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HIV Prevention in the United States:

Expanding the Impact

Expanding the Impact
To Date
in HIV
of HIV

Socioeconomic Factors Affecting HIV Risk

Reducing the toll of HIV on communities that are disproportionately affected requires confronting the complex social, economic, and environmental factors that fuel the epidemic in these communities.

  • Poverty can limit access to health care, HIV testing, and medications that can lower levels of HIV in the blood and help prevent transmission. In addition, those who cannot afford the basics in life may end up in circumstances that increase their HIV risk.
  • Discrimination, stigma and homophobia: Far too prevalent in many communities, these factors may discourage individuals from seeking testing, prevention, and treatment services.
  • Prevalence of HIV and other STDs in a community: More people living with HIV or infected with STDs can increase an individual’s risk of infection with every sexual encounter, especially if, within those communities, people select partners who are from the same ethnicity.
  • Higher rates of undiagnosed/untreated STDs can increase the risk of both acquiring and transmitting HIV.
  • Higher rates of incarceration among men can disrupt social and sexual networks in the broader community and decrease the number of available partners for women, which can fuel the spread of HIV.
  • Language barriers and concerns about immigration status present additional prevention challenges.

While the impact of such factors can be difficult to quantify, one recent analysis documents the association of some critical socioeconomic characteristics with risk for HIV infection. The study found that poverty was a key factor associated with HIV infection among inner-city heterosexuals. Within the low income urban areas included in the analysis, individuals living below the poverty line were twice as likely to be HIV-infected as those who lived in the same community but lived above the poverty line (2.3 percent prevalence vs. 1.0 percent), and prevalence for both groups was far higher than the national average (0.45 percent). Within these high poverty areas, HIV prevalence was high and comparable across racial/ethnic groups. In addition to being more common in low income households, HIV infection was also more common among those who were unemployed and had less than a high school education.6

These findings underscore the urgent need to prioritize and target HIV prevention efforts in disproportionately affected communities and ensure that both individual and social determinants of risk are considered in the design and implementation of prevention efforts.

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