Building the HIV Workforce Pipeline: Practical Strategies to Attract the Next Generation

When I recently spoke with Dr. Amanda Allmacher, AAHIVE, about the future of the HIV workforce, our conversation quickly became personal. We both trained under mentors who built their careers when HIV was widely viewed as a life-altering diagnosis. Those mentors shaped our clinical instincts, our advocacy, and our commitment to communities that have historically carried a disproportionate burden of HIV. Many of those mentors have since retired. Those of us who remain are now expected to carry the torch. The problem is that the next generation is not consistently lining up behind us.

That observation is not meant as criticism of today’s learners. It is a reflection of how health professions education and workforce realities have shifted. HIV is now a chronic, manageable condition for many people with access to timely diagnosis and effective treatment. That progress is a triumph. It has also changed how students perceive urgency, complexity, and professional identity in HIV care. HIV is no longer automatically viewed as “specialty medicine,” yet the clinical, pharmacologic, psychosocial, and systems-level skills required to do it well remain extensive.

At the same time, the HIV workforce pipeline is being squeezed from multiple directions. Funding uncertainty can stall or pause training pathways. In Michigan, we have felt the impact of those pressures directly. Programs designed to build the next generation, such as structured scholar pathways, can be placed on hold when grant funding shifts. That leaves educators asking a difficult question: What do we do when the formal pipeline narrows, but the need remains?

This article is written for all health professions educators, including faculty, preceptors, program directors, and clinical leaders. It offers practical, replicable strategies to increase student exposure, spark interest, and convert that interest into sustained commitment across HIV prevention, HIV primary care, Ryan White systems, infectious diseases, public health, pharmacy, nursing, and advanced practice roles.

Reframing the Problem: HIV is Stable, the Pipeline is Not

One reason the pipeline is weakening is that HIV care has become less visible in many mainstream training settings. Students can complete clinical rotations in large hospital systems with infectious diseases services that rarely manage outpatient HIV longitudinal care. Infectious diseases is also a broad specialty. Not every infectious disease clinician provides HIV care, and not every training site offers meaningful HIV prevention exposure. Without intentional placement, students may finish training with minimal direct experience with pre-exposure prophylaxis (PrEP), post-exposure prophylaxis (PEP), or rapid start models.

This creates a downstream burden. We are seeing primary care clinicians who are uncomfortable prescribing PrEP, even though free training and certification pathways exist. The result is predictable: referrals to infectious diseases or specialty programs, longer waits, and missed opportunities for prevention.

Delay matters. In PrEP implementation research, delayed initiation has been associated with worse PrEP persistence and loss across the PrEP care continuum.¹ In other work, structural barriers (such as lack of insurance) have been associated with delays in PrEP initiation, which increases vulnerability during periods of risk.² When a patient asks for PrEP, there is usually a reason. The job of the health system is to meet that request quickly, safely, and without avoidable handoffs.

If we want students to enter the HIV pipeline, we need to do two things at once. First, we need to make HIV care and prevention visible and professionally attractive. Second, we need to give learners clear on-ramps that reduce intimidation and build competence early.

The Most Effective Lever: High-Quality Clinical Exposure

Exposure changes everything. Many clinicians who choose HIV medicine can name a single rotation, mentor, or clinical moment that shaped their path. We should stop treating that as luck and start designing for it.

Strategy 1: Build elective pathways, not random placements

At Corktown Health, we have taken a deliberate approach. Corktown Health is Michigan’s first LGBTQIA+ integrated medical center and the state’s largest Ryan White-funded program. We partner with multiple colleges and graduate medical education programs. We also try to be thoughtful in selecting learners who are genuinely interested in HIV, LGBTQIA+ care, prevention, sexual health, and health equity.

We do this by offering elective experiences and communicating with academic partners before placements are finalized. That process helps match motivated learners with a site that can provide meaningful exposure. It also protects the learning environment. A highly specialized clinical setting is not the right rotation for every learner at every stage. When the fit is right, the experience can be transformational.

This approach has produced real workforce outcomes. We recently hired a new graduate DNP, FNP-BC who rotated with us. The onboarding was smooth because clinical culture, workflows, and expectations were already familiar. Most importantly, patients benefited from a clinician who entered the role prepared and mission aligned.

Strategy 2: Design rotations around skill acquisition

To attract learners, rotations need to feel educational, not observational. Students should leave with skills that translate to practice.

A high-impact HIV rotation should include structured exposure to:

1. PrEP initiation and follow-up, including same day starts when feasible.
2. Nonoccupational PEP workflows, including rapid evaluation and regimen selection.
3. Rapid start HIV treatment models and linkage processes.
4. Sexual health history taking, trauma-informed care, and stigma-free communication.
5. Ryan White systems, case management, and multidisciplinary team models.
6. Pharmacology decision-making, including drug-drug interaction checks.

Students are more likely to choose a field when they feel competent in it. Competence grows when training is intentional and progressive.

Mentorship is the Second Lever, and It Scales Better Than We Think

Students do not just choose specialties. They choose identities. Mentorship is the bridge between curiosity and identity.

