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Infectious Diseases

The Lack of Equitable Access to HIV Prevention and Treatment

This month marks 40 years since the Centers for Disease Control and Prevention (CDC) published its first report on HIV in the United States, and the story has been one of both deep tragedy and powerful triumph.

Since the first cases of AIDS were reported, the disease has claimed more than 700,000 lives in the United States alone. At the peak of the epidemic in the mid-1980s, there were over 130,000 new HIV infections each year. Since then, investments in HIV prevention and treatment have allowed us to dramatically reduce new infections, and by 2019, there were less than 35,000 new infections nationally.

A lack of equitable access

While this is extraordinary progress, success has not been equal in all populations. As the epidemic evolved, profound disparities by race and ethnicity emerged that persist today. African Americans face rates of infection that are more than eight times higher than white Americans, and Hispanic/Latino populations face rates that are almost four times higher. We can and must do better.

We have witnessed major breakthroughs in HIV treatment and prevention during the history of this epidemic. As a young doctor in New York City in the 1990s, I personally witnessed the miraculous transformation of HIV from a possible death sentence into a manageable, chronic disease, thanks to improved medications.

An impressive array of prevention tools has also emerged, including CDC’s recommendation that everyone between the ages of 13 and 64 get tested for HIV at least once as part of routine health monitoring, as well as the identification of medication that can prevent HIV infection, called pre-exposure prophylaxis, or PrEP. HIV testing is critical to ending the epidemic because it is the bridge to all HIV treatment and prevention. PrEP is highly effective in preventing HIV transmission from sex or injection drug use when it is taken as prescribed.

Looking forward

To help ensure these strategies reach those in need, particularly during the COVID-19 pandemic, the HIV community is advancing innovative solutions designed to reach people where they are. These innovations include expanded self-testing, increasing the number of mobile options for service delivery, and creative community outreach to those disproportionately affected by HIV.

To reach the finish line, we need to accelerate efforts to provide equitable access to HIV prevention and care for everyone. This requires that we address the root causes and social determinants that contribute to disparities among people with HIV, such as poverty, unequal access to healthcare, lack of education, stigma, systematic racism, and work circumstances.

To do this, HIV prevention and care efforts must go outside traditional healthcare settings in ways that respond to community needs, including:

  • Providing or linking to services like transportation, housing, employment, mental health, or substance use disorder treatment services necessary to access and stay in care.
  • Giving people one place to pursue their health needs and engage in care, whether that be for substance use disorder, sexual health, or HIV.
  • Engaging people in need of care with love and respect, rather than defining them by their HIV status or risk.

We know what we need to do. We believe ten years from now, with the infusion of new resources, community innovation, and collective commitment, we will celebrate new triumphs as we reach ever closer to health equity and ending this epidemic once and for all.

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