Commentary Sexual Health

Some Questions and Answers About HIV and AIDS

Dr. Michael Horberg

HIV Medicine Association Chair Michael Horberg, MD, MAS, recently answered several questions for Rewire’s series highlighting STD Awareness Month.

See all of our coverage of STD Awareness Month 2013 here.

Published in partnership with the National Coalition of STD Directors (NCSD).

HIV Medicine Association (HIVMA) Chair Michael Horberg, MD, MAS, recently answered several questions for Rewire’s series highlighting STD Awareness Month, in partnership with the National Coalition of STD Directors. HIVMA is the professional home for more than 5,000 physicians, scientists, and other health-care professionals dedicated to the field of HIV/AIDS.

What role can medical providers play in STD and HIV prevention?

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Medical providers play a key role in sexually transmitted disease (STD) and HIV prevention. They can test their patients for HIV and other STDs and treat those with a positive diagnosis. Providers should teach their patients about safer sex, and regularly reinforce the importance of safer sex. The burden of STDs is massive. Recent data released by the Centers for Disease Control and Prevention (CDC) suggests that there are more than 110 million sexually transmitted infections among men and women nationwide, with an estimated 20 million new infections occurring annually. These cost the U.S. health-care system nearly $16 billion in direct medical costs alone, the CDC estimated, above and beyond the pain and suffering many of these infections also cause.

Why is STD prevention so important in the context of someone who is also infected with HIV? What are the implications when co-infections are involved?

STDs love “working together,” and having one, like HIV, makes it easier for the other STDs to infect you. Additionally, these other STDs can be even more virulent and harder to treat. So, especially HIV-infected patients need to practice safer sex, not only to prevent spreading the virus to others, but also to prevent getting other STDs. If HIV-infected patients get infected with another STD, it is very important that they get treated promptly and effectively. It’s a good idea to make sure they responded to the treatment, and to also test them to make sure they cleared the infection.

Where are we as a nation in terms of screening for HIV and STDs, and how can we do better (patients, providers, policymakers)?

We need to do better. HIV and STD testing and prevention must be part of all routine health care. We need to make sure all Americans know their HIV status, and for those at continued risk, have a plan for regular follow-up testing. An estimated one in five people who are infected with HIV in the United States don’t know their status, and many are diagnosed too late to benefit from effective care and treatment. We need to check for other STDs too on a regular basis. Doctors and other providers should check for these infections regularly and teach their patients how to avoid them, by practicing safer sex.

Hopefully, with the U.S. Preventive Service Task Force affirming its strongest recommendation for HIV testing for all patients age 15 to 65, all pregnant women, and younger adolescents and older adults who are at higher risk, HIV testing will become a covered benefit under health-care reform, offered free of charge to patients. We hope this will make testing even more available as a regular part of routine medical care. Of course, we also need to make sure policymakers understand the importance of adequate funding for HIV and STD quality care, as well as research to improve treatment and prevention of HIV and STDs.

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