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The Lancet Series on HIV in the USA describes the current state of the nation's HIV epidemic, including ongoing inequities and challenges for key populations and comorbidities. [1][2][3][4][5][6] Black Americans have consistently shouldered many of these HIV inequities, a pattern also seen in the COVID-19 pandemic. The overlapping racial disparities related to COVID-19 and HIV 7,8 highlight lessons that policy makers, public health practitioners, providers, and communities can leverage in their strategies to eliminate the Same script, different viruses: HIV and COVID-19 in US Black communities in subgroups of patients including SMuRF-less patients and women is mandatory.However, the success of risk stratification and treatment depends on accurate diagnosis and identification of the underlying disease mechanisms. Several different disease mechanisms have been identified in STEMI. Atherosclerotic coronary artery occlusion is the most common finding in patients with STEMI. 1 However, in myocardial infarction with non-obstructive coronary arteries, which is particularly common in women, several other disease mechanisms have been identified. These include non-obstructive coronary artery atherosclerosis and plaque rupture, coronary artery embo lism, vasospasm, and spontaneous coronary artery dissection (SCAD). 11,12 In female patients with SCAD, Figtree and colleagues observed a lower 30-day mortality rate than for female patients without SCAD; however, SCAD is particularly common among young and middle-aged women (≤50 years) and associated with underlying systemic arteriopathy with a recurrence rate of 10-30% and a reduction in quality of life. 12 A further consideration is that Takotsubo cardiomyopathy or stress cardiomyopathy might mimic STEMI. 13 Therefore, a detailed assessment is indicated in select patients with STEMI, supplementing invasive coronary angiography with cardiac MRI, to exclude myocarditis and detect myocardial necrosis, and an intravascular assessment of coronary flow and structure, possibly also including functional testing. Such a comprehensive assessment would secure correct diagnosis, risk assessment, and treatment, particularly in women with STEMI and nonobstructive coronary arteries.Without consideration of risk, there cannot be gain, and thus new sex-specific risk factors and risk markers should be implemented in clinical risk models that can identify high-risk individuals among SMuRF-less patients with STEMI. Improvement in risk stratification and accurate diagnosis would help to tailor treatment in SMuRF-less patients, reducing the excess mortality and avoiding undertreatment in this subgroup.I declare no competing interests.

Non-medical, community-based workers play a critical role in supporting people living with (or at risk of acquiring) HIV along the care continuum. The biomedical nature of promising advances in HIV prevention, such as pre-exposure prophylaxis and treatment-as-prevention, requires frontline workers to be knowledgeable about HIV science and treatment. This study was developed to: measure knowledge of HIV science and treatment within the HIV non-medical workforce, evaluate workers' familiarity with and attitudes toward recent biomedical interventions, and identify factors that may affect HIV knowledge and attitudes. A 62-question, web-based survey was completed in English or Spanish between 2012 and 2014 by 3663 US-based employees, contractors, and volunteers working in AIDS service organizations, state/local health departments, and other community-based organizations in a non-medical capacity. Survey items captured the following: respondent demographics, HIV science and treatment knowledge, and familiarity with and attitudes toward biomedical interventions. An average of 61% of HIV knowledge questions were answered correctly. Higher knowledge scores were associated with higher education levels, work at organizations that serve people living with HIV/AIDS or who are at a high risk of acquiring HIV, and longer tenure in the field. Lower knowledge scores were associated with non-Hispanic Black or Black race/ethnicity and taking the survey in Spanish. Similarly, subgroup analyses showed that respondents who were non-Hispanic Black or Hispanic (versus non-Hispanic white), as well as those located in the South (versus other regions) scored significantly lower. These subpopulations were also less familiar with and had less positive attitudes toward newer biomedical prevention interventions. Respondents who took the survey in Spanish (versus English) had lower knowledge scores and higher familiarity with, but generally less positive attitudes toward, biomedical interventions. In summary, low knowledge scores suggest the need for additional capacity-building efforts and training for non-medical HIV workers, particularly those who provide services in the communities most affected by HIV.

Transgender and gender diverse (TGD), Black, and Latinx communities have long borne a disproportionate share of the U.S. HIV epidemic, yet these same key demographics are continually underrepresented in national PrEP prescriptions. Black, Latinx, and TGD individuals are also more likely to be uninsured, meaning that a proposed federal program to cover PrEP for people without insurance could provide significant benefit to potential PrEP users from these populations. However, coverage of PrEP costs alone will not end disparities in uptake. This commentary provides additional context and recommendations to maximize effectiveness of a national PrEP program for TGD, Black, and Latinx populations in the US.

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