Primary care’s crucial role in ending HIV: A call to action

Taimur Khan: ©Fenway Health

As primary care physicians, we are on the front lines of the effort to end the HIV epidemic, yet we often underestimate our influence. The recent Conference on Retroviruses and Opportunistic Infections 2025 highlighted just how revolutionary the scientific advancements in HIV have been over the past few decades. The tools to end HIV exist—it is now a matter of implementation.

As an infectious disease specialist, I have seen firsthand how a single conversation in the exam room can alter the trajectory of a patient’s life. Take, for example, a cisgender woman in her 20s who was taken aback when I mentioned HIV prevention during a routine visit. She believed HIV was something that happened to "other" people—a common misconception that persists among many populations, largely due to how HIV prevention has historically been framed.

However, in the current political climate, federal agencies have lost some of their edge to implement bold, radical actions needed to tackle the HIV epidemic. That’s why harnessing the power of partnerships—such as with groups like the U.S. Business Action to End HIV (of which I am a proud member)—alongside the reach and influence of primary care providers and settings, is critical to continue this vital work.

Moreover, the massive investments in HIV research, prevention, and treatment have not only transformed the HIV field but have also yielded broader benefits. The rapid development of COVID-19 diagnostics, treatment, and vaccines was made possible in large part due to the foundational work done in the HIV space. mRNA vaccine platforms, large-scale testing infrastructure, and global public health collaborations all trace their origins to HIV research. The lessons learned in HIV management are being applied to other infectious diseases, reinforcing why continued investment in HIV care benefits medicine.

Despite these advances, gaps in primary care remain a barrier to ending HIV. Many clinicians do not discuss HIV prevention and treatment with patients who could benefit, leading to missed opportunities. By normalizing HIV conversations, expanding access to pre-exposure prophylaxis (PrEP), championing Undetectable = Untransmittable (U=U), and adopting a sex-positive approach to patient care, primary care physicians can help turn the tide against HIV.

A status neutral approach

Stigma thrives in silence. While we routinely screen for diabetes or hypertension, HIV remains a topic that many physicians hesitate to address. Yet, evidence shows that when HIV screening is presented as a standard part of care—rather than something only “high-risk” patients need—acceptance rates increase.

Currently, only about 35% of primary care physicians report that they often or always take a sexual history from their patients. That means many clinicians are missing opportunities to discuss HIV risk and prevention. The key is to integrate HIV conversations seamlessly into routine visits. A simple question like, "I ask all my patients about sexual health because it helps me provide the best care. Is there anything you'd like to discuss regarding HIV testing or prevention?" can make a significant impact.

Words matter, too. Using neutral language like “HIV status” instead of “HIV risk” can help reduce stigma. The goal is to create an environment where patients feel safe discussing their sexual health without fear of judgment.

Demystifying PrEP

The introduction of PrEP was a game-changer in HIV prevention, but its rollout has been uneven. While PrEP usage has increased significantly among men who have sex with men (MSM), cisgender women and heterosexual couples remain largely overlooked. In the U.S., women make up roughly 18% of new HIV diagnoses, yet only account for 8% of PrEP users.

This disparity is not due to a lack of need but rather a lack of awareness. Many patients and their health care providers still believe that PrEP is only for MSM. However, PrEP-use appropriateness is based on behavior, not identity. Primary care physicians should routinely consider PrEP for a wide range of patients, including:

• Heterosexual persons with partners of unknown HIV status
• Serodiscordant heterosexual couples wanting to conceive
• People who inject drugs

Bringing up PrEP in primary care is crucial. A simple conversation like, "There's a medication that can nearly eliminate the risk of HIV. Based on what you've shared, I think you could be a good candidate. Would you like to learn more?" can empower patients to take control of their health.

The stigma-crushing power of U=U

One of the most transformative advancements in HIV medicine is the recognition of Undetectable = Untransmittable (U=U). This means that individuals with HIV who maintain an undetectable viral load through treatment cannot sexually transmit the virus. This is not just hopeful thinking—it is backed by overwhelming scientific evidence.

Yet, despite the robust data, many primary care physicians remain hesitant to fully embrace U=U, often due to lingering misconceptions about transmission risk. This hesitation can have profound consequences. For people living with HIV, understanding U=U can reduce internalized stigma, improve medication adherence, and strengthen relationships. For HIV-negative partners, it offers reassurance and opens new discussions about prevention strategies like PrEP.

By confidently affirming U=U, primary care providers can help dismantle fear and misinformation. A simple statement like, "Your lab results show your viral load is undetectable, which means you cannot transmit HIV sexually while it stays this way," can be life-changing for patients.

The forefront of the HIV endgame

The scientific progress in HIV medicine has been nothing short of revolutionary. Just decades ago, an HIV diagnosis was a death sentence. Today, we have the tools to prevent nearly all new infections and help those with HIV live long, healthy lives. Moreover, the investments in HIV research have benefited other fields, most notably in COVID vaccine development and testing infrastructure.

Primary care physicians play a pivotal role in translating these advancements into everyday practice. By normalizing HIV discussions, expanding access to PrEP, championing U=U, and fostering a sex-positive approach, we can accelerate the end of HIV as a public health crisis.

The work isn’t done yet. But with the power of primary care, we can ensure that the next decade sees HIV transmission become a rare occurrence rather than a persistent challenge. It starts with us—one patient, one conversation, one prescription at a time.

Taimur Khan, MD, MPH, is an infectious disease specialist at Fenway Health in Boston, where he leads efforts in HIV prevention and treatment as the Associate Medical Research Director. He is an Advisor to U.S. Business Action to End HIV, a coalition of private sector companies committed to ending the HIV epidemic, and a vocal advocate for equitable, destigmatized sexual health care. His work focuses on integrating cutting-edge science into community-based primary care settings to help end the HIV epidemic.