The Future of HIV Care

GLP-1 Agonists and HIV: Do Weight-Loss Drugs Make Sense for Your Patients? Three GLP-1 agonist drugs (which originally had been confined to diabetes treatment) are currently FDA approved specifically for weight loss. The rapid uptake of these medications in the U.S. has naturally led to questions within the HIV clinical community about their safety and efficacy in people living with HIV, whose journeys with weight gain and weight loss overlap with the general population but also may differ significantly in a few key ways. Joining us on the podcast this month to provide some answers is one of the most prominent clinician researchers exploring this topic today: Grace McComsey, M.D., a professor of pediatrics and medicine at Case Western Reserve University, as well as the vice president of research and the associate chief scientific officer at the University Hospitals Health System in Cleveland, Ohio. Read the transcript: https://www.thebodypro.com/article/future-hiv-care-glp-1-agonists-semaglutide Credits: Our executive producer is Myles Helfand; our project manager is Alina Mogollon-Volk; our audio producers/engineers are Alex Portaluppi and Lucy Mueller; and our series editors are Maria Elena Perez and Juan Michael Porter II. This episode's audio was edited by Kim Buikema.

For all too many people living with HIV in the U.S., the prospect of facing incarceration because of their status is not an abstraction: It is a real and present danger. And in many states, it has nothing to do with science. This month, Juan Michael Porter II speaks with Joseph Cherabie, M.D., M.Sc., about why it's so important for clinicians to educate themselves about HIV criminalization laws in their state -- and then work to support and empower their patients while pushing to get these laws removed. Read the transcript, which includes valuable links to related resources: https://www.thebodypro.com/article/future-hiv-care-criminalization Credits: Our executive producer is Myles Helfand; our project manager is Alina Mogollon-Volk; our audio producers/engineers are Alex Portaluppi and Lucy Mueller; and our series editors are Maria Elena Perez and Juan Michael Porter II. This episode's audio was edited by Kim Buikema.

Summer weather is transitioning into sweater weather in most of the U.S., and that means we -- and our patients -- are about to spend a lot more time indoors, inevitably getting exposed to numerous microbes. Accordingly, this month we're talking about vaccinations for people living with HIV: why they're critical, what to consider, how to discuss the topic with your patients, and how to help ensure people living with HIV equitably receive the care they deserve. Our guests for this episode, which is hosted by Juan Michael Porter II, are Stella Safo, M.D., M.P.H., of Just Equity for Health and Perry Halkitis, Ph.D., M.P.H., of the Rutgers School of Public Health. Read the transcript: https://www.thebodypro.com/article/future-hiv-care-podcast-vaccinations Credits: Our executive producer is Myles Helfand; our project manager is Alina Mogollon-Volk; our audio producers/engineers are Alex Portaluppi and Lucy Mueller; and our series editors are Maria Elena Perez and Juan Michael Porter II. This episode's audio was edited by Kim Buikema.

This month, we’re clearing the air around integrase inhibitors. They are by far the world’s most commonly prescribed HIV drug class -- but that ubiquity has come with long-standing concerns around their potential to cause a range of adverse events, from weight gain to birth defects and more. Our executive editor Myles Helfand speaks with Laura Waters, M.D., FRCP, the head of the British HIV Association, about what the available science tells us. Read the transcript: https://www.thebodypro.com/article/future-hiv-care-podcast-integrase-inhibitors-laura-waters

Credits: Our executive producer is Myles Helfand; our project manager is Alina Mogollon-Volk; our audio producers/engineers are Alex Portaluppi and Lucy Mueller; and our series editors are Maria Elena Perez and Juan Michael Porter II. This episode's audio was edited by Kim Buikema.

