Ending the HIV epidemic, fighting poverty and inequality, one of the most important treatments

In his State of the Union address, President Trump called for an end to the HIV epidemic in the United States by 10 years ago. Health and Social Services Secretary Alex Azar and public health officials said the government plans to focus on the most affected areas and provide drugs to those at risk.

I am a social scientist and have more than 10 years of experience in the area of ​​health disparities. My research focuses on understanding and addressing disparities in HIV and cancer outcomes, particularly among immigrant and minority populations, using a framework of social determinants of health.

Although remarkable progress has been made in the fight against HIV / AIDS, it will probably take more than 10 years to end the epidemic and more than drugs. Indeed, the main factor of the disease has more to do with social inequalities than with the single virus.

The total annual number of new HIV diagnoses has remained stable in recent years in the United States, but this has not been the case for all groups. In fact, the Centers for Disease Control and Prevention data reveal that racial, ethnic, socio-economic and even geographical inequalities still exist. These inequities exist at each stage of the HIV care continuum, from screening to mortality.

This means that there are gaps in the continuum and that these people are disappearing at every stage, including HIV testing and diagnosis, the link to appropriate HIV care, support during care Access to antiretroviral therapy and treatment. These gaps are due to barriers such as poor access to services, poverty, food insecurity and homelessness, as well as stigma and discrimination.

A hotspot of HIV: the south

Among the CDC's most disturbing recent findings: More than half of all new HIV diagnoses in the United States occur in the South. Factors such as concentrated poverty in cities, suburbs and rural counties, high unemployment, inadequate health care infrastructure and lack of access to health insurance and health services. quality health lead to the heavy burden of HIV in the South. Stigma and discrimination against people living with HIV are other important factors. This can cause people to be tested or treated for fear that someone will discover they have HIV.

Gay and bibadual men account for 66% (25,748) of all diagnoses and 82% of men's HIV diagnoses. And, although African Americans make up 13% of the US population, they account for 43% (16,694) of HIV diagnoses. Similarly, Latinos account for 18% of the population, but 26% (9,908) of HIV diagnoses. Women belonging to an ethnic or ethnic minority represent a disproportionate share of the diagnoses of HIV infection among women.

An arsenal beyond the pharmacy

HIV interventions that focus solely on pharmaceutical or pharmaceutical innovations, or on individual behavioral change, can not effectively address the magnitude and complexity of the HIV epidemic, as I have the ## 148 ## 39, explains in my recently published article with co-investigator David R. Williams, Ph.D., at Harvard TH School of Public Health Chan, in Public Health Reports. What we need most today is a new generation of cost-effective HIV interventions, rigorously evaluated and focused on the underlying contextual factors of the disease. These factors include:

• access to adequate housing
• access to quality health care and health insurance
• access to child care
• education, employment status, gender and income

These factors are generally known as the social determinants of health and have been considered for many decades as the driving force of health by many public health experts.

To cite a few examples, in a scientific study, structural community factors, such as poverty and low employment opportunities, limited women's access to healthcare resources in the South. In addition, stigma, transportation issues, and access to illicit substances have affected health care research and decision-making behavior, as well as the ability to participate in care. HIV.

Similarly, another study found that homeless people were more likely to be uninsured and less likely to adhere to their antiretroviral drugs for HIV, thus demonstrating that housing was an important mechanism for improving the health of this vulnerable group.

In addition, racial / ethnic stereotypes are deeply rooted in American culture and may, consciously or not, have a negative impact on the care providers provide to their patients. Evidence shows that interventions that address implicit racial bias among providers can improve the quality of care and reduce racial / ethnic disparities in HIV outcomes.

Given this scientific evidence, it is perhaps not surprising that, despite three decades of public education and clinical campaigns, more than half of all new infections throughout North America, Western Europe and Central Europe occur in the United States.

Make things right

So what will it take to end the epidemic in the United States?

In simple terms, to fight HIV, we must fight against poverty and social inequalities. This approach is the key to the transformation needed to eradicate the HIV epidemic in the United States. Whenever possible, social determinants must be integrated into behavioral and biomedical strategies to increase their chances of success. A new generation of HIV interventions focused on fundamental SDH should be the focus of efforts to address HIV-related disparities.

There is growing scientific evidence that interventions to reduce poverty and inequities in social and living conditions can be effective in reducing the risk of HIV infection. Many studies reveal that improved education and affordable housing can reduce HIV and AIDS incidence rates because it has been found that low levels of education and unstable housing reduced social stability and increased risky behavior.

These studies reveal that interventions that strengthen women's income, housing stability, and women's empowerment are badociated with improved psychological well-being, economic productivity, and reduced HIV risk. Improving access to care and improving the quality of care can also help reduce disparities in the incidence of HIV.

It is time to recognize that every government action is likely to affect health and health equity, including policies related to finance, education, housing, health, and health. employment, transport and health. Economic studies also confirm that the most rigorous SDH – focused interventions have proven to be cost – effective and allow the company to save money in the long run. It is therefore important to integrate this "health in all policies" approach in order to have the greatest impact on the HIV epidemic.

I believe that Americans must commit to making it clear to their leaders and to all Americans that all sectors of society have an advantage when we invest in fighting inequality in the most vulnerable areas. HIV / AIDS is not a partisan issue. Political will – and goodwill towards our most vulnerable citizens – can lead to a national "health culture" that breaks borders, equals access and makes HIV / AIDS a less visible spectrum.

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