2Center or American Progress | HIV/AIDS Inequality: Structural Barriers to Prevention, Treatment, and Care in Communities o Color
sexual parners and use condoms as oen as heir whie counerpars.
Tus, behavioralrisk acors, while imporan, canno ully explain he racial dispariy.Insead, he racial HIV gap and he racial healh gap in general, is srongly correlaed wih he racial wealh gap, which in urn is he direc oucome o boh hisorical andconemporary processes o segregaion in housing, educaion, employmen, and healhcare as well as racially skewed mass incarceraion. In his way, race—as i inersecs wihpovery, gender, and sexualiy among oher acors—becomes he embodimen o amuliaceed social exclusion and he raionalizaion or massive healh inequiies.
Te high raes o HIV/AIDS we see among communiies o color are no he resulo high-risk behavior in hese communiies, bu srucural inequaliies ha make hemmore likely o come in conac wih he disease and less likely o rea i.Te racial dimensions o he HIV/AIDS epidemic are bes undersood in his ligh. Teglaring healh inequiies revealed by he disribuion o HIV/AIDS demonsrae ha raceis a social index o isolaion and impoverishmen, disregard, and disempowermen raherhan a proxy or divergen sexual atiudes or behaviors—much less geneic rais.
Addressing he srucural orces ha shape he spread o inecious disease—or wha he World Healh Organizaion has ermed “he social deerminans o healh”—represensa undamenal and necessary shi rom he hisoric approach o he domesic HIV/ AIDS epidemic.
Social determinants are a better predictor of HIV outcomes thanrisk behaviors
Te social deerminans o healh—“he condiions in which people are born, grow, live, work and age, including he healh sysem”—weigh more heavily in he cause and courseo every leading caegory o illness han do any atiudinal, behavioral, or geneic deer-minan.
Tis is he case or hear disease, diabees, and cancer and i is equally rue orhe HIV/AIDS epidemic.In ac, he eecs o he social deerminans o healh may be even sarker wih respeco HIV/AIDS because o is communicable naure. For example, a social deerminanlike residenial segregaion inuences a communiy’s access o crucial resources suchas housing, educaion, and healh care, and also plays a role in deermining wih whom, wih wha requency, and on wha erms people inerac wih ohers, boh publicly andprivaely.
Similarly,he acue and chronic sress ha sems rom povery and experi-ences o racism, sexism, and oher power and resource dispariies,
can have prooundimpacs on healh oucomes in he case o exposure o HIV/AIDS.