Five Takeaways on Ending the HIV Epidemic: Insights From My Conversation With the NIH Director

I was honored to join NIH Director Jay Bhattacharya, M.D., Ph.D., on The Director’s Desk podcast to discuss the early days of the HIV epidemic and the evolution of HIV prevention and treatment.

In the late 1980s, I was a new college graduate living in San Francisco—the epicenter of the epidemic in the United States. I was struck by the immense suffering, and it became clear to me that I wanted to do something to help address the epidemic. I earned my graduate degree in clinical psychology, planning to do something to address the mental health needs of people with, and affected by, HIV. As highly active antiretroviral therapy became available in the mid-1990s, HIV shifted from a terminal diagnosis to a chronic condition. Today, thanks to NIH investments in HIV research, people with HIV who have access to care and treatment experience a near normal lifespan.

As the availability of treatment transformed the outlook for people with HIV, my clinical work began to focus on implementation science—the study of methods to promote the adoption and integration of evidence-based interventions into real-world settings to impact public health. I wanted to learn which interventions people were most likely to use to prevent HIV acquisition and the most effective strategies to encourage people with HIV to begin and sustain treatment.

This work remains critically important in our collective efforts to address HIV, and this topic was a key theme in my discussion with Dr. Bhattacharya. We have come a long way in HIV prevention, treatment, and care. But more work remains to achieve epidemic control. Below are five takeaways from the podcast on how we can harness our existing success in HIV research and move closer to the goal of ending the HIV epidemic.

• Collectively, we can end the HIV epidemic as a public health threat by understanding how to deliver, sustain, and scale evidence-based strategies for HIV prevention and treatment. We have effective, lifesaving interventions, but people are not benefiting equally. We have not achieved an end to the HIV epidemic because these interventions are not reaching everyone who needs them most.
  
  Pre-exposure prophylaxis (PrEP) prevents HIV acquisition in people who are exposed to the virus. There are several PrEP formulations from daily oral pills to long-acting injections, giving people choices that fit their needs and lifestyles. According to the Centers for Disease Control and Prevention (CDC), although PrEP use has increased, many people who could benefit from PrEP are not receiving it, with disparities among Black and Hispanic/Latino populations, teens and young adults, women and girls, and people in the South. We also know that people with HIV who take antiretroviral therapy as prescribed and achieve sustained viral suppression—a viral load that is too low to be detected by blood tests—will not transmit HIV to others. This concept is known as Undetectable = Untransmittable, or U=U. But only 65 percent of people with diagnosed HIV in the United States had achieved and maintained viral suppression in 2022, according to CDC data.¹ This is reflective of gaps in care—knowledge of status, adherence to treatment, knowledge of viral load, and lack of knowledge or awareness of the benefits of viral suppression—where implementation science can help us understand how to get effective tools to people who need them.
   
• An increased focus on implementation science research is crucial to identify the best strategies to reach different populations. Implementation science shows us how, where, and when to implement interventions and who should conduct implementation programs to effectively reach people most in need. Implementation science emphasizes tailoring interventions for each population to be effective—one strategy might work for men who have sex with men in the South, but Black women in the urban Northeast or adolescents in rural areas might need a different approach to accomplish the same goal. We need to identify culturally appropriate strategies to encourage adoption and adherence to PrEP for HIV prevention and to engage and retain people with HIV in treatment so they can achieve and maintain viral suppression and prevent transmitting HIV to their partners.
  
  Collaboration with community partners is vital to the success of implementation science. Partnerships with health providers, health systems, and communities with lived experience beginning with idea generation through study development and implementation to manuscript publication ensures research findings are relevant in real-world settings. Together with our NIH partners, OAR is emphasizing implementation science to understand how to increase uptake and adoption of evidence-based interventions and reduce the documented 17-year gap between a discovery and its implementation across the HIV prevention and care continuum, including HIV-related comorbidities. In collaboration with NIH Institutes, Centers, and Offices (ICOs); community and scientific partners; and NIH leadership, OAR will conduct a landscape analysis of implementation science research in HIV; make recommendations to strengthen the research portfolio in this area; develop inclusive, NIH-wide funding opportunities that foster new ideas; and initiate strategies to accelerate innovative science to end the epidemic and improve the quality of life for people affected by HIV.
   
