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April 9, 2019

Addressing the Sexually Transmitted Infection and HIV Syndemic

Author Affiliations
  • 1Division of HIV, Infectious Diseases and Global Medicine, Department of Medicine, University of California, San Francisco
  • 2The Fenway Institute, Boston, Massachusetts
JAMA. 2019;321(14):1356-1358. doi:10.1001/jama.2019.2945

The HIV and sexually transmitted infection (STI) epidemics, which have always been and will always be intertwined, are at an inflection point. Two scientific advancements over the last decade have substantially influenced the sexual health of people living with HIV and individuals at risk for HIV.

First, Undetectable equals Untransmittable (U = U) is an important public health campaign that supports the findings that individuals with a suppressed viral load do not transmit HIV despite condomless sex.1 U = U builds on the findings of several large trials that have demonstrated the remarkable efficacy of HIV treatment as prevention.1,2 U = U, in addition to promoting the power of HIV therapy to halt transmission, has the potential to decrease stigma and improve retention in care.3 Second, preexposure prophylaxis (PrEP), with adequate adherence, provides high protection from HIV for persons at risk, even without condom use, providing the potential to significantly reduce the population-level burden of HIV.4 Widespread and equitable provision of antiretroviral therapy, as well as PrEP, will be critical components of addressing the HIV epidemic.5