This month, Juan Michael Porter II speaks with Tristan Barber, M.D., FRCP, about the challenges we face in determining the precise causes of particular health complications in people living with HIV. As importantly, they discuss how a provider can best make sense of these challenges and work through them to continue to provide exceptional, supportive patient care. Read the transcript: https://www.thebodypro.com/article/future-hiv-care-podcast-treatment-tristan-barber Credits: Our executive producer is Myles Helfand; our project manager is Alina Mogollon-Volk; our audio producers/engineers are Alex Portaluppi and Lucy Mueller; and our series editors are Maria Elena Perez and Juan Michael Porter II.

The concept of "patient-centered care" can feel both nebulous and obvious: As a clinician treating a patient, are you not by definition providing patient-centered care? There is a key difference, however, between care that focuses on the patient and care that centers each patient as a unique individual in need of a specifically tailored approach. This month, podcast co-hosts Myles Helfand and Juan Michael Porter II dig into this issue, and discuss how conversations about achieving long-term successful health outcomes for people living with HIV must start with the most basic of tenets: Believe your patients, trust them, and show that you’re willing to stand up for their rights to existence and equity. Read the transcript, which includes links to the many sources we reference this month: https://www.thebodypro.com/article/future-hiv-care-podcast-trust-your-patients

Credits: Our executive producer is Myles Helfand; our project manager is Alina Mogollon-Volk; our audio producers/engineers are Alex Portaluppi and Lucy Mueller; and our series editors are Maria Elena Perez and Juan Michael Porter II. Audio for this episode was edited by Kim Buikema.

Your Patients Are Probably Having Anal Sex. Let's Talk About It. It’s Pride Month, so we thought: Why don’t we talk about anal health? (Or, as we will frequently refer to it on this podcast, butt stuff?) We know it’s a taboo, and many of us are uncomfortable discussing it with our patients. But even though it is awkward, when we recognize that HIV transmissions often occur through anal sex -- and that regardless of sex or gender, many people have anal sex at some point, whether they are admitting it or not -- we can appreciate that we really do need to talk about this. Our guest for this discussion is Jonathan Baker, PA-C, the Operations Director of Clinical Research at Laser Surgery Care and a leading clinical voice on issues related to anal sex and health care. Read the transcript, which includes links to additional resources you can utilize yourself and share with your patients: https://www.thebodypro.com/article/future-hiv-care-podcast-baker-anal-sex This month’s episode is hosted by Juan Michael Porter II. Our executive producer is Myles Helfand; our project manager is Alina Mogollon-Volk; our audio producers/engineers are Alex Portaluppi and Lucy Mueller; and our series editors are Maria Elena Perez and Juan Michael Porter II. Audio for this episode was edited by Kimberly Buikema.

In the United States, some of our most innovative steps forward in HIV care and research are taking place at one of the oldest HIV care facilities in the world. Humbly named Ward 86, this unassuming wing of San Francisco General Hospital opened 40 years ago as the first U.S. clinic dedicated specifically to the treatment of people living with HIV. Since then, it has been at the forefront of a host of initiatives and programs that seek to improve access to HIV prevention and treatment—and to increase the quality of the care we provide. That mission includes, most recently, a heavy focus on people who are unstably housed; people who are on public assistance; who are dealing with substance dependency; or who have mental illness. The effort underway at Ward 86 aims to prove that these patients are not nearly as “hard to treat” as has often been traditionally assumed. The medical director of Ward 86, and our guest on the podcast this month, is Monica Gandhi, M.D., M.P.H. She joins us to talk about Ward 86’s recent initiatives and thought-provoking study findings. We’ll also explore whether Ward 86’s approach to care can realistically serve as a model for clinics across the country. Read the transcript: https://www.thebodypro.com/article/future-hiv-care-podcast-15-gandhi-hard-to-treat

This month’s episode is hosted by Myles Helfand. Our executive producer is Myles Helfand; our project manager is Alina Mogollon-Volk; our audio producers/engineers are Alex Portaluppi and Lucy Mueller; and our series editors are Maria Elena Perez and Juan Michael Porter II. Audio for this episode was edited by Kimberly Buikema.

