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HIV/AIDS Inequality: Structural Barriers to Prevention, Treatment, and Care in Communities of Color

HIV/AIDS Inequality: Structural Barriers to Prevention, Treatment, and Care in Communities of Color

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Russell Robinson of the University of California, Berkeley Law Working Group on HIV and Inequality and Aisha Moodie-Mills discuss the need for a holistic approach to eliminating racial disparities in HIV/AIDS treatment in communities of color.
Russell Robinson of the University of California, Berkeley Law Working Group on HIV and Inequality and Aisha Moodie-Mills discuss the need for a holistic approach to eliminating racial disparities in HIV/AIDS treatment in communities of color.

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Published by: Center for American Progress on Jul 27, 2012
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1Center or American Progress | HIV/AIDS Inequality: Structural Barriers to Prevention, Treatment, and Care in Communities o Color
HIV/AIDS Inequality: StructuralBarriers to Prevention, Treatment,and Care in Communities of Color
Why We Need A Holistic Approach to Eliminate RacialDisparities in HIV/AIDS
Russell Robinson, et. al. and Aisha C. Moodie-Mills July 27, 2012
Introduction
For he rs ime in more han wo decades he Inernaional AIDS Conerence reurnso he Unied Saes and his week more han 20,000 delegaes rom nearly 200 counriesare in Washingon D.C. discussing a wide array o HIV/AIDS relaed issues, including heroubling racial dispariies o our domesic HIV epidemic, specically:  Arican Americans, who make up only 14 percen o he U.S. populaion, makeup 44 percen o he HIV-posiive populaion.
1
 Lainos ace hree imes he HIV inecion raes as whies.
2
 Men who have sex wih men represen 2 percen o he U.S. populaion bu accounor 61 percen o all new HIV inecions.
3
  While he Obama adminisraion has aken seps oward he eliminaion o hese dis-pariies hrough he Naional HIV/AIDS Sraegy and Implemenaion Plan,
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here issill much work o be done. Tis brie highlighs underexplored explanaions or hesedispariies and oulines possible soluions o begin addressing hem.Oenimes, popular culure has oered unorunaely erroneous explanaions or he sark racial disparae impac o HIV/ AIDS. Te mass media, or example, has suggesed ha black men on he down low” inec black women by secrely sleeping wih male parners,acing as a bisexual “bridge” beween gay and sraigh communiies.
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Bu public healhscholars have ound litle suppor or his heory.
6
Many may assume ha black people su-er rom greaer HIV prevalence because hey are considered less sexually responsible han whies. Ye several sudies have shown ha black women and black men who have sex wihmen—he wo groups mos severely impaced by HIV/AIDS—have similar numbers o 
 
2Center or American Progress | HIV/AIDS Inequality: Structural Barriers to Prevention, Treatment, and Care in Communities o Color
sexual parners and use condoms as oen as heir whie counerpars.
7
Tus, behavioralrisk acors, while imporan, canno ully explain he racial dispariy.Insead, he racial HIV gap and he racial healh gap in general, is srongly correlaed wih he racial wealh gap, which in urn is he direc oucome o boh hisorical andconemporary processes o segregaion in housing, educaion, employmen, and healhcare as well as racially skewed mass incarceraion. In his way, race—as i inersecs wihpovery, gender, and sexualiy among oher acors—becomes he embodimen o amuliaceed social exclusion and he raionalizaion or massive healh inequiies.
8
 Te high raes o HIV/AIDS we see among communiies o color are no he resulo high-risk behavior in hese communiies, bu srucural inequaliies ha make hemmore likely o come in conac wih he disease and less likely o rea i.Te racial dimensions o he HIV/AIDS epidemic are bes undersood in his ligh. Teglaring healh inequiies revealed by he disribuion o HIV/AIDS demonsrae ha raceis a social index o isolaion and impoverishmen, disregard, and disempowermen raherhan a proxy or divergen sexual atiudes or behaviors—much less geneic rais.
9
  Addressing he srucural orces ha shape he spread o inecious disease—or wha he World Healh Organizaion has ermed “he social deerminans o healh—represensa undamenal and necessary shi rom he hisoric approach o he domesic HIV/ AIDS epidemic.
10
 
