Since the beginning of the human immunodeficiency virus (HIV) epidemic in the United States, infectious disease (ID) specialists have provided HIV and primary care for people with HIV. As patients often now have controlled HIV but increasing comorbidities, some advocate that ID specialists shift away from HIV primary care. However, shortages of primary care providers and non–ID-trained HIV providers mean ID specialists stepping back could leave patients without care. In addition, many patients prefer consolidated care and find engaging with multiple providers challenging. Regional differences in HIV burden, morbidity, and mortality also make a uniform approach to who provides HIV primary care impractical. Maintaining ID specialists as primary care physicians supports patients, contributes to the HIV workforce, and may promote trainee interest in ID. Investments in training, education, and innovative care models are essential to expand the HIV workforce and enable ID specialists to keep patients at the center by serving as HIV primary care physicians.