Every year, World AIDS Day compels me to reflect on our HIV response as a nation.
Marwan Haddad, MD, MPH
Chair of the Board of Directors, HIV Medicine Association and Medical Director, Center for Key Populations, Community Health Center, Inc.
This year, on this day, the Biden Administration will release its 2022 National HIV/AIDS Strategy as a road map for ending the HIV epidemic in the United States. While this goal is achievable, it requires breaking down the structural and socioeconomic barriers that remain our greatest challenge.
The COVID-19 pandemic has highlighted the structural racism and systemic inequities, underscored by the HIV epidemic for decades, that leave people of color and other underserved populations especially vulnerable to disease and serious illness. Any U.S. strategy to reduce HIV infections and improve outcomes, therefore, must address stigma and discrimination.
Legacies of structural racism and stigma still affect people with HIV, making it difficult for patients to access health care and other services and less able to adopt health-protecting behaviors. Many of my patients to this day face barriers and discrimination due to their sexual orientation, gender identity, substance use, mental health disorders or involvement in the justice system.
Stigma and discrimination erode mental health, negatively impact quality of care and discourage some from seeking care altogether, ultimately leading to worse health outcomes. Gay and bisexual youth are eight times more likely to attempt suicide and three times more likely to use illicit drugs and engage in risky sex. CDC reports nearly 70% of new HIV infections are among men who have sex with men, of whom almost 70% are Black or Latinx. HIV rates among transgender women are as high as 42% in some cities and reach 65% if they are Black. HIV outbreaks among people who inject drugs have increased.
Because stigma is deeply rooted in social structures and individual perceptions, everyone has a role to play in addressing its effects. Ending the HIV epidemic in the U.S. must include confronting and deconstructing structural racism by rethinking discriminatory policies in and beyond health care. We must dismantle socioeconomic inequities and harmful stigmas surrounding HIV and the populations most vulnerable to it. Most importantly, every human being needs to be treated with respect and dignity. Anything less is unacceptable.
