and we hope both will make us bet-
ter prepared for the next infectious disease threat. But other
medical providers and I working in HIV prevention say we
should not wait to put those lessons to work. We need to apply
some of the urgency and innovation we are using to fight the
raging inferno of the COVID pandemic to extinguish the smol -
dering embers of the still deadly HIV/AIDS epidemic.
The HIV/AIDS community has racked up heroic, lifesaving
victories with medications that make HIV a survivable chronic
condition. When taken properly, these treatments may render
the infection nontransmissible. And when preexposure prophy-
laxis (PrEP) is taken as prescribed by HIV-negative people, it
confers nearly perfect protection against contracting the virus
through sex. Both HIV infections and AIDS deaths have dropped
steadily, and this outcome is worthy of celebration. Neverthe-
less, there are new infections every day in the U.S. and around
the world. In spite of treatments and PrEP, there are still too
many people lacking access to good HIV care and education
about prevention. Here at Nurx, a telemedicine company where
we order home HIV tests and prescribe PrEP, we have to inform
a newly infected patient of their status at least twice a week, or
about 100 times a year. It is never an easy call to make.
We often hear people ask whether HIV even still exists, which
makes my colleagues and me angry—not at the person asking
the question but at public health authorities’ inertia and the
media’s silence around the virus. In the U.S., approximately
1.2 million people are living with HIV, and 14 percent of them do
not know they have it. Persistent stigma and a lack of testing
keep this population in the shadows.
In 2019 the approximately 34,800 new infections in the U.S.
were mostly in Southern states and were not evenly distributed
across their populations. This is because testing, prevention and
treatment are not reaching those who need it most: men who
have sex with men, Black and Latino Americans, and transgen-
der people. That being said, education must be shared with all
groups. Statistics do not matter when you are the one affected.
For instance, we fail women when we leave them out of the
discussion. Whenever we tell a cisgender woman that she is HIV-
positive, she is completely shocked, and often she says she nev-
er thought it was even a possibility. Our patients have included
a divorced grandmother in her 60s who contracted HIV from a
single sexual encounter at her college reunion and a student
attending a privileged, prestigious university. The student was
very sick and had full-blown AIDS by the time she was diag-
nosed, but none of the many doctors she had consulted about
her illness had thought to test her for HIV.
After what we have witnessed this past year, it is hard not to
see HIV’s persistence in the U.S. as a failure of will. COVID
showed that our health-care system can rapidly reorganize to
provide things such as drive-through testing centers in sports
stadiums; a warp-speed vaccine effort; and public education
efforts that had everyone talking about antibodies, antigens and
viral load as easily as they had once chatted about the weather.
We can certainly exert the much less disruptive effort required
to end HIV. Here’s how:- Test, test, test. With COVID we saw that frequent test-
ing, including that of asymptomatic people and especial-
ly of those working or living in high-risk environments,
was essential to containing the virus until a vaccine came
along. Medical providers should recommend that sexu-
ally active patients be tested for HIV unless they are cer-
tain these people are at particularly low risk. Often they
do not offer HIV testing to patients who they assume have
little risk, and patients do not know to ask. Going for-
ward, we should act more like the University of Chicago
Medical Center, which set up a combination HIV- COVID
testing site for the public during the pandemic. - Destigmatize. Health-care providers should not judge
or shame people for COVID infection—whether they
caught it working at an essential job or attending a high-
risk social gathering out of a human need for interper-
sonal connection. Similarly, we should destigmatize HIV
and the ways people contract it. Health-care providers
can be uncomfortable talking about sex, and when their
schedules allow for only 15 minutes per patient, they may
feel there is no time for what are actually crucial conver-
sations about a patient’s sex life. The combination of
these two things may leave patients without the care they
should get because they are being treated within a sys-
tem that does not normalize and prioritize sexual health
as a crucial component of comprehensive care. All peo-
ple should be asked about their sexual health so they can
get tested for HIV at the frequency that is right for them
and be prescribed PrEP if their sex life puts them at risk
for contracting HIV. - Meet people where they are. During COVID we have
brought tests and vaccines to stadiums, schools, super-
markets, and more—so let’s make HIV prevention and
treatment that easy by moving testing and prevention
outside the clinic to where people live and work. Patients
who need HIV testing and prevention have to jump
Lessons from
COVID Could
End AIDS
Taking testing and prevention from the
clinic to where people live is a good start
By Emily Rymland