What is the ‘new HIV’?
Data indicate that fewer medical students and fellows are joining the HIV workforce, perhaps under the impression that HIV is no longer the exciting and rewarding field it once was. We asked Infectious Disease News Editorial Board Member Peter Chin-Hong, MD, professor of medicine and director of the transplant infectious disease program at University of California, San Francisco, what the “new HIV” is — the ID-related field that is attracting today’s young clinicians.
People would expect me to say that the “new HIV” is the growing field of transplant and non-HIV-infected immunocompromised infectious diseases. Over the years, we have seen a steep rise in the interest in ID fellow applicants for careers in transplant ID, curricula have been ratified, fellowships abound and the research agenda is growing. Most importantly, the population of patients who have undergone hematopoietic stem cell transplant, solid organ transplant or are prescribed immunobiologics is increasing — so, job prospects are rosy. Now there are thousands of HIV-infected patients who have received transplants, including the newest population of HIV-to-HIV transplants via the HOPE act.
But I am not going to say transplant infectious diseases. It would be too easy to say it is the singular subspecialty within infectious diseases that is seducing trainees in droves, upending the allure that HIV care and research has held for decades in our field.
There are other competitors.
I could write that climate change is the “new HIV” in terms of scope and the numbers of patients involved, and the protean manifestations on health — including infectious diseases such as diarrheal diseases, vector-borne infections and endemic mycoses. Like with HIV, political mandate has been slow to address this global crisis. As Sir Richard Feachem, PhD, DSc, director of the Global Health Group and professor of medicine at UCSF, recently said, “There are only four scenarios that could actually kill hundreds of millions of people. Nuclear war, meteorites and pandemics are all merely feasible. But climate change is already underway.” Increasing numbers of learners are driven to become activists and content experts in this area, and there is talk of fashioning fellowship programs in medicine to support advanced training.
Perhaps the biggest contenders to be the “new HIV” are the glaring disparities and inequities in health that have come to light with increasing intensity in the past several years. Catherine R. Lucey, MD, executive vice dean of medical education at UCSF, and other leaders in medical education believe that it may be the singular pressing health issue of our time. There are gender, race and ethnicity disparities, not only in new HIV diagnoses and PrEP access and uptake but also in viral hepatitis, STDs and tuberculosis. But the problem of inequity goes beyond HIV or infectious diseases in general and touches on all facets of health care — from health care delivery and medical research to our physician workforce development and retention. Many of us were drawn to HIV in the first place because of the outsized impact of the epidemic on underserved and vulnerable populations. And focusing on disparities is also a way to continue to draw the best and brightest diverse trainees to choose infectious diseases as a career.
The “new HIV” is not a single pressing infectious disease pandemic. Today’s trainees contemplating a career in infectious diseases are drawn to a far more diverse group of interests than ever before — medical education, antimicrobial stewardship, transplant ID, addiction medicine, climate change and disparities in health care are just a few examples of emerging interests that my medical students passionately discuss with me. HIV will always attract our trainees — it continues to have allure and an “I can make a difference” sparkle on so many fronts. But the challenge of workforce development in infectious diseases goes beyond that. To meet the current and emerging needs of practitioners trained in infectious diseases, we must continue to deliberately incorporate trainees’ core passions with the agenda set by leaders not in only our field but in society at large — just like we did in the early HIV days.
- Haines A, et al. N Engl J Med. 2019; doi:10.1056/NEJMra1807873.
- Schwartz BS, et al. J Infect Dis. 2017; doi:10.1093/infdis/jix325.
- Tan SK, et al. Tranpl Infect Dis. 2018;doi:10.1111/tid.12915.
- Manning C. The climate crisis is a health crisis. UCSF Magazine. https://www.ucsf.edu/magazine/climate-crisis-health-crisis. Accessed: December 30, 2019.
Disclosure: Chin-Hong reports no relevant financial disclosures.
Click here to read the cover story, “Push to end HIV epidemic in US complicated by ‘brain drain.’”