Addressing Racism's Role in the US HIV Epidemic: Qualitative Findings From Three Ending the HIV Epidemic Prevention Projects

Abstract

Background: Racist socio-political and economic systems in the United States are root causes of HIV disparities among minoritized individuals. However, within HIV implementation science literature, there is scarce empirical research on how to effectively counter racism. This article names racism and White supremacy as key challenges to the success of the Ending the HIV Epidemic (EHE) initiative and delineates opportunities to integrate anti-racism into HIV interventions.Methods: Formative data were synthesized from 3 EHE studies in California, North Carolina, and South Carolina. Each study engaged with community stakeholders to inform pre-exposure prophylaxis interventions. Key informant interviews and focus groups were used to query individuals-including Black individuals-about implementation challenges. Although racism was not an a priori focus of included studies, discourse on race and racism emerged as key study findings from all projects.Results: Across diverse stakeholder groups and EHE locales, participants described racism as a threat to the success of the EHE initiative. Institutional and structural racism, intersectional stigma, and maltreatment of minoritized individuals within healthcare systems were cited as challenges to pre-exposure prophylaxis scale-up. Some recommendations for addressing racism were given-yet these primarily focused on the individual level (eg, enhanced training, outreach).Conclusions: EHE implementation scientists should commit to measurable anti-racist actions. To this end, we present a series of recommendations to help investigators evaluate the extent to which they are taking actionable steps to counter racism to improve the adoption, implementation, and real-world impact of EHE interventions for people of color.

Understanding why racial/ethnic inequities along the HIV care continuum persist in the United States: a qualitative exploration of systemic barriers from the perspectives of African American/Black and Latino persons living with HIV

“…Yet, national responses to the HIV epidemic inadequately address long standing socio-systemic issues. The national response to HIV such as the initiative to End the HIV Epidemic and the National HIV/AIDS Strategy have been criticized for failing to address systemic racism in efforts to end the HIV epidemic [ 46 , 49 ]. Strategies that fail to recognize and address the role of systemic racism in the HIV epidemic risk reproducing patterns of inequalities that contribute to HIV disparities in prevention and treatment.…”

A Key Comprehensive System for Biobehavioral Surveillance of Populations Disproportionately Affected by HIV (National HIV Behavioral Surveillance): Cross-sectional Survey Study

“…Low-income HET in urban areas have highest HIV burden [10,11]. Stigma and discrimination related to male-male sex and drug use and overall health disparities linked with social and economic disadvantages make the populations surveyed in NHBS susceptible to multiple physical and health problems and can affect whether they seek HIV testing, treatment, and other health services [12][13][14][15][16]. Active community recruitment in NHBS ensures that impactful data are collected to inform prevention efforts for these populations and monitor progress.…”

Peer Case Management Promoting Advancement Along the HIV Care Continuum Among Black Men Who Have Sex with Men Living with HIV: Building Brothers Up

“… 9 , 10 These structural factors are rooted in the sociopolitical and economic systems within the United States, and various forms of racism including institutional and structural racism, intersectional stigma, and the maltreatment of minoritized persons within the health care systems have been cited as key barriers to the success of Ending the HIV Epidemic within racial/ethnic minority populations broadly, and the scale-up of HIV prevention efforts such as pre-exposure prophylaxis interventions, specifically. 11 …”