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To address health inequities and end the HIV epidemic, we need a robust HIV and ID workforce

Judith Feinberg, MD, FIDSA
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Every Dec. 1 since 1988, World AIDS Day has been observed to call attention to the HIV epidemic, increase HIV awareness and knowledge, address HIV stigma and spur increased action to advance ending the HIV epidemic in the United States and globally. This year's theme is “Ending the HIV Epidemic: Equitable Access, Everyone's Voice.In this post, Judith Feinberg, MD, FIDSA, a past chair of HIVMA and professor of medicine/infectious diseases and professor of behavioral medicine and psychiatry at West Virginia University, discusses the need for a robust HIV and infectious diseases workforce to advance health equity and improve health outcomes for people with HIV.

On World AIDS Day, we recognize the substantial progress in the fight against HIV in the United States. While COVID-19 has commanded the nation's attention, the response to the HIV epidemic remains steadfast, with HIV and ID health care professionals on the front lines of both epidemics. Equitable access to health care, including expert providers, is important to address the inequities affecting people with HIV and other populations at greater risk for HIV, including LGBTQ+ persons, individuals with substance use disorders and those living in rural communities.

A June 2020 study in the Annals of Internal Medicine found that 208 million Americans live in areas with little or no access to an ID physician. In my home state of West Virginia, the very limited HIV and ID workforce has challenged our efforts to address public health threats, including HIV, viral hepatitis, COVID-19 and especially infections associated with the injection drug epidemic. For people with HIV who live in rural communities where access to care is scarce, traveling to see a provider can take hours, and both access to transportation and the means to defray its expense are significant barriers.

As a physician, I long ago came to realize the importance of using my voice to speak on behalf of my patients, colleagues and community. Through IDSA and HIVMA, I have been meeting with the West Virginia congressional delegation for several years to help ensure our patients' needs are heard by policymakers. It was through those meetings over the years that I was able to educate Rep. David B. McKinley (WV-1) on the dire need to address ID and HIV workforce shortages in West Virginia. I am grateful that he heard me and others and cosponsored the Bolstering Infectious Outbreaks (BIO) Preparedness Workforce Act (H.R. 5602). This bipartisan legislation introduced in the House of Representatives by Rep. Lori Trahan (D-MA) with Rep. McKinley and in the Senate by Sen. Tammy Baldwin (D-WI) and Sen. Susan Collins (R-ME) will create a new loan repayment program for medical professionals who provide ID care in underserved areas or clinics and facilities that receive federal funding, such as Ryan White HIV/AIDS program clinics. The act will improve health equity by drawing ID and HIV health care professionals to underserved rural areas in West Virginia and across the country. An additional goal of the legislation will be to increase the number of health care professionals from underrepresented populations working in HIV and ID care.

People with HIV being cared for by experienced providers have better health outcomes. With a revitalized National HIV/AIDS Strategy that includes the federal Ending the HIV Epidemic initiative to focus on areas most in need, we must ensure a robust HIV and ID workforce to dramatically reduce new HIV infections and improve the lives of people with HIV. I urge you on this World AIDS Day to celebrate our progress over the last 40 years — turning an almost universally fatal disease into a manageable chronic health condition — and recognize the work that lies ahead by taking action to support the BIO Preparedness Workforce Act. Please also consider getting more involved in HIVMA and IDSA's advocacy activities. Let your voice — and the voices of your patients — be heard.

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