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The Key to Ending HIV
Primary Care Providers and Supporting Healthcare Professionals: The Key to Ending HIV

Released: December 10, 2025

Myra Rutland
Myra Rutland, DNP, FNP-BC
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Key Takeaways
  • Discussion of HIV prevention is the duty of every healthcare professional, not just infectious disease specialists or STI clinics.
  • Normalizing HIV testing and PrEP is key to more widespread adoption of PrEP and reduced HIV transmission.

The HIV epidemic will not end until all licensed primary care providers (PCPs) and supporting healthcare professionals (HCPs) become actively involved in testing and prevention. From a public health perspective, PCPs must revisit the definition of what we do for a living.

In many ways, we are the frontlines of healthcare, the ones who specialists expect to provide referrals, complete preoperative clearances, and support the ongoing refill of prescriptions for specialized chronic conditions.

But we can be much, much more.

We Are a Cornerstone of Healthcare
There are 3 cornerstones to healthcare: Primary, secondary, and tertiary. The goal of primary care is to reduce or eliminate causative risk factors. That means implementing interventions before there is evidence of a disease or injury. 

Let us juxtapose this to HIV testing and prevention. An HIV diagnosis, although no longer necessarily a death sentence, is life altering and completely avoidable. So, why aren’t more PCPs taking time to prevent the obliteration of the immune system, opportunistic infections, and multisystem organ compromise that could be associated with undiagnosed HIV? Somehow, this role has morphed into belonging mostly in the wheelhouse of infectious disease HCPs or “STI Clinics.” That assumption is where the problem lies. 

Normalizing HIV Testing and Prevention
It is the job of every professional in the primary care setting to test and tell. Test for HIV and normalize doing so during routine physical exams and sexual health visits, and tell patients about HIV prevention.

We must avoid a paternalistic approach and should not take it upon ourselves to determine whether the patient needs HIV prevention, as risk factors can sometimes go unseen. We should just offer the information—period.

In turn, patients may share pre-exposure prophylaxis (PrEP) information within their personal circles. Thus, the wheels of public health can begin to turn towards normalization of HIV testing and a status neutral approach to HIV prevention. 

There are other ways to normalize testing: Mobilize, engage, educate, and train (MEET) your nursing and certified medical assistants to offer point-of-care testing, to provide informational handouts in the waiting room, and to include sexual health questions in registration documents.

Prioritizing Patient Education
In my practice, most patients erroneously believe that HIV prevention is only for gay males. People are largely unaware that PrEP is for everyone, and they do not see themselves as possibly at risk for HIV. The vast majority of people are unaware that HIV disproportionately affects Black women and people with substance use disorder, or that the US is experiencing the highest rates in syphilis in over 50 years. Clearly, there is room for improvement in education.

The CDC PrEP Guidelines say that every sexually active individual should be offered PrEP. Personally, I do not see how one can perform a head-to-toe assessment and skip the genitalia. We must understand that personal discomfort is not a pass to forgo a discussion on sexual health; it is just a signal that added skills are needed. Lack of time to address sexual health is not a reasonable excuse either, it is a call to reprioritize and shift time management.

Why would personal discomfort or a lack of time absolve me of the responsibility to provide education and prescribe prevention? The definitive answer is that it should not.

Need another reason? The healthcare costs associated with supporting life with HIV continue to rise to astronomical heights and are untenable without insurance. Therefore, the return on investment of training all PCPs in HIV and STI prevention—and normalizing prevention as a priority in primary care­­—should be a no-brainer.

I hope that my colleagues connect the dots as to why discussion of HIV prevention and PrEP education is absolutely, unequivocally an essential role of all HCPs, including PCPs, dentists, psychiatrists, nurses, and social workers. There is a suitable role for all HCPs and their support teams in HIV prevention.

Obtaining the Tools Needed
Of course, there is a long runway to implementing HIV prevention in all healthcare settings. To this end, I believe there should be mandatory training for HIV prevention, education, and prescribing, similar to the required opioid use disorder training. I believe this should be implemented for nursing, primary care, dental, pharmacy, and social workers, and the appropriate state licensure boards for each profession should have a required HIV prevention certification with a minimum number of training hours.

The training could begin as a part of one’s specific professional curriculum. The content is already developed in HIV prevention circles, such as AIDs Education Training Centers (AETC), American Association of HIV Medicine (AAHIVM), Association of Nurses in AIDs Care (ANAC) and many others. There would be no need to reinvent the wheel, because the legwork has already been done, with clinical expertise available to mentor the process.

Unfortunately, we will not meet the CDC goal of a 30% reduction in new HIV transmissions by 2025. However, with legislative support for added continuing education, I am a firm believer that we can move the needle towards ending HIV by preventing new cases.

The Call to Action
I implore PCPs, licensed HCPs, and all support staff to test and tell, to learn to prescribe PrEP and educate about prevention. At the individual level, doing so will prevent a permanent, life-altering chronic illness. At the population level, focusing on HIV prevention is the only way to effectively end new HIV cases. The call to action is deafening.

Your Thoughts
What methods do you think would be most effective for integration of HIV education and PrEP into primary care? Leave a comment to join the discussion!

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