Dr. Rupa Patel is revolutionizing HIV care in St. Louis—and around the world

In 2013, Washington University recruited Dr. Rupa Patel to create and direct its HIV prevention clinic. Just four years later, her successes are resonating far beyond St. Louis; the day I spoke with her, she’d just been on the phone with the government of Namibia. She was heading there the next week to consult, followed by a convening of the World Health Organization on HIV prevention. 

“We’re using everything from mobile vans and popup tents to engage young women that don’t want to be seen in a clinic by their auntie or neighbor,” she says of the work in Namibia. “So then, how do you bring in lab tests? One of the first clinics here in St. Louis used a point-of-care machine, so we can do it right on the spot.” 

Born in Detroit, Patel earned an M.D. from Wayne State and a master’s in public health from Johns Hopkins and trained in infectious diseases at Mount Sinai in New York City. She also did an internal medicine residency in Dallas with underserved populations and spent several months in Bangladesh with the International Medical Corps, first treating victims of a cyclone, then staying eight months longer to train providers working with rural women, some of whom made four-hour trips to be seen in a hospital. 

“Then I went ahead and took another course to learn more about developing world infectious diseases, in Lima, Peru,” she says. “I stayed there for about two and a half months, learning about their health systems and diagnostics and seeing very different cases, with diseases like leprosy.” 

Her big passion, though, is HIV prevention. When her brother was 17, he came out as gay, and through his eyes she began to see what made communities vulnerable to HIV infection. That knowledge, plus her formidable talents in medicine, helped her create an HIV-prevention program that uses effective medicines but also addresses the whole person, looking far beyond the test results.

The core is something called PrEP—pre-exposure prophylaxis. “It’s basically a pill that people take when they are HIV-negative to keep them negative,” Patel says. “It’s called Truvada; it’s two medications in one.” (PrEP is safe enough that it’s used as a  first-line treatment for pregnant women with HIV.) The clinic helps clients navigate the healthcare system, which some of them are using for the first time. They also help people feel more comfortable getting HIV and STD tests and coach them on the sometimes-tricky negotiations around condom use. There are other challenges; just the barrier of making it to a doctor’s appointment when your work schedule changes without notice keeps many people out of a doctor’s office. Patel says the clinic has addressed this problem in part by forging a partnership with pharmacies that can provide prescriptions or tests after hours on weekends. 

Wash. U. is also participating in trials for an injectable form of PrEP that lasts two months, which can help patients stick to a medication regimen, and there are other forms in development that will last even longer. Patel says the goal is to reduce the incidence of new HIV infections to zero and maintain it there. San Francisco, she says, has reduced HIV infections by 50 percent over the last six years—the lowest it’s been since the height of the AIDS epidemic. Unfortunately, “eradicated” doesn’t mean exactly that, as new cases of measles have proved. “We’ll probably always have our work cut out for us,” she says, “but right now, until we have something that’s effective in a vaccine—like, 90 percent, that we can roll out to the general population—we rolled out this medication, which is minimum 92 percent protective if you take it every day.” And that, she says, has been revolutionary.