Integrating Oral Health into HIV Care – A Public Health Imperative Rooted in Equity and Lived Experience
In the global discourse on HIV/AIDS, oral health is often missing from the conversation, yet it plays a critical role in both the early detection and long-term management of HIV (National Institutes of Health [NIH], 2021). This omission has particularly serious consequences for young people, who are not only at heightened risk for HIV but also face structural, economic, and social barriers to accessing comprehensive care, including oral health services. As a dental surgeon and public health researcher working across underserved communities in the United States and internationally, I have witnessed how this silence around oral health impacts real lives, particularly those of young people and marginalized populations.
Oral health is not secondary to systemic health; it is foundational to overall well-being. Oral manifestations are frequently among the earliest signs of HIV infection (National Institutes of Health [NIH], 2021). Conditions such as oral candidiasis, linear gingival erythema, oral hairy leukoplakia, and necrotizing periodontal disease are not only common but can significantly impair a person’s ability to eat, speak, or maintain social interactions (World Health Organization [WHO], 2022). These untreated conditions worsen nutritional status, lower immunity, and heighten emotional distress—compounding the many challenges already faced by those living with HIV. For youth who may already be struggling with stigma, identity, or unstable housing, these symptoms are not just painful—they are isolating.
According to the Centres for Disease Control and Prevention (CDC), in 2021 alone, individuals aged 13 to 24 accounted for 20% of all new HIV diagnoses in the United States (CDC, 2023). Yet oral health is rarely part of the prevention or care conversation for this age group, leaving them especially vulnerable within fragmented health systems. In my work with the Department of Health and Human Services and Whitman-Walker Health in Washington, D.C., I engaged with youth living with HIV who reported experiencing persistent oral symptoms without understanding their cause. One young individual quietly confided during a routine check-in, "I thought the mouth sores were just something I had to live with. No one told me it was connected to my HIV."
That experience has stayed with me. It revealed just how disconnected oral health services are from mainstream HIV care, even in one of the most resource-rich countries in the world. The problem is not simply a lack of services, but a lack of integrated thinking in public health frameworks. Most HIV clinics operate independently of dental care facilities. Medical professionals may not be trained to recognize oral manifestations of HIV, and dentists often don’t receive guidance on managing immunocompromised patients. This gap is exacerbated by cost barriers and inadequate insurance coverage, especially for adolescents, migrants, and low-income populations. School-based health programs rarely include oral health screenings. Including even a basic oral screening in youth programs could help identify symptoms early and reduce downstream complications. Many young people also lack insurance or legal status, making dental care financially inaccessible.
Even though federal programs such as the Ryan White HIV/AIDS Program offer some oral health coverage, access remains uneven and awareness is limited (Health Resources and Services Administration [HRSA], 2023). Moreover, dental coverage is often the first to be sacrificed in broader health policy discussions, both in the United States and globally. In many low- and middle-income countries, oral health infrastructure is severely underdeveloped, and people living with HIV are often forced to rely on informal or crisis-based care such as emergency-only treatment or unregulated providers.
Addressing this crisis requires intentional integration of oral health into existing HIV prevention and treatment strategies. Clinical settings that serve HIV-positive populations should routinely include oral health screenings and referrals. During my time with community-based organizations in D.C., I saw how feasible and impactful this model can be. Clinics that provided co-located or referred dental services not only caught early symptoms but also built trust with youth who had often been dismissed in other settings, especially in emergency departments or primary care clinics not equipped to address oral symptoms.
Education is equally crucial. Medical, dental, and public health training should include more comprehensive modules on oral health in the context of HIV. Providers need to understand both the clinical implications and the lived experience of those suffering in silence. Engaging youth themselves as health educators and peer navigators can be a powerful strategy, helping break down stigma, share accurate information, and foster supportive care environments.
Global health policies must also evolve. Large-scale initiatives like PEPFAR, the Global Fund, and UNAIDS country strategies should explicitly prioritize oral health within their HIV/AIDS programs (UNAIDS, 2023; U.S. Department of State, 2023). That means allocating funds, collecting data, and monitoring oral health outcomes as part of comprehensive care. Without this systemic inclusion, oral health will remain sidelined, and so will the people most affected by these gaps.
Lede: Without that systemic inclusion, we risk repeating the same exclusions again and again.
For youth living with HIV, oral health is not cosmetic—it is connected to confidence, communication, and care continuity. It affects their ability to attend school, go to job interviews, and participate in community life. Ignoring this dimension of health denies them dignity and support when they need it most.
Oral health is not a luxury. For people living with HIV, especially youth, it is an essential aspect of dignity, quality of life, and medical stability. To ignore the mouth is to ignore pain, stigma, and suffering that is both preventable and unjust. My experience as a clinician and public health researcher has taught me that equity begins where we least expect it—often in the most minor signs that are the easiest to overlook.
If we are truly committed to health equity and holistic care, then we must ensure that oral health is recognized, integrated, and addressed in every step of the HIV response. The mouth, after all, is not marginal. It is central to health and humanity.
Author: Mannat Tiwana