This month, we speak with Kathie M. Hiers and Jean Hernandez of AIDS Alabama about how to overcome barriers to care for vulnerable people -- and how administrators and clinicians alike can better ensure that everyone accesses the services they need. Read the transcript:https://www.thebodypro.com/article/future-hiv-care-podcast-16-aids-alabama

This month’s episode is hosted by Juan Michael Porter II. Our executive producer is Myles Helfand; our project manager is Alina Mogollon-Volk; our audio producers/engineers are Alex Portaluppi and Lucy Mueller; and our series editors are Maria Elena Perez and Juan Michael Porter II. Audio for this episode was edited by Kimberly Buikema.

This month, we’re going to explore a significant set of recent changes to U.S. HIV clinical guidelines. These changes are momentous in and of themselves, but they also reveal an important ongoing shift in how we fundamentally approach the clinician-patient relationship, especially when it comes to pregnant and infant-feeding people who are living with HIV. Joining us for this conversation are two people who have been deeply involved in these guideline changes: Lealah Pollock, M.D., and Ciarra (Ci Ci) Covin. Dr. Pollock is an associate professor of Family Community Medicine at the University of California-San Francisco School of Medicine, and she’s a member of the expert panel that recently updated the guidelines we discuss. Ci Ci Covin is an HIV advocate and mother of two who has been living with HIV since 2008, and she’s a program manager at The Well Project, a nonprofit organization devoted to informing and supporting women who are living with, or vulnerable to, HIV. Read the transcript: https://www.thebodypro.com/article/future-hiv-care-podcast-15-breastfeeding-chestfeeding

This month’s episode is hosted by Myles Helfand. Our executive producer is Myles Helfand; our project manager is Alina Mogollon-Volk; our audio producers/engineers are Alex Portaluppi and Lucy Mueller; and our series editors are Maria Elena Perez and Juan Michael Porter II. Audio for this episode was edited by Kimberly Buikema.

It’s Black History Month, the shortest month of the year. It's not enough to simply talk about racism in health care as an issue or to acknowledge that the house is on fire; at a certain point, one has to formulate a game plan for addressing the issue effectively beyond analyzing data and conducting studies. We speak with Susan Cole-Haley, an incredible HIV advocate and Black woman who is living with HIV, about her experience and creating a way forward. We also speak with John Schneider, M.D., M.P.H., a white physician who is researching and developing practical applications around HIV within clinical settings to help listeners transform their practices. Read the transcript: https://www.thebodypro.com/article/future-hiv-care-podcast-14-medical-racism-solutions

This month’s episode is hosted by Juan Michael Porter II. Our executive producer is Myles Helfand; our project manager is Alina Mogollon-Volk; our audio producers/engineers are Alex Portaluppi and Lucy Mueller; and our series editors are Maria Elena Perez and Juan Michael Porter II. Audio for this episode was edited by Kimberly Buikema.

This month, we take stock of the most notable developments in 2022 that affected HIV medicine and clinical practice in the U.S. — and we'll also take a glimpse at the highlights that 2023 may hold in store. Our guide on this journey is David Alain Wohl, M.D., a professor of medicine in the Division of Infectious Diseases at the University of North Carolina. He's the author of an annual opus on TheBodyPro in which he delves deeply into the top 10 HIV-related clinical developments of the year. Read the transcript: https://www.thebodypro.com/article/future-hiv-care-podcast-13-top-clinical-developments Read David Alain Wohl's Top 10 HIV Clinical Developments of 2022: https://www.thebodypro.com/gallery/gallery/top-10-hiv-clinical-developments-of-2022

This month’s episode is hosted by Myles Helfand. Our executive producer is Myles Helfand; our project manager is Alina Mogollon-Volk; our audio producers/engineers are Alex Portaluppi and Lucy Mueller; and our series editors are Maria Elena Perez and Juan Michael Porter II. Audio for this episode was edited by Kimberly Buikema.

