You were the first combined adult and pediatric infectious diseases fellow at Johns Hopkins University, Baltimore, Maryland, USA. What drew you to train across both specialties, and did you have to overcome any challenges given this path did not yet exist?
Internal medicine-pediatrics, or med-peds, where you’re training in both adult and pediatric medicine, has been around for a long time, but the move towards doing med-peds and then doing a specialty has been evolving. When I did this many years ago, I did it because I didn’t want to leave anybody behind. I grew up in Nigeria, and I knew I wanted to provide care in underserved communities, and I didn’t like the idea that I could see a mom but couldn’t see her baby, or that I had to give up my patients at a certain age. This is why I aimed to train in both.
The path is always interesting, in the sense that, given that my university had not had a combined fellow before, sometimes you got left off the adult list or off the pediatric list, and there’s a bit of advocacy that you have to do to say: “Hey, I didn’t receive this, and I need equal treatment as the other categorical fellows.” Now, more than 20 years later, they’ve had another med-peds fellow, and we have more people interviewing for med-peds. So, it’s not that you can’t do it, it’s how you do it. You may need to grease the wheels a little bit. It’s been amazing to have gotten the training that I did at John Hopkins University, and to stay and be able to continue to do the programming on both sides of the aisle.
In your role as founder and medical director of the Accessing Care Early (ACE) Clinic, what have you learned about making the move from pediatric to adult care successful?
First, you have to listen to the people who are transitioning. You can do what you think is the most important thing, but if you don’t listen to them, then you’re most likely going to fail. It’s designing something with their input, and then modifying it. Hearing from young people that they “can’t sit in the lobby because it is stigmatizing” for them, and then creating ways they can get to clinic without having to sit in the lobby, like red carpet care, where they come to us and literally get pulled right in without sitting in the lobby. It’s about adjusting and not thinking that you’re the smartest person in the room at all times, otherwise you’ll fail. It’s working in partnership with individuals who are living the path to then help them move the path forward.
How has your leadership of the HIV Medicine Association (HIVMA), and your wider work with Infectious Diseases Society of America (IDSA), shaped national HIV policy and practice?
HIVMA honestly gave me my voice. For years, I had been advocating in the hospital for my patients, or I’d speak to the news, or do things locally. HIVMA is an organization that listens to me, that actually wants to hear from me and other providers who are taking care of people living with HIV, and helps you shape the message of what you’re trying to do, but also then puts you in front of the people who can move that message forward. It helped me speak to Congress and to senators, to fully be able to tell the stories of my patients to the people who can make a difference. It has honestly been transformative knowing that you could go and sit there and say: “We need Ryan White funding because of X, Y, and Z,” and bring patients into the room, and have people listen. Sometimes they don’t, but they can’t say they didn’t hear it. That has truly been transformative for me, to reiterate the word. I then take that into other spaces. If I could speak to this senator, then I can help my patients do that too, even if through me.
So, I tell everybody to advocate, and to lean into HIVMA and IDSA, because they have the tools. You may have the idea, or you may have the need, but they have the ability to help you. They support you. They give you the data that you need. So, if you’re thinking, “I wonder how many people have this,” you can have the tools to advocate even more than you were planning to do with your N of 1. Now you have the N of 1,000 to help you with that. It’s been amazing to be a part of.
The other piece to add to that is, I’m in Maryland, someone else could be in Kansas, but what IDSA and HIVMA do is bring all the issues together. In my talk, I said this one is suya, that one is gumbo. They’re different flavors, but it’s the same issues that our patients have. They may look a little different if there’s no Medicaid expansion, or if they’re in a rural environment, but it’s still adherence. It’s still stigma. It’s still disclosure. There are still challenges and social determinants. You may just need to frame it differently for the legislator to hear you, and that’s what HIVMA helps you to do.
Which developments in HIV treatment do you expect will most influence the next guideline updates?
I formerly sat on the guidelines panel. I don’t sit on it now, and even if I did, I wouldn’t be able to say where they were headed. I do think the things that the guideline committee is probably looking at are all the evolving data on long-acting injectables for individuals who have challenges with adherence. Currently, the FDA approval and the guidelines talk about people who are already suppressed, with a mention that there may be a role for people who are having challenges with adherence. But now, in the last year, we’ve seen LATITUDE and CROWN, and we see all these coming forth. I think there’s going to be more data to perhaps move that in a different direction, but I can’t speak with any kind of certainty. I anticipate that’s where we might be going. Of course, guidelines, data, and then the insurance and implementation challenges that we’ve seen for injectables are going to determine how that moves forward.
In terms of what I’m excited about, it’s hearing about weekly oral agents. Getting more 48-week data, bigger data, and as much as possible ‘real-world-ish’ data on oral long-acting agents. I think they’re potential game changers, in addition to long-acting injectables, because not everybody wants an injectable. It’s exciting to hear about expanding choices.
Which sessions or themes did you relish at IDWeek 2026?
