World AIDS Day: How the Social Determinants of Health Affect HIV Transmission

As COVID-19 continues to wreak havoc on the US and world, it’s important to remember that care for other diseases is still needed. With our healthcare systems strained, many are missing routine checkups, mammograms, colonoscopies, and even dental appointments.  

Today is World AIDS Day, raising awareness for the 38 million global individuals living with HIV currently and transmission prevention practices. Though we're all staying home as much as we can, it's important to STILL TRACK ANY HIV RISK FACTORS YOU MAY HAVE and get tested accordingly.

Moving forward, The US still needs to adopt a more patient-centered model of healthcare to prevent transmission and provide more well-rounded treatment to those affected.

AIDS is a classic example of how the Social Determinants of Health (SDoH) play an instrumental role in an individual's health. According to "Addressing Social Determinants of Health in the Prevention and Control of HIV/AIDS, Viral Hepatitis, Sexually Transmitted Infections, and Tuberculosis", by HAZEL D. DEAN, ScD, MPH and KEVIN A. FENTON, MD, PhD, most transmission prevention occurs within a wider narrative of social determinants:

"These more proximal determinants of transmission risk also occur within the context of wider social and structural determinants.7,8 Structural factors include those physical, social, cultural, organizational, community, economic, legal, or policy aspects of the environment that impede or facilitate efforts to avoid disease transmission. Social factors include the economic and social conditions that influence the health of people and communities as a whole, and include conditions for early childhood development, education, employment, income and job security, food security, health services, and access to services, housing, social exclusion, and stigma [1]".

Early models for preventing HIV focused on the actions of an individual: condom use, screening, drug injection education, and more. While these models have led to some measure of improvement in infection rates, it neglects the stronger social health aspects of transmission.

"There is also a growing appreciation that although some individually oriented interventions have shown results in reducing risk behavior, their success is substantially improved when HIV prevention addresses the broader structural factors that shape or constrain individual behavior, such as poverty and wealth, gender, age, policy, and power [1]".

"There is also a growing appreciation that although some individually oriented interventions have shown results in reducing risk behavior, their success is substantially improved when HIV prevention addresses the broader structural factors that shape or constrain individual behavior, such as poverty and wealth, gender, age, policy, and power [1]".

Some intersection of community and societal interactions include:

• Incarceration
• Alcohol abuse
• Gender
• Birth Country
• Economic security

Patient-centered healthcare means taking care of the entirety of patient health: which includes food, transportation, education, and other social determinants.

IN OUR MOST RECENT EPISODE OF OUR PODCAST, The Patient's Journey, we spoke with EMS expert Mike Sechrist on how ignored social aspects of healthcare can have a pronounced impact on patient health:

"A lot of patients' health problems are a result of their social environment. I’ve run over seventy-five thousand 911 calls in my career, and, while you do see legitimate 911 emergent problems, you see a greater number of people with medical problems exacerbated by social issues. These patients suffer due to lack of good food, lack of available follow-up care, receiving their medication on time, receiving physical therapy, etc. Sure, a hospital can take care of a medical emergency. But what our system really needs to do is take care of the social and follow-up elements from care."

"Sure, a hospital can take care of a medical emergency. But what our system really needs to do is take care of the social and follow-up elements from care."

CLICK HERE TO LISTEN TO THE PODCAST EPISODE, and we recommend visiting HIV.GOV for more information related to HIV transmission and prevention.

1. Dean, H. D., & Fenton, K. A. (2010). Addressing social determinants of health in the prevention and control of HIV/AIDS, viral hepatitis, sexually transmitted infections, and tuberculosis.Public health reports (Washington, D.C. : 1974),125 Suppl 4(Suppl 4), 1–5. https://doi.org/10.1177/00333549101250S401