Leon McCrea, MD, MPH

 vaccinations has evolved over the years. We have successfully made HIV part of the primary care visit, but many patients are still hesitant to undergo testing due to the stigma associated with the disease. Similarly, fears persist about the COVID-19 vaccine – primarily because some patients unfortunately still don’t trust our science-based institutions. 

Yet for most people, solid trust in their primary care doctor has not wavered. For that reason, clinicians have a great opportunity to increase COVID-19 vaccinations and testing for HIV. It begins with a candid conversation; but starting that dialogue can be difficult. From our experience, here are a few key approaches that can help open the door.

Being open and honest with patients must always be our top priority. Many patients doubt the safety of the COVID vaccines when seeing friends and family members fall sick after vaccination. As clinicians, we have to remind patients that vaccines were never meant to prevent infections 100% of the time. Instead, their greatest use is preventing 

 infections, hospitalizations, even deaths. But in the messaging to patients, we may have oversold the capability of vaccines. 

Similarly, the stigma and misinformation surrounding HIV has led many to question why vaccines have been quickly developed for emergent infections such as COVID-19 and Monkeypox, yet we still don’t have a vaccine for HIV. This has spurred even more distrust and fueled skepticism about the origins of HIV.

When we as clinicians provide explanation, we help debunk these dangerous myths and misunderstandings. Honesty builds trust, and every subsequent conversation becomes a little easier.

Your patients see you as a highly reliable source of information. They will look to you for direction and trust your guidance. But if they have questions, they’ll be able to quickly tell if you aren’t sure of the answers. We always have to do our best to stay up to date on new research, guidelines, and recommendations. But obviously, we won’t always have all of the answers.

One way to build trust is to actually look up the information with your patient right there in the exam room. So when starting a conversation about HIV testing, you can actually show the patient the latest recommendations of the U.S. Preventive Services Task Force for testing based on patient demographics. You can show them which specific guidelines are recommended for them. And when you want to discuss COVID vaccines, show them the CDC.gov website, walk them through the recommendations, and guide them toward the answers.

When it comes to HIV and COVID-19 discussions, it’s crucial that patients don’t feel targeted. Questions should never feel accusatory or taboo, and the best way to avoid this is to make testing and screening questions part of your routine in every primary care visit. Patients will then come to expect this discussion, and even if they aren’t willing to undergo testing or screening, it won’t cause any ill feelings between you and the patient.

The CDC recommends that we keep our feet on the gas pedal, continually having conversations with patients about the dangers of COVID-19. This should also be the approach with HIV testing. We hope that we can reach a point when COVID vaccines and HIV testing become routine topics just like screenings for breast cancer, diabetes, and other diseases. 

There are efforts to help inform clinicians about navigating conversations with patients on these topics. For instance, the "Two in One: HIV + COVID Screening and Testing Model" from George Washington University has launched a training series for all clinicians to routinize HIV screening and COVID-19 vaccine screening for all of their patients. The next free webinar in the training series will take place in May. More information can be found on the 

We must help our patients by sharpening our skills in using the simple but powerful tools of patience, transparency, and honesty based on evidence.

Annette Gadegbeku, MD, is Associate Dean of Community Health at Drexel University College of Medicine and an Associate Professor in the Department of Family, Community & Preventive Medicine and Chief of the Division of Community Health. She is on the advisory board for George Washington University’s 

Two in One HIV +COVID Screening and Testing Model.

Leon McCrea, MD, MPH, is the Senior Associate Dean of Diversity, Equity & Inclusion at Drexel University College of Medicine and an Associate Professor in the Department of Family, Community & Preventive Medicine. He is on the advisory board for George Washington University’s 

Clinicians and experts interested in replying to this piece or submitting an article to HCPLive can 

Leon McCrea, MD, MPH

Articles

The Power of the Primary Care Visit to Combat COVID-19 and HIV