The Broader Context of “Ending the HIV Epidemic: A Plan for America” Initiative

Kates, J; Millett, Gregorio A.; Dawson, Lindsey; Honermann, Brian; Jones, Austin; Sherwood, Jennifer; Garcia, Zulema Iboa; Kuenzle, Katherine

doi:10.2105/ajph.2019.305429

Cited by 12 publications

(9 citation statements)

References 4 publications

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“…An estimated eight million Americans (disproportionately Black and Brown) have slipped into poverty since May 2020 [70]. People at risk for or living with HIV likely have a fundamentally different baseline of economic, housing and insurance stability in the wake of the COVID‐19 pandemic.…”

Section: Discussionmentioning

confidence: 99%

New pathogen, same disparities: why COVID‐19 and HIV remain prevalent in U.S. communities of colour and implications for ending the HIV epidemic

Millett

2020

J Int AIDS Soc

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Introduction The U.S. Ending the HIV Epidemic (EHE) Initiative was launched nationally in February 2019. With a target of ending the HIV epidemic by 2030, EHE initially scales up effective HIV prevention and care in 57 localities that comprise the greatest proportion of annual HIV diagnoses in the United States (US). However, the EHE effort has been eclipsed by another infectious disease 11 months into the Initiative’s implementation. SARS‐COV‐2, a novel coronavirus, has infected more than eight million Americans and at least 223 000 (as of 23 October 2020) have succumbed to the disease. This commentary explores the social conditions that place communities of colour at greater risk for COVID‐19 and HIV, and assesses challenges to EHE in a post‐COVID‐19 universe. Discussion One of the many common threads between HIV and COVID‐19 is the disproportionate impact of each disease among communities of colour. A recent report by the National Academy of Sciences surmised that as much as 70% of health outcomes are due to health access, socio‐economic factors and environmental conditions. Social determinants of health associated with greater HIV burden in Black and Brown communities have re‐emerged in epidemiological studies of disproportionate COVID‐19 cases, hospitalizations and deaths in communities of colour. Using data from the scientific literature, this commentary makes direct comparisons between HIV and COVID‐19 racial disparities across the social determinants of health. Furthermore, I examine three sets of challenges facing EHE: (1) Challenges that hamper both the EHE and COVID‐19 response (i.e. insufficiently addressing the social determinants of health; amplification of disparities as new health technologies are introduced) (2) Challenges posed by COVID‐19 (i.e. diverting HIV resources to address COVID‐19 and tapering of EHE funding generally); and (3) Challenges unrelated to COVID‐19 (i.e. emergence of new and related health disparities; repeal of the Affordable Care Act and long‐term viability of EHE). Conclusions Racism and discrimination place communities of colour at greater risk for COVID‐19 as well as HIV. Achieving and sustaining an end to the U.S. HIV epidemic will require structural change to eliminate conditions that give rise to and maintain disparities.

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Section: Discussionmentioning

confidence: 99%

New pathogen, same disparities: why COVID‐19 and HIV remain prevalent in U.S. communities of colour and implications for ending the HIV epidemic

Millett

2020

J Int AIDS Soc

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“…The above account of Houston’s HIV epidemic and response pays tribute to many unsung heroes and illustrates the shaping of the current face of HIV in the worst affected US region, the Deep South [ 53 , 54 ]. Moreover, it highlights the importance of addressing stigma, discrimination, criminalization, healthcare barriers, and inequities, as well as prioritization of research, alongside implementing biomedical interventions, for EHE success [ 55 , 56 ].…”

Section: Hiv Through the Ages In Houston: Insiders’ Accountmentioning

confidence: 99%

“…Besides efforts geared towards implementation of biomedical interventions, success of EHE hinges upon optimizing its operational environment [ 56 ]. In the South including Texas, access to HIV prevention, care and support services is impeded by the lack of Medicaid expansion and restrictive eligibility criteria, high uninsured rates and low public and private funding.…”

Section: Wider Perspectivementioning

confidence: 99%

“…There is still substantial HIV stigma in the South [ 76 ], more recently evolving into stigma against biomedical prevention tools, such as PrEP [ 77 ]. Social determinants of health continue to drive HIV-related disparities [ 56 ]. Finally, reminiscent of the loss of ATEU, the Baylor-UTHouston Center for AIDS Research (CFAR) operated from 1994 until 2016 [ 78 ].…”

Section: Lessons and Measures From Houstonmentioning

confidence: 99%

“…Table 1 shows a comparison of Harris County with select other EHE priority jurisdictions, in terms of core [ 79 ] and other indicators [ 28 ] from the following areas [ 56 ]: policy and legal, socioeconomic, and service availability. Based on modeled forecasts, EHE scale-up of interventions is likely to be cost-saving in Houston/Harris County similar to other Southern hotspots such as Atlanta, Baltimore, and Miami [ 80 ].…”

Section: Lessons and Measures From Houstonmentioning

confidence: 99%

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Human Immunodeficiency Virus in the State of Texas of the United States: Past Reflections, Present Shortcomings, and Future Needs of the Public Health Response

Abbas

Hallmark

McNeese

et al. 2020

Open Forum Infectious Diseases

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Ending the HIV Epidemic: A Plan for America aims to reduce HIV incidence in the United States by at least 90% by 2030, using diagnosis, treatment and prevention strategies. Texas is a Southern state, that has one of the highest numbers of new HIV diagnoses and people with HIV in the country, and where HIV disproportionately impacts minorities. We retrace the historical epidemic in its largest city, Houston, to illustrate the lessons learned and milestones accomplished; that could serve as guideposts for the future. We examine the current epidemic in Texas, including the achieved levels of HIV testing, treatment continua and pre-exposure prophylaxis prescription, and compare and contrast these with the national estimates and Plan targets. Our findings call for urgent and accelerated expansion of efforts to end HIV in Texas.

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Ending HIV Hinges on Reducing Poverty

Kalichman

2022

AIDS Behav

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The Broader Context of “Ending the HIV Epidemic: A Plan for America” Initiative

Cited by 12 publications

References 4 publications

New pathogen, same disparities: why COVID‐19 and HIV remain prevalent in U.S. communities of colour and implications for ending the HIV epidemic

New pathogen, same disparities: why COVID‐19 and HIV remain prevalent in U.S. communities of colour and implications for ending the HIV epidemic

Human Immunodeficiency Virus in the State of Texas of the United States: Past Reflections, Present Shortcomings, and Future Needs of the Public Health Response

Ending HIV Hinges on Reducing Poverty

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