Social determinants are a better predictor of HIV outcomes thanrisk behaviors
Te social deerminans o healh—“he condiions in which people are born, grow, live, work and age, including he healh sysem—weigh more heavily in he cause and courseo every leading caegory o illness han do any atiudinal, behavioral, or geneic deer-minan.
11
Tis is he case or hear disease, diabees, and cancer and i is equally rue orhe HIV/AIDS epidemic.In ac, he eecs o he social deerminans o healh may be even sarker wih respeco HIV/AIDS because o is communicable naure. For example, a social deerminanlike residenial segregaion inuences a communiy’s access o crucial resources suchas housing, educaion, and healh care, and also plays a role in deermining wih whom, wih wha requency, and on wha erms people inerac wih ohers, boh publicly andprivaely.
12
Similarly,he acue and chronic sress ha sems rom povery and experi-ences o racism, sexism, and oher power and resource dispariies,
13
can have prooundimpacs on healh oucomes in he case o exposure o HIV/AIDS.
14
 
 
3Center or American Progress | HIV/AIDS Inequality: Structural Barriers to Prevention, Treatment, and Care in Communities o Color
Tereore, atemping o comba HIV/AIDS hrough atiude adjusmen and behaviormodicaion alone is incomplee and ineecive. A sricly behavioral ocus may also be misleading and increase sigma by implying ha individuals’ bad decisions are solely o blame or heir poor healh oucomes. Raising public awareness abou he social,poliical, and economic condiions ha exacerbae HIV/AIDS may comba he racialsereoype ha blacks and Lainos suer rom higher HIV/AIDS prevalence becauseo heir irresponsible sexual pracices or hyper-homophobic culures.
15
 Governmenal eniies—inernaional and domesic—have already begun o ocus onhe social deerminans ramework. Te World Healh Organizaion recommends ha weocus on improving daily living condiions; ackling he inequiable disribuion o power,money, and resources; and measuring and undersanding he impac o inervenions,
16
 o promoe healh equiy. o his end, he Naional Insiue on Minoriy Healh andHealh Dispariies, an eniy wihin he U.S. Deparmen o Healh and Human Services,has launched he Social Deerminans o Healh Iniiaive, which ses ou o perorm hisresearch. Meanwhile, he Ceners or Disease Conrol and Prevenion published a WhiePaper on he social deerminans o healh as hey relae o inequiies in HIV, viral hepai-is, sexually ransmited inecions, and uberculosis in he Unied Saes.
17
 
Addressing structural inequalities is necessary to eliminatingracial disparities
Tis brie builds on he holisic ramework promoed by hese agencies and urherexplains he srucural orces underlying he sark realiy depiced in Presiden Obama’sNaional HIV/AIDS Sraegy.
18
Te Obama adminisraion’s eors have cas an impor-an ligh on he gross dispariies in he disribuion o HIV/AIDS in he Unied Saes,especially hose aecing men who have sex wih men, racial and ehnic minoriies, youh, and populaions o he Norheas and he Souh.
19
 Ulimaely, his brie spolighs wha he Naional HIV Sraegy recognizes (alhoughhe media largely overlooked his developmen when he presiden released he sra-egy): We mus move beyond exclusively argeing he so-called risk behaviors o hemos vulnerable groups o also address he roo causes o hose srucural inequaliies—he disribuion o wealh, power, and resources based on real or perceived dierenceso race, class, gender, sexualiy, naional origin, and immigraion saus—ha consrainindividual and collecive agency, generae chronic sress, erode immune sysem unc-ioning, and block access o eecive reamen.In our emphasis on he srucural dimensions o HIV dispariies, we do no aim oundermine he ecacy o behavioral inervenions ha have been successul. Raher,our goal is o draw atenion o he ac ha such inervenions alone will never be ableo miigae he harsh racial dispariies ha HIV saisics depic.

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