Dr. Theodore Empowering Change

While new diagnoses of HIV in the United States are going down, there were still nearly 5,500 new diagnoses among women in 2020. Since HIV testing was lower than usual during the height of the COVID-19 pandemic, there were probably many more new infections among women than were diagnosed. More research is needed to help identify women who might be exposed to HIV and to give them the information they need to take care of themselves.

One of the proponents of women-centered HIV research is Dr. Debbie Theodore, an Assistant Professor of Medicine in the Division of Infectious Diseases at Columbia University Irving Medical Center and Associate Program Director for the Infectious Diseases Fellowship Program. In recent years, she has contributed to women-centered research about prevention of HIV and other sexually transmitted infections.

Diving into her background and journey into medicine, Dr. Theodore remarked about her specific interest in women's health, saying, “I've always been interested in women's perspectives and women's experiences—even dating back to college, my thesis was mostly built around novels focused on women's experiences.”

After finishing medical school, she completed a residency in internal medicine and then a fellowship in infectious diseases. Upon being offered a chance to learn more about clinical trials for HIV prevention, she joined the Columbia Research Unit, which “conducts a range of studies, from interventional multi-center clinical trials looking at products for HIV prevention, including vaccines and broadly neutralizing antibodies, to single-center investigator initiated studies looking at attitudes towards sexual health and attitudes and knowledge about PrEP.”

Dr. Theodore described how she has loved getting involved with clinical research across the spectrum of HIV prevention, with a particular interest in studies that revolve around the experiences and viewpoints of cisgender women and trans individuals.

Dr. Theodore describes how years of HIV research have led to major advances in HIV treatment and prevention. “[Now we know] if it’s undetectable, it’s untransmittable,” she says, meaning that people living with HIV who are taking medication regularly can lead normal lives and engage in sexual activities without worry of infecting their partners.

Similarly, the development of Pre-exposure Prophylaxis (PrEP) has revolutionized HIV prevention research. PrEP is a type of HIV preventative medication for people with activities that could put them at risk of contracting HIV. PrEP includes different medications that each work to prevent HIV before possible exposure, kind of like taking birth control to prevent pregnancy, Dr. Theodore explains. Although, unlike birth control, PrEP is not as available or advertised to communities who need it.

Dr. Theodore highlights the differences in various kinds of PrEP saying, “Daily pill-based PrEP is the most common type of PrEP prescribed, but there are some people who prefer and benefit from injectable PrEP. Cabotegravir, which is the injectable PrEP, is still pretty new and there are a lot of challenges about how to scale it up.”

She went on to explain the importance of treatment options and how availability is important for patients to feel comfortable seeking preventative care. Care providers should give people options to consider, which makes people more comfortable exploring and participating in treatment plans. Whether through the injectable method or the daily pill, PrEP is a crucial and effective part of preventative care for HIV.

Currently, researchers are trying to figure out how to make advances in HIV preventative care and treatment that will positively impact women, and in particular, women who are from underserved, marginalized, or minority communities. Dr. Theodore emphasizes the role of spreading awareness and education in that process.

When asked about specific obstacles that block HIV preventative care from reaching the people who need it, she answered, “there's been really just sort of a lack of awareness, both among providers, people who could prescribe PrEP, and also among people who might want to take PrEP. There's the provider education, and then there's also patient education.” She continued talking about where HIV researchers need to direct their efforts in order to reach communities in need and make the greatest impact.

I think often, what we're seeing is that the biggest advocates for PrEP are [those who are] involved in infectious diseases. But most people aren't coming to infectious diseases clinics. Most people aren't coming to sexual health clinics. Most people, most women, are going to their OBGYN and their family planning provider, right? So that's where PrEP education needs to be right now.

Lack of awareness greatly contributes to why many women who might want to take PrEP aren’t on it. When women are healthy, they are likely not going to infectious diseases clinics that inform patients about PrEP. Therefore, it’s important to spread HIV preventative care information to providers in all fields so that patients of all backgrounds can be informed. Not many people know that PrEP is effective and appropriate for people of all ages, right from adolescence up to older people.

One way to increase awareness of PrEP in non-infectious diseases settings is through informational pamphlets. Dr. Theodore suggests that “provider spaces should have information available, whether it's posters or pamphlets, so that people in the waiting room can look around and pick something up and say, ‘Is this for me?’”.

Dr. Theodore said she’s excited to keep working in the field of HIV prevention and to see what new strategies and options show promise for the future. She gave insight about HIV as well as on the importance of following your passion to further develop your field of study.