By Aaliyah Moore, BA and Jessica McCann, MPH
Background
December 1 marked World AIDS Day, a global occasion to unite in the fight against HIV, support those living with the virus, and remember those who have lost their lives to AIDS-related illnesses. This year’s theme for 2024 World AIDS Day, “Collective Action: Sustain and Accelerate HIV Progress,” underscores the urgency of advancing policies and development that support these goals. Below, in honor of this day, we examine global and domestic HIV issues and persistent disparities impacting communities across the United States.
Globally, the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) has saved millions of lives and improved access to HIV/AIDS prevention, treatment, and care in regions with limited resources. For example, in Sub-Saharan Africa, which carries a disproportionate share of the global HIV burden, PEPFAR has been a cornerstone for care, treatment, and prevention. However, despite global progress, challenges persist, including access to medications, stigma, and social determinants of health that disproportionately affect vulnerable populations. This underscores the importance of continued international collaboration and innovation to achieve collective action to sustain and accelerate HIV progress.
HIV Trends and Disparities
Here in the United States, we still face poorer health outcomes than other high-income nations despite spending twice as much on health care. Certain populations, including Black and Latino communities, LGBTQ+ individuals, and people in rural areas, continue to experience stark disparities in access to prevention and treatment services. According to the Kaiser Family Foundation, in 2022, Black adults and adolescents experienced a new HIV diagnosis rate of 41.6 per 100,000 people — eight times higher than white people and twice as high as Latinos. Black men face the highest HIV diagnosis rate of any demographic at 66.3 per 100,000, with Latino men following at 40.8 per 100,000. While HIV prevention efforts focus on men, Black women bear a disproportionate burden, accounting for 54% of new infections among women despite being less than 15% of the U.S. female population. These statistics highlight the urgent need to strengthen and expand targeted prevention efforts tailored to the needs of the most vulnerable communities within the U.S., ensuring equal access to resources and support.
These barriers are further compounded by systemic inequalities, including lack of health care access and stigma and discrimination, that affect HIV treatment and prevention. The American Medical Association reported that 65% of rural regions in the United States face shortages of primary care physicians. These shortages, coupled with rural hospital closings – 138 hospitals between 2010 and 2017 – historically affect marginalized populations who also face access barriers such as inadequate mental health treatment, lack of proper health insurance, high costs, poor quality of care, and limited awareness. Stigma and discrimination, which may include believing that people deserve HIV because of their choices, isolating a member of a community because they have HIV, and even refusing health care to people with HIV, negatively affect the mental and emotional well-being of people living with HIV and may prevent individuals from considering preventive treatment and testing. Addressing these structural issues is critical to advancing the movement toward a national collective action to sustain and accelerate HIV progress.
Progress
Over the past few decades, HIV prevention and treatment have undergone remarkable improvements, with advances significantly improving quality of life and reducing transmission rates. One of the most impactful developments has been pre-exposure prophylaxis (PrEP), which became widely available in 2012. Taken daily, PrEP effectively prevents HIV transmission when used consistently, reducing the risk of sexual transmission by 99%. Once regarded as a terminal diagnosis, HIV is now managed effectively through antiretroviral therapy (ART), allowing people to live long and healthy lives with the virus being undetectable and untransmittable. Also proven effective, Cabenuva, a bi-monthly injection approved in 2021 to treat HIV, revolutionized HIV care, offering an alternative to daily ART. Lenacapavir, an HIV treatment approved by the FDA in 2022, is also life-changing as it requires only biannual injections. These advancements have drastically reduced HIV transmission and made HIV a manageable condition for many.
Why Should We Care
Globally, almost 40 million people are living with HIV, and despite significant advancements in treatment and prevention, the virus continues to spread, especially in underserved communities.
In 2023, 1.3 million people were newly infected, affecting communities everywhere. Without active participation and shared commitment to addressing this health crisis, inequalities will continue to persist, and prevention and treatment will move slowly, ensuring vulnerable populations remain at high risk. HIV is far from eradicated and will continue to spread without collective action. Groundbreaking tools like PrEP, Cabenuva, and Lenacapavir offer revolutionary solutions, yet systemic barriers like care access, stigma, and discrimination prevent access to these life-saving interventions. Until we eliminate these barriers, HIV will continue to have societal and economic impacts, both globally and in the U.S.
Looking Forward: Collective Action to Sustain and Accelerate HIV Progress
To honor this year’s theme of collective action to sustain and accelerate HIV progress, we must look inward as a nation and confront these barriers head-on. We must invest in community health programs that bring advancements to those in need, expand Medicaid in states that have resisted expansion, and address social determinants of health that perpetuate inequalities. We must sufficiently fund public education programs that fight stigma and provide culturally competent care for marginalized populations, especially Black and Latino communities, who bear the brunt of new infections. We need a national collective action so that our strides are not undermined. As a collective, we can ensure that the fight against HIV reaches everyone, leaving no one behind, including the people suffering within the walls of our nation.
To learn more, see our previous work: