Roosevelt Institute | Cornell University

Strengthening the National HIV/AIDS Strategy Through Humans Services

By Catherine GoreyPublished November 15, 2018

HIV/AIDs Virus
While historical strides have been made by previous administrations to increase policy, programs, and advocacy for HIV/AIDS prevention and treatment, the social determinant framework of prevention is a valuable outlet for future research and funding directives.

Historically, the United States has invested in programs and research to fight the epidemic of HIV and AIDS infections. Efforts have been made by public health organizations, policy advocates, and medical researchers. A particular concern in this field is access for low-income and other marginalized groups. At the time of the diseases’ origin, HIV/AIDS related policies were not strongly advocated for because they primarily affected gay men, a marginalized societal group. It was not until celebrities and children began to be affected that public attention and dedication to research started to emerge.


Executive Order 13649implemented by President Barack Obama in 2015 outlined a strategy for 2015 to 2020 that called for an HIV care continuum working group. This initiative was headed by the Office of National AIDS Policy, and it included membership of six federal agencies and a 6-month mission to report on the progress of efforts. While this order initiated important steps in increasing collaboration of federal agencies, special attention should be given to the revisions that pay attention to specific barriers that social groups face when receiving treatment and ensuring prevention of HIV/AIDS. Groups that were named included women and girls, cultural competency, and homelessness. This improvement is notable from original policy strategies, as the social determinant of health are better predictors of HIV outcomes than risk behaviors.


Current CDC data shows that only 30% of people living with HIV in the United States are virally suppressed, demonstrating that the 70% of those who have been diagnosed have not been supported in the necessary manner to navigate the existing system. Of those who do not retrieve treatment, minorities are disproportionately affected. African Americans make up 14% of the US population, but 44% of the HIV positive population. Along similar racial minorities, Latinos face three times the HIV infection rates as whites. Additionally, the original stigma against men who have sex with other men represent 2% of the population, but 61% of all new HIV infections.


The US Department of Health and Human Services should create an HIV research agenda based on the most sensitive populations affected by HIV in order to identify barriers of treatment that overlap with other issues of inequality. Issues such as contemporary segregation in housing, education, employment, health care, and mass incarceration should be addressed and specifically targeted. These factors intersect with poverty, gender, and sexuality to produce a multifaceted social exclusion from health care.


Additional research should be completed on populations affected, timing, extent of treatment, access to health services, and other structural inequalities present in populations. This research should then inform public policy efforts previously established in order to allocate funding effectively to areas where it is most needed. Once research of factors has been gathered, prevention efforts and programs can be tailored to those that will most effectively moderate the continuation of HIV/AIDS. Interpreting HIV/AIDS as a human rights and inequality issue will increase the potential framework for advocacy and possibility for expansion of programs that will increase other areas of health for the disadvantaged as well.