This transcript has been lightly edited for clarity.
My name is Lewis Musoke. I’m an ID physician here at the VA [Veterans Affairs] Northeast Ohio Healthcare System.
A little bit of background about myself: I’m originally from Nairobi, Kenya; grew up there. I did my undergrad in the U.S. in a liberal arts college, Austin College; and then went ahead and did my medical school in Grenada; and then did my residency training at Rutgers/New Jersey Medical School; and then subsequently ended up in Cleveland for my fellowship training, where I’ve now stayed on full-time as faculty here at the VA. That’s my circuitous route to where we are today.
Having grown up in Sub-Saharan Africa, HIV was not a surprise, especially given how prevalent the epidemic was at that time, particularly [while I was] growing up. And so, I always sort of knew I wanted to go into medicine for that reason. I didn’t even, at that time, know infectious disease was a specific specialty and that you could focus on HIV; as far as I knew, all physicians back home were managing patients with HIV. And I think that’s very much still the case. But obviously, that’s changed as science has moved on.
Then fast-forward to when I became a resident. At one time, I was staffing a patient in clinic, and this happened to be a Spanish-speaking patient. I didn’t speak a lot of Spanish; he didn’t speak a lot of English. When we sat down for our first encounter and I asked him—he was a young guy, probably around the same age as me, and I said: “What brings you to clinic?” in as many words as I could say that he could understand.
And he said, “PrEP.”
And I said, “Oh.” And I said, What’s that? in my mind.
That was the beginning of this journey as to why [I got into this field]. I learned, obviously, subsequently what PrEP was as a first-year resident, and then became fond of this particular patient population, and with the ideas and with the strategies around uptake of PrEP.
So that’s a little bit of background. Most people don’t know that about my route into HIV, actually, and into HIV prevention.
The context of PrEP has to start off with a story of where we are in the HIV epidemic. And although we’ve made massive strides—which we have, in terms of drug development; we’ve [also] made massive strides in terms of community engagement—HIV continues to be a big problem worldwide. And it continues to be an issue in particular populations, very vulnerable populations.
And so, even though after all these years we’ve been able to develop tools, such as pre-exposure prophylaxis for HIV—whether it be oral tenofovir, or if we’re looking at, now, injectable cabotegravir—unfortunately what we’ve come to realize is that these tools are not reaching the people at highest risk for acquiring HIV.
And that, in a nutshell, I would say, has been a mission of mine since I started as an ID fellow, and now faculty: trying to see if we can come up with strategies that can bridge those gaps. But I think before you come up with strategies, it’s always important to know what the current landscape is.
I can talk about PrEP for a long time; I’m involved in multiple national workgroup meetings. But I think, ultimately, we all kind of leave those forums thinking: OK, we’ve aggregated all this amazing data, but now we need to pull the trigger.
We need good implementation science to be able to start to roll these tools out. Because while I am a huge advocate for the bench research that got us where we are today with HIV, [and] I’m a huge advocate for all the immunologic studies that got us here, we need to find strategies whereby we can make these tools equitable—not just from a global perspective, but also in a national perspective. We can start here, in the U.S., and be that beacon of hope, I think, for these individuals.
