Susan Buchbinder, MD ’84, Resident Alum : Turning HIV Into a Preventable Disease

Inside the AIDS Ward

When Susan Buchbinder arrived at San Francisco General Hospital for her medical school clinical clerkships in the early 1980s, she walked into an epidemic. Young men were coming in with mysterious cancers and opportunistic infections, and there was almost nothing medicine could offer. “We could [only] provide care in its most fundamental way,” she recalls, “for both patients and their partners, who were often ostracized in other settings.” That early crucible of compassion — and of limitation — would define everything that followed for Buchbinder. Over the decades, she would help turn HIV from a once nearly universal death sentence into a preventable disease.

The Study That Made Testing Possible

After residency, Buchbinder joined a landmark natural history study that drew on blood specimens collected from thousands of gay and bisexual men in San Francisco, originally gathered for hepatitis B research. That biobank helped develop the HIV antibody test. “On the clinical side, I was helping patients, but when I started working in research, the community was helping me answer questions,” she says.

The Pre-Exposure Drug Revolution

Buchbinder led the San Francisco site of the international iPreEx trial, which showed that pre-exposure prophylaxis (PrEP) — antiretroviral medication taken before potential HIV exposure — could prevent infection. Named the 2010 Breakthrough of the Year by Science, PrEP became the standard prevention strategy. It paved the way for broader guidelines, community programs, and five distinct options, including daily pills, event-driven dosing, and long-acting injections, that have sent new infections plummeting globally. But her goal remains unchanged: zero new infections. She’s continually innovating to ensure patients adhere to PrEP protocols. “If we have these drugs but people aren’t able to use them, or aren’t using them as directed,” she says, “then what was it all for?” As director of Bridge HIV at the San Francisco Department of Public Health, she and her team developed the PrEP Smart app to help patients determine their next on-demand PrEP dose and set reminders. A devoted champion for the community she has served, she has never given up on her decades-long pursuit of an HIV vaccine. “I do have great hope that we’ll have a vaccine in my lifetime.”