Beyond Viral Suppression: The Need for Listening in HIV Clinical Encounters

As a medical student preparing to enter clinical practice, I read with keen interest the recent article by Tadese et al ¹ on the importance of patient–provider communication in the holistic care of people living with HIV (PLHIV). The remarkable advances in antiretroviral therapy have rendered HIV a manageable chronic condition. However, the findings of this article underscore that viral suppression alone is insufficient to optimize overall health outcomes.

Notably, that one-third of participants perceived their overall health as poor to fair, despite over 90% being virally suppressed, speaks volumes about the unmet psychosocial and quality-of-life needs in this population. Particularly striking is that 18.2% of study participants reported suboptimal satisfaction with their primary HIV clinician, while 16.8% found it challenging to verbalize their HIV-related concerns. In this context, trust, stigma reduction, and open dialogue are central to adherence and engagement, making these figures all the more alarming.

One takeaway is the need for specific measures to educate trainees on the art of communication related to HIV care. Studies show that targeted training in empathetic listening and stigma-free counseling can improve both patient satisfaction and health outcomes. ² Moreover, allocating time within patient visits to discuss non-HIV health matters, including mental health, lifestyle factors, and comorbidities, may help close the divide highlighted by the finding that one-fourth of PLHIV rarely discuss their HIV medications with their clinician. A clearer understanding of patients’ social supports and broader life situations is also crucial, as health is significantly influenced by these factors.

The associations the authors describe between poor communication, social determinants of health such as housing instability, and lower self-rated health status also call for interprofessional, community-linked care models. ³ Importantly, while aligning with community organizations is an important component, structural changes at the healthcare system level are also necessary. These may include lengthening the time for visits, overlaying social needs into electronic health records, and developing streamlined referral pathways to community-based resources. Without making these systemic changes, clinicians may continue to feel constrained in their ability to address the nonmedical domains that strongly influence health outcomes.

As future physicians, we need to be prepared not only to prescribe effective medicine, but also to establish an environment in which PLHIV feel comfortable sharing their concerns without fear of judgment. Tadese et al.'s work reminds us that the “U” in “undetectable = untransmittable” should be accompanied by a third “U”: “understood.” The next frontier in HIV care will be ensuring that every patient's voice is heard as clearly as their viral load is measured. It is time we pursue a vision of HIV care that is not only undetectable and untransmittable, but also universally understood.