When I was first diagnosed with HIV in 2012, the idea of seeing anyone other than an infectious disease specialist would have felt reckless, even dangerous. This was before PrEP, before U=U. Specialists were the gatekeepers – the people who knew the ever-changing science, the ones who gave me the sense of being in the safest possible hands. For a long time, they were the difference between life and death.
So when I learned today at my routine HIV lab follow-up that the Damien Center is shifting away from relying on infectious disease doctors, and instead training primary care physicians to handle HIV, my first reaction wasn’t celebration. It was shock. Fear. Even a little sadness. A part of me wanted to feel special, to believe that my care required the highest tier of expertise, that my condition set me apart in a way that demanded more than “just” primary care.
But sitting with that discomfort, I realized something important: this change is a milestone.
It’s not about being less cared for. It’s about HIV care becoming ordinary in the best possible sense. What was once an emergency requiring specialists is now a chronic condition that can be managed alongside everything else. Just like diabetes, high blood pressure, or asthma. And just as most people with diabetes don’t see an endocrinologist every month, most people living with HIV don’t need an infectious disease doctor at their side for every check-up. We need skilled, compassionate primary care providers who are equipped with the right training. That’s exactly what this new model is delivering.
The truth is, the biggest factors in HIV health today aren’t whether you have access to a specialist; they’re whether you can access care at all, whether your doctor treats you with dignity, whether you have support for housing, food, mental health, and transportation. Medicine has advanced so much that the day-to-day fight isn’t with the virus itself – it’s with the systems that surround care. And if we’re honest, it’s with stigma itself. Stigma kills.
When I was first diagnosed, I was in the hospital. A case of misdiagnosed stage-2 syphilis landing me in the ER. Thankfully, my visit to the ER is the reason I was diagnosed so soon after being exposed to the HIV virus. My infectious disease doctor told me they caught my HIV very early – he only saw a handful of cases each year like mine. I was lucky to be in his hands.
Around the time I was diagnosed in 2012, newer medications were available, and the medical advice began to shift towards starting treatment right away. Why? Because the side effects of the latest antiretroviral treatments (ARTs) were much milder, making it smarter to begin medication quickly to lower the viral load. This was all before the idea of U=U was introduced.
So, I’m very thankful for my infectious disease specialist, because he caught me “on the forefront of change.” Looking back, that was huge step forward.
Now, 13 years later, the fact that I don’t “need” one anymore isn’t a downgrade — it’s proof of progress. It means that medications work so reliably, and outcomes are so good, that HIV can finally be seen for what it is: not a death sentence, but a manageable chronic condition.
Of course, specialists still exist for rare or complicated cases – and that’s important. But the default has shifted. HIV no longer requires a small elite circle of experts. Instead, it belongs in the hands of everyday doctors, woven into the fabric of routine healthcare.
That’s not loss. That’s victory.
So yes, there was some grief in letting go of the idea that I needed a specialist. But in the end, this shift means something profound:
I am not defined by HIV. My care is not extraordinary because of this virus.
This disease is not terminal. It’s ordinary.
And that’s extraordinary.
Keep tellin’ the story,
Professor Peacock
Note: These are my thoughts and my story. I used AI to make helpful edits to my ramblings and online journaling, including some organization to be more blog-friendly.
The Magical Storybook of Professor Peacock 