Why Monica Gandhi says it feels we’re going back to the 1980s regarding HIV

Monica Gandhi, MD, MPH is a trusted professional informing the community about infectious diseases such as HIV and how it’s affecting other parts of the world. Through her research, Gandhi has a special interest in HIV in women, including differences between men and women in exposure to antiretroviral medication and therapy.

Gandhi spoke with rolling out about the stigmas surrounding HIV in different countries, choosing between long-acting injectables and pills and the laws and criminalization of HIV.

Why did you choose this area of health?

I’m an infectious disease doctor, and I think HIV is a disease of social justice. It’s a disease of disparities; it is always somehow the more vulnerable members of any community. Let’s start from Africa in terms of adolescent girls, young women, [and] poverty and then come to the U.S.; the highest rates are at this point in the south and southeast of this country. [T]here are great racial and ethnic disparities in new infections and how people are doing with HIV. This is a virus because of stigma because of people shaming others in terms of their sexuality. There are lots of reasons why this virus has not been equitable in terms of its outcomes, so I’m very interested in [it], and that’s important to me.

How do patients choose between long-acting injectables versus daily pills?

We’ve only had long-acting injectables … for both treatment and prevention [for HIV} for a few years. We’ve had antiretroviral therapy, the oral pills for so long since 1996. It really should be up to the patient. This is shared decision-making; we shouldn’t have all these access issues so that a patient [isn’t] given a choice. There was just this amazing study from East Africa that if you gave patients a choice between their oral or injectable, you increase the number of people on PrEP massively. So you just have to give people a choice.

There’s also a vaginal ring for women. We haven’t given people a choice yet, but when we get there, it should be about the patient deciding. Sometimes, they’re traveling and they say they’re going to take a pill. Sometimes they’re like, “I need to hide this from my family, and I’m gonna go and get a shot but not bring pills home.” There is a lot of stigma worldwide about HIV, unfortunately, and a lot of anti-homosexuality laws that are burgeoning — and that’s making it harder for people to take pills.

What are those laws and the criminalization of HIV that people should know about?

This feels like we’re going back to the 80s. We had made progress on not criminalizing HIV and not being this prejudiced against people who are LGBTQ, but some real reactionary laws are going on. Criminalization, for example, of sex workers occurs in almost every African country, which is really problematic because then you hide activity, you may not be able to demand condoms from your clients — and that can lead to HIV risk. In terms of laws, there’s an anti-homosexuality law in Uganda, which is probably the most regressive. At our recent HIV meeting in Denver just two weeks ago, a … Ugandan-based activist came and spoke, and he said a lot of this … anti-homosexuality sentiment is being imported from the West. In Africa, it wasn’t inherent in the culture, and I think that is true. … [O]f course, seeing what’s going on in the South and Southeast of [the U.S.], there are more of these anti-trans, harder-to-be gay laws, … that is sad if it’s spilling over to make cultures that were moving past this to become even more aggressive in their laws.