A Day of Reckoning:
World AIDS Day 2022
By Dr. Stephaun Elite Wallace
We have spent much of the recent past rightfully focused on COVID-19, conflicts and wars, other health and social issues, and now recently Monkeypox (MPX). Still, for nearly four decades, HIV/AIDS has impacted individuals, families, and communities globally and in the United States. According to the World Health Organization1, more than 1.5 million people globally acquired HIV in 2021, nearly three times global estimates. In the same year, about 650,000 people died of AIDS-related complications, which translates to about one death per minute. Globally, cisgender women and girls (especially young women) bear the most significant HIV burden due to a host of socio-cultural challenges, including but not limited to intimate partner violence, bodily autonomy/rights, and patriarchy. According to UNAIDS, Eastern Europe, North Africa, the Middle East, and Latin America have had increases in new HIV cases over the past decade. In Asia and the Pacific, where new HIV cases have been decreasing over the last decade, new HIV cases are starting to rise. About 40 million people live with HIV globally, but only about 30 million (including about half of the children living with HIV) have access to treatment.
Globally about 4,000 persons acquire HIV daily (about 1,000 of those persons are young people ages 15-24), and it is projected that unless these trends change, we will see 1.2 million new cases of HIV in 2025 (exponentially greater than the current goal of 375,000 new cases). In the United States, we continue to see more than 30,000 new HIV cases each year. Of those cases, Black/African Americans represent about 42%, Latin/Hispanics represent about 27%, Whites represent about 26%, Asians represent about 2%, American Indian/Alaska Natives represent about 1%, and Native Hawaiian/Pacific Islanders represent less than 1%. When considering the population sizes of these groups, it is essential to note that in the United States, every other group except Whites bear a disproportionate HIV burden, with Blacks bearing the most significant burden by race. Among key communities, Black cisgender women, Black and Latin/Hispanic gay and bisexual men, and Black and Latin/Hispanic transgender women and men bear the most significant HIV burden. HIV is still a critical health condition, and its impact is felt across all communities globally. Still, specific communities experience the burden uniquely due to social and structural systems and challenges.
In the United States and globally, the social and structural systems and challenges that create the burden on key communities include stigma/discrimination, heterosexism, poverty, intimate partner violence, economics, and cultural and social norms regarding gender and sex assigned at birth, sexuality, and ethnicity/race. These systems and challenges converge and intersect to create the conditions that make acquisition and transmission more likely. From a structural perspective, whether individuals and community’s access high-quality health services that are culturally responsive and trauma-informed, including the cost and availability of services, insurance status, and language considerations, also play a critical role in HIV acquisition and transmission. For key communities in the United States, like Black and Latin/Hispanic communities, and specifically Black and Latin/Hispanic transgender, gay, bisexual, and queer persons, systemic biases (implicit and explicit) based on race, sex, sexuality, and gender norms, run rampant throughout our societies political, education, legal/criminal justice, healthcare, and housing systems. These biases influence attitudes, behaviors, and policies that affect these communities and undermine their ability to attain equity across these systems.
We have taken significant steps to end the HIV epidemic, but much work is still needed. Recently, government officials declared racism a public health threat, still the political will to prioritize and fund the required structural interventions that would make this statement more than a talking point has not been actualized. To realize the end of the HIV epidemic goals that we continue to see (and push back) will take more than aggressive efforts within an overtaxed and burdened public health system, but will require an overhaul of this system and an investment in social and health policy that prioritizes the prevention of HIV and the previously mentioned social conditions that make HIV transmission more likely.
It will take moving our society from a place of being reactive to public health threats to a place of being proactive at addressing the root causes of disease and inequities instead of applying temporary fixes which do not work for all of us. It will take action-oriented and charismatic leadership in our community- and faith-based organizations, health departments and clinics, policy tables, and federal health agencies. It will take the research and medical enterprise actively working with, involving, and centering communities underrepresented in research and healthcare and not acquiescing to beliefs and thoughts fueled by biases about key communities. It will take the general public to turn their attention to HIV and other health inequities and reengage advocacy efforts that move our systems leaders forward.
On this World AIDS Day, I call on all of us to do our part to help end HIV and other health inequities in our communities. I believe we can do it, but it will require all of us.
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Dr. Stephaun Wallace is a research epidemiologist, clinical assistant professor, public health and business consultant, and internationally recognized public health/social justice leader. He is the Director of External Relations for the Fred Hutch-based COVID-19 Prevention Network (CoVPN) and HIV Vaccine Trials Network (HVTN), a Staff Scientist in the Vaccine and Infectious Disease Division at Fred Hutch, a Clinical Assistant Professor in Global Health at the University of Washington, Founder and Director of the Office of Community Engagement in the UW/Fred Hutch Center for AIDS Research, and Founder and Grandfather of the House of Marc Jacobs. He can be reached via IG and Twitter at: @IAMSTEPHAUNELITE.