• We must work closely with federal partners who are equipped to implement proven strategies to facilitate uptake, adoption, sustainability, and scale-up of evidence-based interventions. The role of NIH, in collaboration with federal partners, is to support research that identifies lifesaving interventions and determine the best ways to foster widespread adoption. But our federal partners take the next step of implementing these interventions in the real world. CDC, the Health Resources and Services Administration (HRSA), and the Substance Abuse and Mental Health Services Administration (SAMHSA), among other federal agencies, implement HIV prevention, treatment, and care programs. As NIH-supported research identifies effective, evidence-based strategies, we at NIH need to share those findings with our federal partners and say, “This is what works. This is the best evidence-based implementation strategy.” NIH and OAR have worked effectively with federal agencies as part of the Ending the HIV Epidemic in the U.S. (EHE) initiative. With continued collaboration and a robust HIV research pipeline that includes implementation science, I believe we can accomplish the goal of ending HIV as a public health threat in the United States in the next decade.
   
• A comprehensive NIH HIV research portfolio is essential. While it is vital that we ramp up NIH-supported implementation science in HIV research, we must continue to support the full range of science encompassing prevention, treatment, and cure to truly end the epidemic. New discoveries and approaches will lead to ever-improved tools and even more choices for implementation and will help improve the lives of people with, and affected by, HIV. NIH will continue to fund research in basic science, new therapeutics, and treatments for people with HIV who are managing comorbidities. Continued evolution of the virus, resulting in viral resistance to prevention and treatment medications, remains a critical challenge, making it essential to pursue HIV cure research. Ongoing research also is critical to addressing comorbidities, coinfections, and complications that exacerbate health challenges among people with HIV.
   
• New prevention tools are necessary for continued progress, but they are not sufficient to end the HIV epidemic. The U.S. Food and Drug Administration (FDA) recently approved the long-acting injectable medication lenacapavir, which is administered every six months, for HIV prevention. In the PURPOSE I, II, and III clinical trials, the medication was 96-100 percent effective in preventing HIV transmission. If we can reach people most in need of PrEP and sustain uptake, we can go a long way toward addressing HIV as a public health threat. Long-acting injectable PrEP formulations of lenacapavir and cabotegravir are game-changers. An oral once-a-month PrEP formulation, now in Phase III clinical trials, also is promising. But we must remain vigilant. We also need to think about the people who already have HIV. According to CDC, in 2022, there were about 1.2 million people with HIV in the United States.² These people will need treatment for the rest of their lives to stay healthy and prevent further transmission. We must ensure all people with HIV receive sustained HIV treatment and are retained in care.

As I reflect on the tremendous progress in HIV research, I’m reminded that we reached this point through NIH investments and the dedicated work of researchers, health providers, advocates, and members of the HIV community. With continued commitment and collaboration across government, academia, health care, and community to ensure we reach people most in need, I am confident we can come together to end HIV as public health threat by the end of decade.

Listen to The Director’s Desk podcast to learn more.

1 - Centers for Disease Control and Prevention. Monitoring selected national HIV prevention and care objectives by using HIV surveillance data—United States and 6 territories and freely associated states, 2022. HIV Surveillance Supplemental Report 2024; 29(No. 2). Accessed August 4, 2025. https://www.cdc.gov/hiv-data/nhss/national-hiv-prevention-and-care-outcomes.html

2 - Centers for Disease Control and Prevention. Estimated HIV incidence and prevalence in the United States, 2018-2022. HIV Surveillance Supplemental Report 2024; 29(No. 1). Accessed August 1, 2025. https://www.cdc.gov/hiv/data-research/facts-stats/index.html

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