On World AIDS Day (December 1), it is crucial to recognize the progress that has been made concerning prevention, treatment, and care efforts and all of the urgent work that still needs to be done. Worldwide, 33 million people are living with HIV. In the United States alone, 1.1 million people are living with HIV (CDC, 2010). Within the US, 20% of people are not aware that they are living with the virus. In the richest nation in the world, 3 decades into the epidemic, 56,000 people per year are infected, HIV is the leading cause of death for African-American women age 25-34, the epidemic has an alarming impact on communities of color, particularly young MSM of color, and there are vast disparities in access to prevention, treatment, and care (El-Sadr, Mayer, & Adimora, 2010).

Despite the fact that I normally discuss the state of the HIV pandemic globally, I am going to focus my comments on the epidemic in the United States. This is because in July of 2010, President Obama put into place the FIRST National HIV/AIDS Strategy in history of the United States. The goals of the policy (White House, 2010, p. vii) are to:

  1. Reduce the number of people who become infected with HIV,
  2. Increase access to care and health outcomes for people living with HIV; and,
  3. Reduce HIV-related health disparities.

In order to meet goal #1, the policy proposes that the US:

“intensifies HIV prevention efforts in communities where HIV is most heavily concentrated, expand targeted efforts to prevent HIV infection using a combination of effective, evidence-based approaches, and educate all Americans about the threat of HIV and how to prevent it” (p. vii).

In order to meet goal #2 (increasing access to care and improving health outcomes for people living with HIV), the policy calls for: 

“establishing a seamless system to immediately link people to continuous and coordinated quality care when they are diagnosed with HIV, take deliberate steps to increase the number and diversity of available providers of clinical care and related services for people living with HIV, and to support people living with HIV with co-occurring health conditions and those who have challenges meeting their basic needs, such as housing” (p. ix).

Finally, in order to reduce HIV related health disparities, the public and private sector are called upon to:

“reduce HIV-related mortality in communities at high risk for HIV infection, adopt community-level approaches to reduce HIV infection in high-risk communities, and reduce stigma and discrimination against people living with HIV” (p. ix).

The US National HIV/AIDS Strategy can be found here.

Meeting these goals is an enormous task and will require efforts well beyond the federal government, academia, media, health care institutions and practitioners, policy-makers, community mobilization and community based groups to include each and every sector of society. In December of 2010, a special issue of JAIDS was released that assessed the state of the epidemic in the US and made suggestions to ensure that the goals of the National Policy are realized. In it, Chris Collins and Dazon Dixon Diallo praised the National Policy and argue that for prevention efforts to truly succeed, it will be important to advance prevention funding alignment (ensure funding matches epidemic conditions and priorities) and accountability (improve transparency of prevention funding), go to scale with effective prevention efforts in communities at elevated risk, foster synergies between evidence-based prevention and community-based efforts for home-grown and locally developed interventions, and to go “beyond individual behavior change programming by putting a greater emphasis on structural, network, and policy interventions” (Collins & Diallo, 2010, p. S. 148).

Colleagues Ada Adimora and Judith Auerbach agree with this last point in particular, underscoring that “social determinants — the conditions in which people are born, live, work, and age — are critical influences on health and that these determinants, which are shaped by the distribution of money, power, and resources can be influenced in positive ways” (Adimora & Auerbach, 2010, p. S. 132). They detail how social determinants both influence HIV risk and the course of the epidemic and reveal how several structural interventions (such as comprehensive sex education with access to male and female condoms, syringe exchange programs, health care availability, and housing) help to reduce risk behaviors and increase access to care.

Indeed, the National HIV/AIDS policy and its implementers hope to reduce the number of people who become infected with HIV, increase access to care and health outcomes for people living with HIV and reduce HIV-related health disparities. To do so, it will be necessary to support work that intervenes on social and structural determinants of HIV, including poverty reduction, incarceration, homelessness, and food insecurity, along with the numerous other strategies that are discussed and planned as a result of the National policy.

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References:

  • Adimora, A.A. & Auerbach, J. (2010). Structural interventions for HIV prevention. JAIDS, 55 (S2),  S132-135.
  • Collins, C. & Diallo, D.D. (2010). A prevention response that fits America’s epidemic: Community Perspectives on the status of HIV prevention in the United States. JAIDS, 55 (S2), S148-S150.
  • El-Sadr, W., Mayer, K., Adimora, A.A. (2010). The HIV Epidemic in the United States: A time for action. JAIDS, 55 (S2), S63.