Ending HIV in the USA: integrating social determinants of health reply

• Type of Material: Article
• Authors: Chris Beyrer, Johns Hopkins University; Adaora A Adimora, University of North Carolina; Patrick Sullivan, Emory University; Errol Fields, Johns Hopkins University; Kenneth H Mayer, Harvard School of Medicine and Fenway Health
• Language: English
• Date: 2021-08-28
• Publisher: ELSEVIER SCIENCE INC
• Publication Version: Final Published Version
• Copyright Statement: © 2021 Elsevier Ltd. All rights reserved.
• Final Published Version (URL): http://dx.doi.org/10.1016/S0140-6736(21)01231-9
• Title of Journal or Parent Work: LANCET
• Volume: 398
• Issue: 10302
• Start Page: 743
• End Page: 743
• Grant/Funding Information: Support for this Correspondence and the Lancet Series on HIV in the USA was provided in part by the Foundation for AIDS Research, the US National Institute on Drug Abuse, the Center for AIDS Research (grant number P30AI094189) at Johns Hopkins University, Emory University, Harvard University, and the University of North Carolina, and the Desmond M Tutu Professorship in Public Health and Human Rights at Johns Hopkins University.
• Keywords: General & Internal Medicine; Science & Technology; Medicine, General & Internal; Life Sciences & Biomedicine
• Research Categories: Health Sciences, Public Health; Health Sciences, Epidemiology

Abstract

In their response to our call to action1 in the Lancet Series on HIV in the USA, Courtenay Sprague and Sara E Simon argue that biomedical solutions alone have failed, and will continue to fail, to control the HIV epidemic in the USA and that policy must include efforts to address the social determinants of health. We concur, and believe that the Series on HIV in the USA highlights these important concerns.2 Sprague and Simon note that the health disparities and structural barriers that have characterised the US health-care system since its inception, which we reviewed in the Series as correlates of HIV prevalence and incidence,1 have also been drivers of poor outcomes in the COVID-19 response. We would add that although the COVID-19 vaccines represent remarkable achievements in biomedical sciences, the uneven roll-out via the patchwork of US public-health systems swiftly revealed that unaddressed social determinants can undermine even the most efficacious interventions,3 as is true with high-efficacy HIV preventive tools like antiretroviral pre-exposure prophylaxis (PrEP). These drugs offer virtually complete protection if taken as prescribed for men who have sex with men (MSM) and other populations at risk, yet PrEP uptake, adherence, and use are lower among US MSM and women in minority racial and ethnic groups, in south USA, among people with lower-level incomes, and in circumstances in which social determinants (eg, poverty, unstable housing, anti-gay stigma, anti-Black racism, and policies limiting health insurance coverage) undermine the effectiveness of this intervention