I always go to the HIV update, just to hear what’s coming. But at this conference, because I spend so much of my time in HIV, I like to go to other things, for example occupational health and measles. There was the Plotkin lecture, which was about mother-to-child transmission of other viruses, and the things that we are now using, like the monoclonal antibodies, which prevent transmission. Unfortunately, the uptake is not great. We’re seeing that the research has led from bench research to action in guidelines, but the moment we’re in is not keeping that as positive as we’d like it to be. There were data on a herpes vaccine for recurrent herpes, so new therapies are coming forth. I didn’t get to see the debates, but I always love them, so I will go back and look at them, because there’s always tension in some of the things that we do.
There was also a lot on AI. The sessions were on how we could potentially harness the power of AI in medical care and antimicrobial stewardship, and the pitfalls and the things we need to be thoughtful about as we’re designing and training models. I think it’s fascinating, because we can’t run away from it. It is here. Either we’re going to use and control the power, or it will control us.
The program includes a symposium on the global elimination of hepatitis C in 2026. What role can HIV care programs play in reaching young people with hepatitis C?
Hepatitis C is one of our care indicators. Every year, when they’re doing quality control of our data, they come back and say: “This person has never been tested,” or, “this person could use a test.” Then we go back and find that, for whatever reason, we aren’t testing them. I think those are opportunities. Oftentimes, particularly if we don’t think someone is injecting drugs, we may not test, but hepatitis C can be sexually transmitted, too. HIV programs are very good at asking people about sexual exposures and about what they’re doing in their lives in a nonjudgmental way, but I think we could be more intentional about making sure that we’re doing hepatitis C testing, and embedding hepatitis C treatment within programs. Sending people, particularly young people, off to be tested or get treated in other places leads to a decrease in the continuum of care. We are seeing young people who are acquiring hepatitis C, and we’re better off if we can contain all of that treatment under one roof. Identifying risk factors, screening, testing, and then offering treatment within those programs will be really important, as well as letting young people know they can be at risk. I think people think it’s someone else’s problem, and not a thing that they can be affected by.
Can you summarize the message of your talk, the Edward H. Kass Lectureship in the History of Medicine, ‘Sankofa and Ubuntu: The Enduring Lessons of Dandelions Illuminate the Path Forward for HIV and Beyond’?
The message was about Sankofa. It’s an Akan proverb, and it’s means the bird looking backward. The idea is to look back at the past to guide us on how to move forward. We need to learn from what’s happened in the past, so that we replicate the good and not the bad, to guide ourselves forward. Then there is Ubuntu, this idea of collective humanity. We’ve heard, “I am because we are,” “I am my brother’s keeper,” and “If you want to go fast, go alone, but if you want to go far, go together.” These are the principles of Ubuntu: how we can guide ourselves and our path.
I am discussing a population that I’m very passionate about, which is lifetime survivors: individuals who acquired HIV early in life (at birth or within their first decade). They were a population that was not very visible. They were the children. There was ACT UP and other advocacy organizations who were very vocal, but they were the littlest ones without a voice, and people had to see them to be able to advocate for them. When people saw them and started to advocate for them, they had better outcomes. They started to survive. Now they’re old enough to advocate for themselves, be in the room and say, “Hey, we’re here. We’re small in numbers. We’ve been advocating for all of you. How do you help us advocate for us as well?”
The message at this time is that when we see the smallest of us, and we cater to, and reach, the smallest of us, we actually do better for everyone. At this time that we’re in, which feels like the world is on fire due to erasure, diversity, lack of access, war, etc., you can be in your bubble, do your thing, and be numb. But how about trying to see the lifetime survivors, or the little people, the missing people, and doing something in your sphere? That was the goal.
The talk, which ended in a standing ovation, drew on concepts about learning from the past and collective humanity. What do you hope attendees will carry forward?
I jammed so many things into that talk! One was the lifetime survivors themselves. I hope people took away that they’re not this obscure population. There are about 3 million of them worldwide. They’re missing from data, but not because they’re not there. They’re missing because they’re not thought about, not included, in the thinking or the formulation of research. As we approach research, we’re not thinking intentionally about how this could be different. We’re not asking those questions. And when you don’t see people, they have poor outcomes. They do worse. I talked about the recently held Women’s Research Initiative, where the focus was on lifetime survivors who were female at birth, but it really is all lifetime survivors, looking at the issues they’re having: not just the physical, but the mental, the psychosocial, all of it, and having them in the room. There were eight lifetime survivors in the room talking about their needs. The questions are theirs: “Why aren’t we included? Why aren’t you asking about us? Why aren’t we at the table?”
I’m hoping that people think about lifetime survivors, but also about who else they’re missing in other spaces. When there’s a full plenary stage of people giving talks, who is missing? Whose stories are not being included? Where are the people of color, the diverse people, at whatever table we have? It shouldn’t be the people on the outside looking in asking to have a seat. It should be the people at the table looking around and saying: “Well, who are we missing?” That’s the key: using their stories and their advocacy, what happens when you actually see them, and unfortunately, what happens when you don’t. That’s what I’m hoping people can take out of it.
This fits for HIV and the lifetime survivors, but it actually goes for everything. Who are you going to look out for? It’s not just your brother or sister. It’s your neighbor, it’s your plumber, it’s the person who was cleaning your house. They’re missing. It’s people who have been gentrified out of discussions.
Look back at what happens when you don’t do anything, and let our collective humanity push us to get the future that we desire and want. That’s the goal.