Over the long term, successful HIV treatment is not about addressing a single issue; it requires a full continuum of care. Anita Ravi, M.D., M.P.H., the founder and medical director of the PurpLE Clinic, shares how clinicians can best address the small-but-critical moments in the patient-provider relationship that make the difference between optimal outcomes and people falling out of care. Read the transcript: https://www.thebodypro.com/article/future-hiv-care-podcast-12-continuum-of-care This month’s episode is hosted by Juan Michael Porter II. Our executive producer is Myles Helfand; our project manager is Alina Mogollon-Volk; our audio producers/engineers are Alex Portaluppi and Lucy Mueller; and our podcast editors are Maria Elena Perez and Juan Michael Porter II.

Drug use is highly stigmatized not only within U.S. society, but within our health care system as well. This is all the more concerning in the context of HIV care, given the stigmas already associated with HIV. But it's within our power as health care providers to change that. In this month's episode, Joshua Barocas, M.D., of University of Colorado School of Medicine, explains how -- and why it's both cost-effective and morally imperative to do so. Read the full transcript: https://www.thebodypro.com/article/future-hiv-care-podcast-11-opioid-use-disorder-treatment

This month's episode is hosted by Juan Michael Porter II. Our executive producer is Myles Helfand; our project manager is Alina Mogollon-Volk; our audio producers/engineers are Alex Portaluppi and Lucy Mueller; and our podcast editors are Maria Elena Perez and Juan Michael Porter II.

For providers of HIV-related care and services in the U.S., the legal landscape has grown more fraught in recent years. Despite protections baked into the Affordable Care Act, acts of medical discrimination are on the rise -- and are sometimes even encouraged by a provider's institution. We speak with Valerie Blake, J.D., of West Virginia University about these current realities, and how providers can work within the law to administer just, equitable, and science-based care to their patients. Read the full transcript: https://www.thebodypro.com/article/future-hiv-care-podcast-10-medical-discrimination This month's episode is hosted by Juan Michael Porter II. Our executive producer is Myles Helfand; our project manager is Alina Mogollon-Volk; our audio producers/engineers are Alex Portaluppi and Lucy Mueller; and our podcast editors are Maria Elena Perez and Juan Michael Porter II.

This month, we talk with Joseph Cherabie, M.D., M.Sc., of the Washington University School of Medicine about the keys to successfully taking a sexual history and discussing sex with your patients. Though sexuality is an essential aspect of our humanity, taking a sexual history can often be a challenging experience for providers and a traumatizing one for patients. But to provide effective HIV care, speaking to patients about their sexual health is crucial. We discuss how to communicate with patients about sex in a way that honors who they are without stigmatizing them or their choices. Read the full transcript: https://www.thebodypro.com/article/future-hiv-care-podcast-9-sexual-history

Our podcast team: This month's episode is hosted by Juan Michael Porter II. Our executive producer is Myles Helfand; our project manager is Alina Mogollon-Volk; our audio producers/engineers are Alex Portaluppi and Lucy Mueller; and our podcast editors are Maria Elena Perez and Juan Michael Porter II.

We talk with Gregorio (Greg) Millett, M.P.H., a longtime HIV and public health advocate, about the implicit (and explicit) stigmas that harm our ability to fully tackle the new monkeypox epidemic—and about how we can do better as a clinical community. We'll also dispel a few medical misconceptions about monkeypox along the way. Read the full transcript, which includes links to the many studies cited throughout this conversation: https://www.thebodypro.com/article/future-hiv-care-podcast-8-monkeypox-clinical-bias

Our podcast team: This month's episode is hosted by Juan Michael Porter II. Our executive producer is Myles Helfand; our project manager is Alina Mogollon-Volk; our audio producers/engineers are Alex Portaluppi and Lucy Mueller; and our podcast editors are Maria Elena Perez and Juan Michael Porter II.

This month, gastroenterologist Jessica Korman, M.D., joins us to discuss one of the more common, yet underscreened, comorbidities that an HIV care provider can encounter in their patient: anal cancer and its precursors.

