Real Health Equity: HIV and Beyond
In the 40+ years since the human immunodeficiency virus (HIV) was first identified as a new infections disease, scientists and researchers have made significant progress in preventing and treating HIV. Instead of HIV being a death sentence, biomedical advancement such as anti-retroviral therapies has transformed the virus into a manageable chronic disease with improved mortality rates—for some. Despite these important advances, HIV/AIDS persists as a serious public health challenge in the United States. According to the U.S. Centers for Disease Control and Prevention, nearly 37,000 people received an HIV diagnosis in 2019—the most recent year for which data is available—and an estimated 1.2 million people are living with HIV. Unfortunately, no HIV/AIDS vaccines have been shown to be effective despite decades of research.
Furthermore, issues with access to pre-exposure prophylaxis (PrEP) and therapeutic treatments continue to persist, and critical inequities exist, with Black and Latinx gay and bisexual men and transgender women being disproportionately affected by HIV. The Centers for Disease Control and Prevention estimates that 50% of Black and 25% of Latinx gay and bisexual men will encounter HIV in their lifetime. A staggering 49% of Black and 33% of Latinx transgender women account for new HIV diagnoses among transgender people. Staying true to his commitment to end the HIV epidemic, President Biden launched an updated National HIV/AIDS Strategy (NHAS) in December 2021 to coincide with World AIDS Day. The NHAS identified various social and structural determinants of health that contribute to this disproportionality among Black and Latinx LGBTQ+ people. These include lack of access to affordable and safe housing, equitable education and employment opportunities, medical coverage, transportation and food instability.
Racism is also a key factor in addressing health inequity in the Black and Latinx LGBTQ+ community. During the early days of the HIV epidemic, most people thought of HIV/AIDS as a white gay man’s disease. But that wasn’t correct. In fact, Black and Latinx gay and bisexual men were also succumbing to AIDS-related opportunistic infections. In many cases, they weren’t given the opportunity to tell their stories, and many died in silence. Additionally, when the U.S. government began to allocate resources and develop programming for people living with HIV and those dying from AIDS, it did not acknowledge or consider the unique barriers people in Black and Latinx communities face. Unfortunately, many in the Black and Latinx LGBTQ+ people were not able to access those life-saving resources. Now, over 40+ years into the HIV epidemic, data indicates that Black and Latinx communities are disproportionately affected by HIV compared to other racial/ethnic groups, Black and Latinx people are still not given the opportunity to participate in the health care system, adversely impacting their health outcomes.
However, we have an opportunity to put health equity guiding principles to work by building on lessons learned over the past four decades. We can ensure that every person has an opportunity to achieve their full health potential, and that no one is disadvantaged from achieving this potential because of social position or other socially determined circumstances. In today’s culture, health equity has become a corporate buzzword. However, real health equity means improving the health care ecosystem and investing in innovative and holistic programs and policies that will increase overall health outcomes for communities disproportionately affected across all disease states. To advance health equity, we must acknowledge that the health care system – which was built for and by white men – is rooted in centuries of racist and oppressive policies, historical trauma and violence. And we must take an approach that is rooted in inclusive data.
One of the most important things we have learned from the HIV/AIDS epidemic is that data matters. Data enables the health care ecosystem to determine prevalence and populations that are disproportionately affected and identify gaps in service delivery. Data helps us better determine funding, program design and allocation of resources. Data has shown us that rates of HIV diagnoses remain relatively high among Black and Latinx gay and bisexual men and transgender women. But data also confirm that people with HIV who achieve and maintain an undetectable viral load—the amount of HIV in the blood—by taking antiretroviral therapy (ART) daily as prescribed cannot sexually transmit the virus to others. This scientific concept is known as Undetectable=Untransmittable (U=U). And data has shown us that PrEP reduces the risk of getting HIV from sex by about 99% when taken as prescribed.
But data isn’t everything. In advancing health equity for historically excluded communities, it is important to include Black and Latinx people in the development and implementation of programming and policy. This will ensure that their lived experiences are considered and addressed accordingly. This approach must be intentional and nonperformative because lives are at stake.
To increase health equity, reduce barriers to health care access, and address syndemics, we also must address structural racism and disparities within communities of color through vital partnerships with industry leaders to enact policies and to increase health equity.
By applying the lessons we’ve learned from the HIV epidemic, we are positioned to collaborate, innovate and deliver solutions that put marginalized communities at the core, improve health outcomes and save lives.
J. Maurice McCants-Pearsall serves as Vice President of Health Equity and Special Initiatives within Real Chemistry’s Health Equity & Justice Practice.
