The HIV situation in the United States is complex and Multifaced. As per the Centre for Disease Control and Prevention (CDC), an estimated 1.2 million people in the U.S. were living with HIV as of 2019. HIV disproportionately affects certain populations, such as Hispanics/Latinos, African Americans, and gay and Bisexual men. In the U.S., HIV affects the African American (A.A.) population at a higher rate compared to other ethnicities. While A.A.s represent around 13% of the U.S. population, they account for 42% of new diagnoses and people living with HIV (Fauci et al., 2019). The gap in testing and treatment is attributed to stigma, substance abuse, and lack of quality health insurance.
Despite current public health campaigns, Black Georgians, specifically those living in Metro Atlanta, still represent a disproportionate number of new HIV infections. According to the Georgia Department of Public Health, African Americans also make up 32 % of the state’s population, but 71% of the 2500 Georgians were diagnosed with HIV in 2019 (Georgia Department of Public Health, 2021). Hence, policy focussed solutions targeting HIV in the Black community are essential. Barriers such as poverty, systemic inequalities, residential segregation and social and economic marginalization, homophobia, HIV stigma, and racism are among the longstanding barriers to health access and opportunities among Black or African American communities (HIV and Black/African American people in the U.S., 2022). These barriers create profound negative impacts which are pervasive and deeply embedded in society, including inequalities in access to employment, wealth, quality education and housing, and other social and economic benefits (Nosyk et al., 2020).
(Egede et al., 2020). Hence, the best plan of action to tackle HIV in Georgia is a state prevention approach that deals with the structural, social, and contextual environments that cause health disadvantages among African Americans.
Policy Recommendation
Georgia should allocate more funding and resources for programs led by community-based organizations to the Prevention of the virus, significantly because the unavailability of access to HIV testing and healthcare, as well as cultural AIDS stigma, has increased the rate or delay of treatment and diagnosis within the A.A. population (Airhihenbuwa et al., 2018). Georgia state legislators can pass a bill that supports more allocation of resources and funding to the A.A. communities through community-based organizations to do more outreach and testing. This will have a great impact on the A.A. population as it will increase access to treatment upon diagnosis, help save the state money, and reduce death and stigma through mass media awareness conducted by the community-based organization. Strategic campaigns to increase testing, abstinence, and pre-and post-exposure prophylaxis access. Effective prevention measures campaigns by community-based organizations should align with the National HIV/AIDS strategy goals, including; Prevention of new HIV infections, Improving HIV-related health outcomes of people with HIV, reduce HIV related health inequalities and disparities, and attaining coordinated efforts that address the HIV epidemic among stakeholders and partners (National HIV/AIDS strategy 2022-2025, 2023)
In addition, this policy would help address the structural and social environment as resources and funding would help initiate support from medical professionals, leaders, the public health sector, and the community at large on reviewing the many factors related to HIV. The current barriers in Georgia which affect the Prevention and treatment of HIV among the A.A. include the lack of culturally competent care, socioeconomic factors such as unemployment and poverty, limited access to prevention methods, stigma and discrimination to access HIV prevention and treatment service, and the lack of success to healthcare. These barriers can result in delayed diagnosis, inadequate care, and poorer health outcomes.
Georgia has implemented a number of prevention and treatment programs to address the issue. The state offers free HIV testing and counseling services at public health clinics throughout the state. It also has a syringe services program that provides clean needles and other harm-reduction services to people who inject drugs. The state also has programs that provide support and treatment to people living with HIV, such as the AIDS Drug Assistance Program (ADAP) and the state’s Ryan White HIV/AIDS program. These programs provide free medication and medical support services to people from low-income households. However, these programs are not effective in addressing the issue of HIV. However, the current CBOs in Georgia, such as AID Atlanta and Someone Cares Inc only handle HIV among all populations, but my policy aims to liaise with organizations dealing with marginalized communities such as African Americans. Effective prevention programs and initiatives focused on A.A. have the potential to greatly reduce the financial burden of the HIV/AIDS pandemic as well as create balance in health equity.
