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Celeste Watkins-HayesBack to OpinionCeleste Watkins-Hayes

Ending the AIDS epidemic

It has been 21 years since Magic Johnson held a press conference on November 8, 1991 announcing his retirement from the Los Angeles Lakers when he revealed he had contracted HIV. He went on to create the Magic Johnson Foundation and is now one of the wealthiest African American entrepreneurs in history, with an estimated net worth of $500 million. (Johnson initially invested in and built a chain of movie theaters in under-served, urban communities and recently became part owner of the LA Dodgers, the first African American to become a franchise owner in MLB history.)

Although Johnson is perhaps the most visible face of HIV, his story obscures an important fact. HIV/AIDS is increasingly a disease of economic inequality. While sexual and racial minorities have borne the brunt of the epidemic’s burden. Living in poverty now increases the chances of being personally affected by the disease.

The Centers for Disease Control (CDC) report that 2.1 percent of heterosexuals living in high-poverty urban areas in the United States are infected with HIV, a rate well above the 1 percent designating a generalized epidemic.

While those with the most resources are best positioned to gain access to the latest and most effective HIV prevention and treatment efforts, those at the bottom of the social and economic ladder are not-finding themselves at a significant disadvantage when it comes to avoiding exposure to the virus and receiving treatment once infected.

World AIDS Day, December 1, is a reminder that this infectious disease has not defeated all its victims. But the virus has not yet been defeated either. More than one million people are living with HIV in the United States, and one in five don’t know that they have it. Approximately 50,000 Americans will become infected this year.

Still, we cannot allow “AIDS fatigue” to overtake our opportunity to end this epidemic, even if it means grappling with the economic inequalities that are now driving it.

For the past several years, I have studied more than 100 women living with HIV/AIDS in Chicago. Many live in communities overrun by the targeted marketing of legal and illegal drugs, which can encourage substance abuse and risky sexual behavior. They have seen loved ones incarcerated, disrupting the stability of intimate relationships. And with limited access to health care throughout their lives, his adds up to a deadly scenario.

At this summer’s International AIDS Conference in Washington, D.C., thousands of researchers, clinicians, activists, advocates, and people living with HIV/AIDS convened. From scientists laboring for a cure to activists working to prevent new infections through community outreach, attendees reflected on the possibility of an end to AIDS.

This is, of course, a question posed at AIDS-related conferences held annually throughout the world. Due to cutting-edge virus detection tools, promising prevention strategies and increasingly effective treatment regimes, we have more opportunities than ever to stem the tide of the epidemic.

The community of individuals and organizations contributing to this fight observe what’s happening on the ground, collect trend data, attempt interventions and evaluate their impact eventually- then making decisions on what avenues to pursue. In our attempts to do this, we seek out the most effective ways to reduce transmission and AIDS related deaths, as well as identify what to fund as the most promising scientific, policy, and programmatic advances. Additionally, we test messages to communicate to the public about our collective role in ending the epidemic.

After decades of trial and error, we have found that the most effective ways to fight the AIDS epidemic is to target our prevention and treatment efforts. Low-income populations are now in need of a targeted approach given the high numbers. To that end, two ingredients are critical to success.

First, we need more data. The CDC and the states that report local HIV infection rates to the CDC do not collect socioeconomic status data as part of their AIDS prevention and treatment surveillance. The CDC’s National HIV Behavioral Surveillance (NHBS) system gathers income information from a high-risk low-income urban population, but that is not a broad enough tool.

The trouble with this limited approach is that while we have witnessed the toll that has been taken on low-income populations, we can’t track trends, determine patterns, and pursue opportunities to unlock the relationship between HIV disease and economic disadvantage in every kind of community in the country. This constrains what we can prescribe.

Second, we must recognize that HIV/AIDS prevention is about more than safe sex, testing, and treatment (if infected). It is about more macro issues such as: access to affordable and accessible health care (including drug treatment), the rethinking of criminal justice policies for non-violent offenders, who have disruptive effects on community health when in and out of jails, and ensuring access to living-wage paying jobs so people can avoid relationships that may yield financial resources but limit their power to protect their sexual health.

One of the most important but often ignored frontiers in the AIDS battle is the social environment. The most consequential medical advances must be coupled with structural, community shifts to ensure that access and efficacy of these discoveries are not hampered.

To be sure, talking about the poor in relation to the AIDS epidemic should not require us to ignore the needs of middle class people who also grapple with the disease and who may suffer from other kinds of disadvantages on the basis of race, gender, or sexual orientation.

In my own research, middle class women living with HIV/AIDS report strong reluctance to attend AIDS support groups because of the stigma and association with women who seem very different except for their shared HIV status. Collecting socioeconomic data and targeting our messages and services could open up possibilities for improved outcomes through better strategies and communication.

Reducing the AIDS epidemic has required us to couple a universal message of protecting oneself with a targeted approach to the populations most affected. We should now gather the data and reduce structural, institutional, and interpersonal inequalities in order to prevent poverty from halting the progress toward the end of AIDS.

Celeste Watkins-Hayes, a Public Voices Fellow with the OpEd Project, is Associate Professor of Sociology and African American Studies at Northwestern University. She is also a Faculty Fellow at Northwestern’s Institute for Policy Research and Cells to Society (C2S): The Center on Social Disparities and Health.