While conducting research in South Africa on expanding the use of HIV and mental health-care services, a new friend Lindsey Filiatreau met during her time in the country said something that has stuck with the public health researcher ever since.

“What I know about HIV is that people don’t die from HIV,” the woman said. “They die from stress.”

Filiatreau, MPH, PhD, now an assistant professor at WashU School of Public Health, frequently thinks about those words. The sentiment reflects a perspective shaped by lived experience, and recognition of social and environmental factors that influence health.

The woman lives in a setting where HIV continues to be not only a medical issue, but a condition shaped by repeated exposure to significant life stressors and limited access to quality health care. Challenges such as political unrest, unreliable public transportation, and harsh or unwelcoming care environments can discourage patients from attending their medical appointments. Financial strain and stigma further contribute to delays or interruptions in care.

The UNAIDS 2025 Global AIDS Update indicates that at the end of 2024, efforts led by communities and governments had brought down the number of new HIV infections by 40% and of AIDS-related deaths by 56% since 2010. But the report also shows gaps in HIV prevention: In 2024, there were 1.3 million new HIV infections.

Filiatreau’s research focuses on implementation science — studying how to effectively employ evidence-based interventions in real-world settings. Using epidemiologic methods, she aims to identify and address barriers that prevent individuals from accessing consistent, effective care.

“An important focus of Dean (Sandro) Galea’s strategy at the School of Public Health is interdisciplinary research, specifically that aims to address policy issues,” Filiatreau said. “The more we engage with policymakers, the more impact our research will have. I don’t think that has always been the priority of public health work, but if we want to change what’s going on, we must get our hands dirty and start those very difficult conversations across all political parties.”

What inspired your interest in HIV research, and what led you to make it an area of focus?

“I grew up in rural Kentucky and had not been outside the U.S. In fact, I had only been on an airplane once. When I got to stay in a community in rural Kenya (for school), my goal at the time was to work in the health clinics. I had this significant realization, though, that as a clinician, I could only impact a limited number of people. What was needed more was support and development of health-care infrastructure. And so that was kind of a light bulb for me on my educational journey.

“Then, just before I left to complete my master of public health degree at the University of Ghana, a very good friend of mine was diagnosed with HIV. Being with him during his experiences as he navigated that diagnosis had a profound impact on what I chose to look at as I embarked on my public health training. Coincidentally, when I arrived in Ghana, there was a specific area in the country that had experienced almost a doubling of new HIV diagnoses in the year I was there. For my master’s thesis research, I chose to explore factors that influenced HIV testing and counseling uptake in that community, setting me on a trajectory to explore HIV care through my research.”

What in Kenya was most impactful to you?

“While I was living in Kenya, I got to engage in a community-based leadership project, and instead of going in and saying, ‘I have this idea of what I’d like to do to engage in the expansion of medical services,’ I did a community needs assessment. The thing people said they were most concerned about was access to water. For around six months, I led a project on household rainwater harvesting as a method to offset the impact of prolonged drought on outcomes like crop failure and subsequent food insecurity. 

“Near the end of my stay in Kenya, a professor hosted a group of pre-med students who worked directly in the clinic in my village. It was so enlightening to see how the community engaged with those students. On a typical day at this health-care facility, just a handful of people would go to the clinic because of staffing shortages; these clinics were routinely run by a nurse, with an occasional visit from an area doctor. When doctors from the U.S. would come, there would be a line that was a million people long. People were eager to be seen by a clinician from the United States, as there was a pervasive perception that medical care in the United States was likely better than that which was regularly available in their village. Through that experience, I saw that people needed access to health care, but that there are some fundamental, underlying challenges that are going unaddressed that could perhaps capacitate the health-care system and the population’s health more broadly. Improving public health infrastructure, including reliable access to people’s most basic needs such as food and water, could likely offset the immense burden on a health-care system already stretched thin by lack of human and capital resources.”

What guidance would you offer to the next generation of public health students as they prepare to enter the field?

“I would recommend that students look for opportunities to integrate themselves into systems that continue to prioritize the work that we do. We should be asking the question daily, ‘How do we as public health professionals communicate the importance of our work to the public?’ Focusing on improved communication of public health research is going to be critical to changing the current narrative about the benefits of research in the general population.”

How do public health professionals communicate persuasively and effectively without turning away people who are hesitant to trust those in this field?

“Sometimes we’re inundated with so much information that we’re paralyzed into inaction instead of propelled into action. Engaging in one-on-one dialogues can really have an important impact. I’ll give an example:

“A very dear friend of mine was very opposed to getting the COVID-19 vaccine. Over the course of probably an entire year, I talked with him maybe once a month about the benefits of vaccination. Even though he maintained his resistance to being vaccinated across that period, probably six to eight months after that I got a call from him.

“He said, ‘I want you to know that I got vaccinated, and I’m not sure it was the right decision, but because you walked with me through my journey around vaccination, I felt like it was an important thing to do.’

“I don’t think we can ever replace the value of one-on-one conversations with people who have ideas that differ from our own. Being open-hearted to having those conversations is critical.”

Hayley Abshear is the School of Public Health’s digital content strategist and social media coordinator. She brings almost a decade of experience in writing, content strategy and social media marketing to the team.