Overall, the policy could help analyze the current primary status of HIV/AIDS and create a fundamental understanding of the African American community issues. Adequate and appropriate resource allocation will help meet the community at the root, and this will help implement more culturally appropriate solutions. This can help create health equality as all stakeholders, including public health practitioners, policymakers, community leaders, and the public health sector, work towards assessing the stigma and access underlying the disease and encourage safe practices among the patient population.
A Major Policy Alternative
A major policy alternative would be to expand Medicaid. Currently, Georgia has not yet expanded Medicaid under the Affordable Care Act (ACA) (Michener, 2021). This means that the eligibility criteria for Medicaid in Georgia are more restrictive than in other states with Medicaid. A policy on the expansion of Medicaid would help ensure the eligibility of HIV patients guaranteed. This policy can be aimed at lowering the disproportional impact of HIV on African Americans but would require extensive engagement by Georgia Legislators, which could be tedious and costly. However, the implementation of this policy is not as effective as it requires that the state sends State Plan Amendments to Centres for Medicare and Medicaid Services for review and approval. This means that it would take a longer period of time and probable political interferences within the process. Hence, it is the least-recommended policy.
Conclusion
Expanding the prevention measures for the spread of HIV among the African American population will support the efforts towards achieving health equity among the disproportionate rates of Blacks in Georgia. HIV continues to be a national and international public health issue. It further causes health disparities in America, and everyone should be part of the solution to fight against the spread of HIV. The racial HIV and health gap is highly correlated with the racial wealth gap, a direct outcome of historical and systemic issues of segregation in employment, education, healthcare, and housing. These factors intersect with sexuality, gender, and poverty, among others, embody sexual exclusion and standard health inequalities. HIV/AIDS distribution indicates that race is a social index for impoverishment, isolation, and health inequalities. The current health system was established when racial segregation and other forms of discrimination based on disability, sexual orientation, and gender identity were sanctioned by custom and law. This widespread discrimination led to structural health disparities for racial groups, which can only be solved through affirmative action.
References
Airhihenbuwa, C. O., DiClemente, R. J., Wingood, G. M., & Lowe, A. (2018). HIV/AIDS education and Prevention among African-Americans: a focus on culture. AIDS Education and Prevention. Economically disadvantaged | HIV by group | HIV/AIDS
CDC. (2022, April 1). Centers for Disease Control and Prevention. https://www.cdc.gov/hiv/group/poverty.html
Egede, L. E., & Walker, R. J. (2020). Structural racism, social risk factors, and Covid-19—a dangerous convergence for Black Americans. New England Journal of Medicine, 383(12), e77.
Fauci, A. S., Redfield, R. R., Sigounas, G., Weahkee, M. D., & Giroir, B. P. (2019). Ending the HIV epidemic: a plan for the United States. Jama, 321(9), 844-845.
Georgia Department of Public Health, HIV/AIDS Epidemiology Section HIV Epidemiologic Profile, Georgia, 2021 https://dph.georgia.gov/epidemiology/georgias-hivaidsepidemiology-section/georgia-hiv-surveillance-data, Published September 2021, [Accessed: date]
HIV and African American people. (2022, June 28). Centers for Disease Control and Prevention. https://www.cdc.gov/hiv/group/racialethnic/africanamericans/index.html
HIV and Black/African American people in the U.S. (2022, August 25). Centers for Disease Control and Prevention. https://www.cdc.gov/nchhstp/newsroom/fact-sheets/hiv/black-african-american-factsheet.html
Michener, J. D. (2021). Politics, pandemic, and racial justice through the lens of Medicaid. American Journal of public health, 111(4), 643-646.
National HIV/AIDS Strategy 2022-2025 (NHAS). (2022). HIV.gov. https://www.hiv.gov/federal-response/national-hiv-aids-strategy/national-hiv-aids-strategy-2022-2025/
Nosyk, B., Zang, X., Krebs, E., Enns, B., Min, J. E., Behrends, C. N., … & Montaner, J. (2020). Ending the HIV epidemic in the USA: An economic modeling study in six cities. The Lancet HIV, 7(7), e491-e503.
Yancy, C. W. (2020). COVID-19 and African Americans. Jama, 323(19), 1891-1892.
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