Korman is a co-author of the newly published ANCHOR study, which explores the value of treating (versus simply observing) high-risk, pre-cancerous anal lesions. In this episode, she shares highlights of the ANCHOR study results, analyzes their clinical implications, and talks about optimal approaches to clinician-patient conversations about anal cancer screening.

Read the full transcript (clicking the link helps support the podcast!): https://www.thebodypro.com/article/future-hiv-care-podcast-7-anal-cancer-hsil-screening

Our podcast team: Executive producer Myles Helfand; project manager Alina Mogollon-Volk; audio producers/engineers Alex Portaluppi and Lucy Mueller; and podcast editors Maria Elena Perez and Juan Michael Porter II.

Please note that this episode discusses depression and suicide, which some listeners may find triggering. IF YOU NEED HELP: The peer counseling service we discuss within this episode is called the Physician Support Line; it can be reached at 888-409-0141. It is a free service available every day between 8 a.m. and 1 a.m. Eastern Time. For this podcast, we are stepping away from the discussion around what doctors and medical professionals need to do in order to be better. This framing rarely considers the well-being of medical professionals, or that they themselves often need support and are rarely afforded the grace to ask for it. Many clinicians feel it is potentially damaging to their careers to acknowledge that they are experiencing strain or to ask for help, for fear of facing stigma or being perceived as unable to handle the pressures of their profession. TheBodyPro contributing editor Juan Michael Porter II speaks with Perry Lin, M.D., FACP, an assistant program director of the internal medicine residency program at Mount Carmel Health System in Columbus, Ohio. The conversation focuses on the expectations medical providers place on themselves; the expectations that society and our systems place on them; the challenges of asking for help; and how systems can change -- and are changing -- to make it easier for clinicians to seek counseling and care when they need it. Read the full transcript (clicking the link helps support the podcast!): https://www.thebodypro.com/article/future-hiv-care-podcast-6-mental-health-for-medical-care-providers

Our podcast team: Executive producer Myles Helfand; audio producers/engineers Alex Portaluppi and Lucy Mueller; project manager Alina Mogollon-Volk; and podcast editors Maria Elena Perez and Juan Michael Porter II.

For this episode, we are looking at the provision of trauma-informed care to people who have experienced sexual assault. This includes, but is not limited to, helping survivors regain a feeling of control, effectively communicating with patients, and offering STI testing. Amanda Reames Pitelli, ANRP, M.S.N., the director of clinical services at Planned Parenthood of Metropolitan Washington, D.C., joins us to talk about simple, specific steps HIV clinicians can take to create a safe space for their patients and improve outcomes. Our host for this episode, TheBodyPro contributing editor Juan Michael Porter II, uses his own personal experience as a person living with HIV who has been subjected to sexual assault and sub-optimal trauma care as a case study for how to engage with this difficult subject matter. Read the full transcript (clicking the link helps support the podcast!): https://www.thebodypro.com/article/future-hiv-care-podcast-5-trauma-informed-care Our podcast team: Executive producer Myles Helfand; audio producers/engineers Alex Portaluppi and Lucy Mueller; project manager Alina Mogollon-Volk; and podcast editors Maria Elena Perez and Juan Michael Porter II.

There have been quite a few moments from our prior interviews that felt powerful and important, but which didn’t make the cut for the final podcast audio, usually due to time constraints. These are moments that embrace the essence of this podcast, which is to go beyond the data to discuss where HIV medicine and services are changing in the United States, and to talk about how we can learn and adapt to create better outcomes for patients and clients and, ultimately, to lead to a better future.

Your co-hosts this month, TheBodyPro executive editor Myles Helfand and contributing editor Juan Michael Porter II, offer analysis as we review never-before-heard conversations with Deborah Cohan, M.D., M.P.H., of the University of California-San Francisco and David Alain Wohl, M.D., of the University of North Carolina. We'll discuss racism, COVID-19, telehealth, and how the answer to so many of the systemic issues we face in HIV care today lies within an approach that focuses on one person at a time, one moment at a time -- and by taking simple steps to acknowledge and respect one another's humanity.

