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Unveiling the Silent Crisis: HIV/AIDS and Health Disparities in Unhoused Communities



December is HIV/AIDS Awareness Month, which means communities across the world are joining to broadcast the current state of the epidemic, and more importantly, how the global community plans to move forward. Each year, the Federal Government funds multi-million dollar initiatives on the local, state, and national level to curb the prevalence of HIV and create pathways for treating AIDs-related illnesses. And still, despite these efforts, health disparities for certain populations continue to persist.  It is known that people experiencing homelessness are not only at a higher risk of contracting HIV but also face unique hurdles in accessing healthcare. These exacerbating health disparities perpetuate a gap in care for those who are often overlooked. As we collectively observe HIV/AIDS Awareness Month, it's crucial to shine a spotlight on the interconnected issues that plague our unhoused neighbors, emphasizing the urgent need for empathy-driven, direct action in the US. 


“After nearly 40 years of tireless advocacy, determined research, and dedicated delivery of diagnostic, prevention, care, treatment, and supportive services, the United States now has the opportunity to end the HIV epidemic.” -NIH 

The statement above is taken directly from the National HIV/AIDS Strategy (NHAS), sponsored by the White House, in 2022. For those suffering from AIDS, or those coming to terms with a new HIV diagnosis, these words hold significant weight. The fight for adequate HIV/AIDS education, health screenings, and equal access to services has been an ongoing fight since the 1980’s. But in order to end the HIV epidemic by 2030, as the NHAS intends to, we must be open to facing and solving multiple health disparities first.


Prevalence of HIV within Marginalized Groups: 


In 2021, the United States recorded 1.2 million diagnosed cases of HIV. Despite an overall decline in the HIV incidence rate by 7% annually since then, thanks in large part to the implementation of innovative public health measures, these improvements don't uniformly extend to marginalized communities. In fact, marginalized populations often have the least amount of access to healthcare, life-saving medicine, and social HIV/AIDS support. Notably, Queer men face the highest HIV impact, particularly among Black and African American men who bear the brunt of the suffering. As is often the case with health disparities, the unhoused population remains disproportionately impacted by infectious diseases. 


Historically, AIDS has ravaged underserved communities that already face stacking discrimination from systems of power – especially in health care. Still today, BIPOC and LGBTQIA+ people, people who used injection drugs, sex workers, and those experiencing homelessness are not only at higher risk for contracting HIV, but they are often met with discrimination from the same institutions that are intended to treat them. One’s housing status, recognized as a social determinant of health—conditions that shape an individual's well-being—exerts a substantial influence on the outcomes of HIV prevention and care.


The homeless LGBTQ+ community faces a particularly heightened risk, as they often encounter discrimination and violence, contributing to higher rates of HIV/AIDS. Limited access to healthcare facilities, lack of awareness, and the struggle for basic necessities create an interwoven net of health disparities that disproportionately affect this community.


Community-Based Care is Paving the Way: 

Despite being pushed to the margins of society, those who are most at risk are the same people who are often leading the charge for collaborative efforts to treat AIDS-related illnesses and innovation in preventing the spread of HIV. Since the first days of the epidemic, in the 1980s, communities have played a vital role in facilitating person-centered public health services, fostering trust, promoting innovation, overseeing policy implementation, and ensuring provider accountability. However, the leadership potential of these groups is hindered by challenges such as funding shortages, policy obstacles, regulatory constraints, capacity limitations, and restrictions on civil society and the human rights of marginalized peoples. Overcoming these barriers would empower community-led organizations to significantly enhance the global HIV response, accelerating progress toward ending AIDS.


In the face of this crisis, the City of Boston has taken commendable steps to address the specific needs of the homeless community in relation to HIV/AIDS. Since 1999, Massachusetts has seen a 52% reduction in new HIV diagnoses. Collaborative efforts between local non-profits, healthcare providers, and government agencies have led to increased outreach programs, mobile clinics, and the distribution of free prevention resources such as PrEP. Our city has prioritized destigmatizing HIV testing and improving healthcare accessibility for the unhoused population. Initiatives include providing shelters with educational resources and training staff to recognize the signs of HIV/AIDS, fostering a more compassionate and informed community response. 


While Boston has set a strong example for how a community-driven approach can significantly reduce new HIV diagnoses and provide adequate treatment for those suffering from AIDS, the national response to the HIV epidemic must be just as robust and unified. Less than one-half (39%) of the U.S. population has ever been tested for HIV. Increased funding for outreach programs, affordable healthcare, and housing solutions for the homeless can go a long way in curbing the spread of HIV/AIDS and addressing the health disparities prevalent in this vulnerable population.


A Call to Action for Supporting Community-Based Care

December 1st marked the annual World AIDS Day, where communities show solidarity with those living with HIV and/or those who have died from AIDS-related illnesses. This year, the theme for World AIDS Day (sponsored by UNAIDS) was “Let Communities Lead,” emphasizing the importance of grassroots organizations that adequately represent the populations they serve. 


In the spirit of December's HIV/AIDS Awareness Month, let us strive to transform empathy into action and advocacy for:


1. Robust Community Education: Launch comprehensive education campaigns within homeless shelters, community centers, and schools to raise awareness about HIV/AIDS, prevention, and available resources.


2. Integrated Healthcare Services: Advocate for the integration of healthcare services within homeless shelters, ensuring that individuals have access to regular check-ups, testing, and treatment.


3. Affordable Housing Solutions: Address the root causes of homelessness by investing in affordable housing solutions, providing stable environments that support overall health and well-being.


4. Unconditional Collaboration and Support: Foster collaboration between local non-profits, government agencies, and healthcare providers to create a holistic support system for homeless individuals living with HIV/AIDS. Fund the staffing needs of these organizations, and reduce barriers to leadership. 


Conclusion: 

By understanding the unique challenges faced by Boston's unhoused community in the context of HIV/AIDS, we can work together to build a more inclusive and compassionate city, where health disparities are replaced with hope and resilience.

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