As People With HIV Age, Who is the Best Medical Provider for Them?
In the second episode of the series with Perry N. Halkitis, PhD, MS, MPH, he brings his personal experience to this topic and questions if there should be a shift in who manages the primary care needs of these patients.
This year marks the 45th anniversary of the Centers for Disease Control and Prevention's (CDC) first Morbidity and Mortality Weekly Report (MMWR) publication describing AIDS. As a way to mark this anniversary as well as discuss other aspects of the disease such as how far treatments have come, The American Journal of Managed Care’s Lead Editor Maggie Shaw and Contagion’s Assistant Managing Editor John Parkinson spoke with Perry N. Halkitis, PhD, MS, MPH, dean of the Rutgers School of Public Health, on a variety of topics around AIDS/HIV.
Perry N. Halkitis, PhD, MS, MPH, dean of Rutgers School of Public Health, has had HIV for nearly 40 years and he brings up a significant point around the time of his diagnosis to the evolution of care and to where people of his generation are living to be seniors.
“I actually have a tattoo that has a bunch of stars, which is all the people who I lost in my life to HIV…I too was detected to be living with HIV, and that was not until 1988 that I actually tested. And like so many of my generation, I expected the end to be near, and here I am at age 63,” Halkitis said.
Halkitis is one of hundreds of thousands of people with HIV in the US living longer. Not only are they living longer, the age demographics demonstrate there are more older people than younger people living with HIV. In fact, about 54% of people with HIV in the country were aged 50 and older as of 2022, according to the Centers for Disease Control and Prevention. Of them, 39% (over 432,000 people) were between the ages of 50-64, and 15% (over 163,000) of them were 65 years of age and older.1
With aging comes the likelihood that people will have more medical interactions. Halkitis points to recent tests he has taken including a coronary artery calcium (CAC) scan, and an echocardiogram.
His own personal care experience has him rethinking the paradigm in determining who is the best provider to handle the primary care needs for older people with HIV. Should it be infectious disease (ID) clinicians or should it be primary care providers?
“My doctor is great…but he's an infectious disease doc, and he knows everything he needs to know about my HIV. Does he know about other things?”
“Here's the question I will pose: In this moment, where HIV is primarily embedded in older adults who are facing a myriad of aging issues, is an infectious disease doctor the right provider for those folks? Yes, we still need infectious disease specialists, absolutely. But they should not be the folks who are providing the primary care to people with living HIV,” posits Halkitis.
Does Having Primary Care Providers Aid a Shrinking ID Specialty?
It is difficult to find any definitive statistics around how many HIV specialists there are currently. One study did identify a little over 5,000 clinicians who provided HIV care, of whom 28% were HIV-experienced. Of that group, 48% were more likely to specialize in infectious disease. However, the study did use data from a single source (Medicaid), looked at just 14 states in the South, and was extracted from the years 2009-2011, which is outdated.2
By transitioning care from infectious disease clinicians to primary care providers, this may reduce some of the strain on the shrinking former group. The future of the specialty will continue to get smaller with less
Data from the National Resident Matching Program shows that fewer physicians applied for ID fellowships compared to the 2021 pandemic surge. Over half of programs in 2025 did not fill their spots. This trend reflects a continued decline, with only 319 physicians applying for 2026, filling only about 60% of positions, down from 404 applicants in 2021.3
Halkitis is exploring the idea of applying for a grant to study this subject.
From the AIDS crisis in the 80s and 90s to the COVID-19 pandemic just a few years ago to Ebola and Hantavirus today, Halkitis discusses why these public health crises continue to happen some of the root causes of these failures in the next episode.
References
1.HIV and Specific Populations. NIH. Reviewed April 21, 2026. Accessed August 27, 2026.
https://hivinfo.nih.gov/understanding-hiv/fact-sheets/hiv-and-older-people
2. Weiser J, Tie Y, Crim SM, Riedel DJ, Shouse RL, Dasgupta S. Do HIV Care Outcomes Differ by Provider Type?. J Acquir Immune Defic Syndr. 2024;96(2):180-189. doi:10.1097/QAI.0000000000003410
3. IDSA and PIDS statement on 2025 infectious diseases fellowship Match results. IDSA December 3, 2025. Accessed April 2, 2026.
https://www.idsociety.org/news--publications-new/articles/2025/idsa-and-pids-statement-on-2025-infectious-diseases-fellowship-match-results
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