Strategy 3: Formalize mentorship, then keep it human

Mentorship can be as simple as a structured monthly touchpoint for students who express interest. It can include case discussions, career planning, and research or quality improvement opportunities. The Midwest AIDS Education Training Center (MATEC) and other Ryan White HIV/AIDS Education and Training Center (AETC) programs have long demonstrated the value of structured training and mentorship models for building HIV workforce capacity.³

If formal programs are paused, educators can still build micro-mentorship structures locally. A quarterly virtual session with a few preceptors and a group of interested learners can keep momentum alive. The key is consistency and belonging.

Strategy 4: Give learners early wins

If the first HIV clinical experience feels overwhelming, students will disengage. Instead, start with achievable responsibilities: counseling scripts, guideline navigation, regimen comparisons, and motivational interviewing practice. Then build complexity as confidence grows.

Scholarships, Training Pathways, and Credentials Lower Barrier to Entry

Students respond to clear pathways. “You should consider HIV” is not a pathway. “Here is exactly how you start” is a pathway.

Strategy 5: Promote AETC pathways like MATEC

ATEC programs are one of the strongest workforce development resources in the United States. The Midwest AETC, including MATEC, offers training and capacity-building support for HIV prevention and care.⁴ Programs such as the MATEC Clinician Scholars Program are designed to increase the number of clinicians prepared to provide HIV care, including physicians, nurse practitioners, physician assistants, advanced practice nurses, and pharmacists.³^,⁵

Even when certain scholar tracks are paused, the broader training ecosystem remains important. Learners and early-career clinicians should know these programs exist and how to connect.

Strategy 6: Use free certification programs to normalize PrEP competence in primary care

If primary care clinicians are not comfortable prescribing PrEP, the system will continue to overload specialty care. One practical solution is to integrate free or low-cost micro-credentials into training.

For pharmacists, the Academy offers, together with APhA, a Pharmacy-Based HIV Prevention Services Certificate Training Program to expand knowledge of HIV prevention tools like PrEP and PEP. Additionally, HealthHIV offers an HIV Prevention Certified Provider program, which is a self-paced certification program designed to support HIV prevention implementation.⁶ They also have an HIV PrEP Navigation Certification program to strengthen the prevention workforce.⁷

These types of programs are powerful because they offer structure, legitimacy, and a clear milestone. Students and trainees like checking a box that matters. Faculty should treat these credentials as on-ramps into the pipeline.

Strategy 7: Highlight fellowships and funded training experiences

The Academy offers the Dr. Dawn K. Smith HIV Prevention Clinical Fellowship for providers who are new to HIV. The fellowship targets clinicians who practice in fields such as emergency medicine, family medicine, obstetrics and gynecology, pharmacy practice, primary care and others to increase PrEP awareness and use in under-resourced communities.

Beyond AAHIVM opportunities, several external programs can be highlighted depending on learner type.

For physicians, HIVMA’s HIV Clinical Fellowship Program provides grants to support a year of HIV clinical experience with underserved or marginalized patient populations.⁸ For learners interested in structured training pathways, the National HIV Residency Pathway Consortium provides mentorship and support for HIV training pathways within residency and NP or PA training programs.⁹

For students and early-career investigators leaning toward research, opportunities such as the Gilead Research Scholars Program in HIV and similar initiatives can be relevant depending on eligibility and timing.¹⁰

Not every student will pursue a fellowship, but simply knowing that funded opportunities exist increases perceived feasibility.

Fixing the Perception Gap: HIV is Rewarding, Complex, and Deeply Relevant

Many learners assume HIV is “already solved.” We need to correct that narrative without reverting to fear.

Strategy 8: Teach the modern complexity of HIV work

HIV medicine sits at the intersection of:

1. Pharmacology innovation and resistance science.
2. Chronic disease management.
3. Mental health and substance use.
4. Sexual health and reproductive health.
5. Social determinants of health and systems navigation.
6. Stigma reduction and culturally responsive care.

Students are drawn to specialties that feel meaningful and intellectually alive. HIV remains both.

Strategy 9: Connect HIV prevention to patient safety and health equity

When PrEP is delayed, when patients are referred away, or when stigma blocks access, the outcome can be preventable infection. The urgency is real. We should teach HIV prevention as a core patient safety responsibility in primary care, emergency care, obstetrics, pharmacy, and community health.

The Educator Role: Be Selective, Be Intentional, and Measure What Works

In my own faculty role, I have become more intentional about choosing learners who are interested in the work. That is not exclusionary; it is stewardship. When a rotation is well matched, the learner benefits, the preceptor avoids burnout, and the clinic’s mission is protected.

We should also measure outcomes. A simple tracking approach can include:

1. Number of learners rotating through HIV-focused sites.
2. Number who pursue additional HIV training or certification.
3. Number who return for advanced rotations, capstones, or employment.
4. Number of primary care trainees who initiate PrEP independently after training.

Pipeline work is not abstract. It can be measured. When it is measured, it can be defended during periods of funding uncertainty.

Conclusion: The Pipeline Needs Intentional Design, Not Hope

The HIV workforce is in a transition. Our mentors built the field in an era of crisis. We are building it in an era of progress, complexity, and evolving prevention science. That requires a new approach to recruitment.

If we want students to enter the HIV pipeline, we must make HIV visible in training, create high-quality clinical exposures, formalize mentorship, and provide clear pathways that reduce intimidation. We also need to normalize PrEP and prevention competence across primary care so that the system does not collapse into avoidable referrals and delays.

The torch is still worth carrying. The next step is ensuring someone is ready to take it.