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While we have the tools to achieve this goal, the persistent barriers to healthcare services experienced by too many individuals will need to be addressed to make significant progress and improve the health and quality of life of all people with human immunodeficiency virus (HIV). The necessary structural changes require actions by federal, state, and local policymakers and range from ensuring universal access to healthcare services to optimizing care delivery to ensuring a robust and diverse infectious diseases and HIV workforce. In this article, we outlines 10 key principles for policy reforms that, if advanced, would make ending the HIV epidemic in the United States possible and could have much more far-reaching effects in improving the health of our nation., Competing Interests: Potential conflicts of interest. A. K. P. reports serving on the HIV Medical Association (HIVMA) Board of Directors. W. S. A. reports serving on the Therapeutics and Prevention Data and Safety Monitoring Board at the National Institutes of Health and is a member of the Infectious Diseases Society of America (IDSA) and HIVMA boards of directors, the American Board of Internal Medicine Subspecialty Board, and the CDC/Health Resources and Services Administration HIV/AIDS, Hepatitis C and STI Advisory Committee. T. E. reports serving on the HIVMA Board of Directors. J. J. W. F. reports serving on the HIVMA Board of Directors and as vice chair of the IDSA Clinical Affairs Committee. M. H. reports serving on the HIVMA Board of Directors and receiving a stipend from IDSA. M. K. J. reports serving on the HIVMA Board of Directors. H. E. T. reports receiving grants or contracts from Gilead Sciences and ViiV Healthcare. A. L. W. reports receiving a stipend from Merck for participation in a health policy forum. J. F. reports receiving honoraria from Clinical Care Options and ViiV Healthcare; receiving payment for testimony in Cabell County Commission v AmerisourceBergen Drug Corporation, CVS Indiana LLC, Cardinal Health, Inc, Rite Aid of Maryland, Inc, Kroger Limited Partnership I, Kroger Limited Partnership II, Wal-Mart Stores East, LP, McKesson Corporation, and H.D. Smith Wholesale Drug Co; and serving on the HIVMA Board of Directors, the HarborPath, AIDSVu/HepVu Board of Directors, and the COVID-19 Early Treatment Fund Scientific Advisory Board. All other authors report no potential conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed., (© The Author(s) 2022. Published by Oxford University Press on behalf of Infectious Diseases Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

We examined a novel hypothesis for the maintenance of communal nesting in the salamander, Hemidactylium scutatum, namely that communal nests are more likely than solitary nests to be associated with cutaneous antifungal bacteria, which can inhibit fungal infections of embryos. A communal nest contains eggs of two or more females of the same species. The nesting behavior of H. scutatum females and survival of embryos were determined by frequent nest surveys at three ponds. For communal nests, embryonic survival tended to be higher and catastrophic nest failure was lower. Pure bacterial cultures of resident species were obtained from the salamanders' skins by swabbing and tested against a fungal pathogen of embryos (Mariannaea sp.) in laboratory assays. We found that 27% of females had skin bacteria inhibitory to Mariannaea sp. Communal nests were more likely to have at least one female with antifungal bacteria than were solitary nests. Using a culture-independent assay (denaturing gradient gel electrophoresis of 16S rRNA gene fragments), we found that bacterial species on females and embryos were more similar to each other than they were to bacterial species found in soil within the nest, suggesting that females transmitted skin bacteria to embryos. The presence of anti-Mariannaea skin bacteria identified from the laboratory assays did not prevent fungal presence in field nests. However, once a nest was visibly infected with fungi, presence of anti-Mariannaea bacteria was positively correlated with survival of embryos. Microbe transmission is usually thought to be a cost of group living, but communal nesting in H. scutatum may facilitate the transmission of antifungal bacteria to embryos.