Takeaway
It will take all of us working together to eradicate HIV. Get comfortable discussing sexual health and start treatment when indicated.
Lifelong learning in clinical excellence | August 11, 2026 | 2 min read
By Kaitlin Poole, MSN, CRNP, and Matthew Hamill, MBChB, PhD, Johns Hopkins Medicine and Sexual Health Services at Baltimore City Health Department
A 24-year old Black man came to an initial appointment with an infectious disease doctor after being diagnosed with HIV one month ago by his primary care provider. For the past month, he’d struggled to navigate the healthcare system and eagerly awaited further information about the HIV diagnosis. At his first visit, he shared that he had sex with both men and women. He said he’d never been on HIV pre-exposure therapy (PrEP) and had never heard of it. He hadn’t yet started on antiretroviral therapy. He was motivated to start medication that day and within 30 days his HIV viral load dropped from 45,000 copies/ml to less than 200 copies/ml.
A public health crisis
The rates of HIV in Black men who have sex with men are a public health crisis. A report released over a decade ago reported that one in two black men who have sex with men will be diagnosed with HIV. Now, in 2026, we have readily available biomedical tools to significantly impact this disparity, but these tools aren’t reaching the people who need them most.
What we can do to close the gap:
1. Providing PrEP is very straightforward in almost all cases. It gives us insights into another dimension of our patients’ lives, allowing us to give better care.
2. Get comfortable talking about PrEP and HIV. We can’t expect our patients to be the experts—this creates an equity gap where people aware of interventions have disproportionate access. We don’t expect patients to come in and initiate discussions around statins— this should be no different for HIV prevention. Take some training on sexual history taking if you need it.
3. Use objective measures to guide PrEP initiation decisions. Guidelines recommend PrEP for anyone who has had a STI in the past six months.
4. Don’t delay! Initiate PrEP and HIV treatment as soon as possible. Same-day initiation of PrEP and HIV improves individual outcomes and reduces transmission of HIV. Starting PrEP and HIV treatment in primary care settings is typically safe and appropriate for most patients.
5. Engage your multidisciplinary care team to navigate cost barriers—while antiretroviral medications are expensive, most people can access medications with zero or little cost to them.
6. Familiarize yourself with newer modalities of prevention and treatment. Injectable prevention and treatment options are available and desirable by many patients. Lenacapavir is a highly effective PrEP medication that’s administered twice annually.
7. Know your community resources. Work with your local health department to link patients to appropriate care as soon as possible.
Finally, here is a great resource: Clinical guidance taking a sexual history
And always ask someone if you aren’t sure of next steps:
STD Clinical Consultation Network
UCSF Clinical Consultation Network
This piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.