Read the full transcript (clicking the link helps support the podcast!): https://www.thebodypro.com/article/future-hiv-care-podcast-4-human-touch

Our podcast team: Executive producer Myles Helfand; audio producers/engineers Alex Portaluppi and Lucy Mueller; project manager Alina Mogollon-Volk; and podcast editors Maria Elena Perez and Juan Michael Porter II.

We talk with Chloe Orkin, M.D., about one aspect of our future that in some very concrete ways has already arrived, and yet is currently out of reach for millions: long-acting medical interventions for HIV, the first of which were approved in the U.S. and Europe for treatment over a year ago and approved in the U.S. for prevention late last year. The beginning of the long-acting era has revealed anew some longstanding questions regarding who these drugs primarily benefit, who is able to receive them, and how our entire medical system is set up to serve -- or not serve -- the people who can most benefit from it. Dr. Orkin is a professor of HIV medicine at Queen Mary University of London and the president of the Medical Women’s Federation. She is one of world’s leading minds in HIV research in medicine -- as well as one of the leading voices in conversations about health equity, access, and anti-discrimination. Read the full transcript (clicking the link also helps support the podcast!): https://www.thebodypro.com/article/future-hiv-care-podcast-3-long-acting-antiretrovirals

Our podcast team: Episode host and executive producer Myles Helfand; audio producers/engineers Alex Portaluppi and Lucy Mueller; project manager Alina Mogollon-Volk; and podcast editors Maria Elena Perez and Juan Michael Porter II.

For our second episode, we tackle structural racism and power differentials in HIV care and services within the U.S. We focus on acknowledging current issues and identifying potential solutions that providers can employ in their daily work. Our staff writer Juan Michael Porter II takes the host chair.

We have two guests in store this month: Michael Chancley, M.S.W., and Deb Cohan, M.D., M.P.H.

Chancley is a social worker, educator, writer, and HIV advocate whose work in the South has transformed the lives of thousands. He is the communications manager of PrEP4All and the administrator of PrEP Facts: Rethinking HIV Prevention and Sex, a Facebook group that educates over 20,000 on HIV prevention.

Cohan is a professor of obstetrics, gynecology, reproductive services, and family/community medicine at the University of California-San Francisco School of Medicine. She is also the medical director of HIVE, a multidisciplinary clinic based at San Francisco General Hospital that provides reproductive and sexual wellness services to women and couples living with HIV.

Our podcast team: Episode host Juan Michael Porter II; producers Alex Portaluppi and Lucy Mueller; project manager Alina Mogollon-Volk; content editor Maria Elena Perez; and executive editor Myles Helfand.

We review some of the most important clinical developments in HIV that we’ve witnessed in 2021, with an eye toward how those developments will inform and alter our response to HIV in 2022 and beyond. Our guest: David Alain Wohl, M.D., a professor of medicine in the Division of Infectious Diseases at the University of North Carolina and the site leader of the HIV Prevention and Treatment Clinical Trials Unit at UNC Chapel Hill. Our topics: HIV and COVID-19; long-acting antiretroviral treatment; PrEP (pre-exposure prophylaxis); and how racism impacts HIV mortality rates. Our host: Myles Helfand, executive editor of TheBodyPro. Relevant reading: -- Top 10 HIV Clinical Developments of 2021: https://www.thebodypro.com/article/hiv-top-10-2021-clinical-developments -- Cabotegravir PrEP FDA approval: https://www.fda.gov/news-events/press-announcements/fda-approves-first-injectable-treatment-hiv-pre-exposure-prevention -- Islatravir trials halted: https://www.aidsmap.com/news/dec-2021/trials-long-acting-islatravir-hiv-treatment-and-prevention-placed-hold
The podcast team: Alex Portaluppi and Lucy Mueller, producers; Alina Mogollon-Volk, project manager; and Maria Elena Perez, content editor.