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Shadow of HIV exceptionalism 40 years later
  1. Michela Blain1,
  2. Stephaun E Wallace2,3,
  3. Courtney Tuegel1,4
  1. 1 Medicine, University of Washington, Seattle, Washington, USA
  2. 2 Global Health, University of Washington, Seattle, Washington, USA
  3. 3 Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
  4. 4 Medicine, VA Puget Sound Health Care System, Seattle, Washington, USA
  1. Correspondence to Dr Michela Blain, University of Washington, Seattle, WA 98195, USA; michela.blain{at}


During the AIDS epidemic in the 1980s, it was crucial that providers take steps to protect patients by managing HIV with the perspective of ‘HIV exceptionalism’. However, in 2020, the social and historical barriers erected by this concept, as demonstrated in this patient’s case, are considerably impeding progress to end the epidemic. With significant medical advances in HIV treatment and prevention, the policies informed by HIV exceptionalism now paradoxically perpetuate stigma and inequities, particularly for people of colour. To improve overall HIV care, the medical community must move past HIV exceptionalism by liberalising diagnostics, instituting clinician implicit bias training and advocating to fully decriminalise HIV non-disclosure.

  • public health ethics
  • HIV infection and AIDS
  • ethics
  • general medicine / internal medicine
  • quality of healthcare

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  • Contributors MB and CT led the development of the manuscript. MB, SEW and CT contributed to, edited and approved the final document.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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