Updated: Feb 17
I shouldn’t still be seeing patients walk into my clinic with AIDS in Texas, or anywhere in the U.S. But I do. Effective treatment for the human immunodeficiency virus that causes AIDS has been available for more than 20 years. But not everyone who needs HIV care and treatment gets it, and for us to end the epidemic, they must. Disparities within the HIV epidemic are stark. While 38% of the US population is in Southern states, 52% of new HIV diagnoses occur here. From 2014 to 2018, the rate of new HIV infections in Black women was 13 times that of white women and four times that of Latina women. While 13% of the U.S. population is Black, 41% of people with HIV are. As HIV rates drop in urban settings and nationally overall, they are growing in rural America. The same disease that has spurred an unprecedented level of misinformation has also accelerated advancement towards an HIV vaccine. With lessons learned from development of the COVID-19 vaccine, has come new optimism for the HIV vaccine pipeline. But the communities that will benefit most from an HIV vaccine are also the communities that have poor access to quality health care and are vulnerable to misinformation. Within the current landscape of digital and other misinformation, we can predict high levels of refusal for an eventual HIV vaccine like we can forecast a tsunami after an earthquake on the ocean floor. An effective HIV vaccine is coming, though, and we must develop strategies to combat misinformation that, as has been seen with the COVID-19 vaccines, fuels vaccine hesitancy and refusal. It will take more than a vaccine to end the HIV epidemic. Now is the time to define the necessary strategies. First, the messenger matters as much as the message. More HIV providers who are Black, Hispanic and identify as a gender minority are needed. About 11% of HIV providers are Black. I’ve had patients dissolve in tears when they realize that for the first time in their lives, they are going to have a Black doctor who looks like them. My own eyes fill with tears every time it happens. The pipeline of minority doctors, nurse practitioners, pharmacists and physician assistants must be strengthened. This will require deliberate efforts by health professions programs to ensure they are not subject to bias during admission processes. Students need support and nurture once they start their training. Second, it is within secure medical home environments that trust is built and we can have ongoing conversations about difficult topics. To this end, community-engaged, whole-person centered, high-quality primary care must be the status quo, with HIV care delivered by more primary-care providers. This requires changing models of primary-care delivery to ones where quality of care delivered is valued and rewarded over the quantity of care delivered. Also needed are innovative ways to facilitate and support learning and task shifting for primary care providers, such as telementoring and development of virtual communities of practice and learning. Third, in public health, one message does not fit all. We cannot rely on scientists and health professionals to be the only sources of accurate health information. We need much better messaging tailored for different audiences, lived experiences and cultural contexts. Community leaders and members should be engaged to develop and maintain mechanisms to obtain input in crafting and delivering evidence-based information. To engage them, bridges have to be built on genuine, deep, mutually beneficial relationships between academic medical centers and the communities they serve. Those bridges require academic medical centers to invest time, human and financial resources in those communities. Finally, there must be consequences for spreading misinformation that can lead to serious illness or death. Health professionals must know that they risk loss of their licenses if they spread such misinformation. Spotify and companies like it must know that they risk loss of artists, celebrity content creators, subscribers and their stock gains or profits. They must know that free speech is not free when it costs lives. Wari Allison is the incoming vice president for health policy at the University of North Texas Health Science Center at Fort Worth. She is a physician, infectious disease specialist and public health researcher.