Addressing Social Determinants of Health for HIV Prevention and Care
By Reilly O'Neal | March 20, 2024
Contractor, ETR
Anyone can acquire HIV, but HIV doesn’t impact everyone equally. Why?
Factors beyond our individual behavior can make it easier or harder to engage with HIV prevention and care. These factors are known as social determinants of health. In honor of LGBT Health Awareness Week, we wanted to highlight how social determinants of health can affect HIV prevention and care, as well as how you can access our free course on social determinants of health and HIV available through CDCTRAIN.
What Exactly are Social Determinants of Health?
Social determinants of health are the non-medical factors influencing health and wellness for people and communities. They are “the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life,” as defined by the United States Centers for Disease Control and Prevention. Where you live, how safe your workplace is, and whether your gender identity is welcomed at your doctor’s office are all examples of social determinants of health.
Why do Social Determinants of Health Matter with HIV?
For many years, HIV prevention efforts focused on behavior change, such as increasing the use of condoms and PrEP (pre-exposure prophylaxis). Research on social determinants of health helps us understand how other factors, outside of individual behavior, contribute to HIV outcomes and overall health—and that can help us better serve disproportionately affected communities.
We can think about social determinants of health in five key domains related to education, health care, environment, social context, and economic stability. Life experiences in these domains can make people more or less likely to access HIV prevention tools, acquire HIV, know their status, connect with care and treatment, and stay healthy with an HIV diagnosis.
Let’s explore an example in the “health care access and quality” domain. A recent study with nearly 400 transgender and gender-diverse participants found that lack of culturally responsive, trans-inclusive care was a barrier to accessing PrEP, a powerful HIV prevention tool.
In the study, PrEP awareness was high, but few participants (under 5%) had used it despite having condomless sex and other factors linked with HIV acquisition. Participants described health care experiences that made it harder to access PrEP, such as having to switch providers to find one they felt comfortable with, as well as providers using the wrong pronouns and other misgendering language. Additional experiences included not asking questions about sexual history, not being knowledgeable about PrEP, or not suggesting PrEP as an option. All stressed the value of having affirming providers who could relate to transgender and gender-diverse clients.
As one PrEP-seeking participant put it, “I know a lot of my friends have this fear of going to the doctor’s office and having to, first, explain to their doctor that they’re trans, and then, how that affects everything else, and sort of feeling like they’re going to the doctor’s office with more knowledge than the professional.”
How Can You Address Social Determinants of Health in Your Work?
Addressing social determinants of health in our communities is an essential part of supporting people in getting the HIV services they want and need. Here are some ways to get started:
Acknowledge and address bias. We all have implicit bias, also called unconscious bias, that shapes how we perceive and treat people based on things like race, gender identity, or sexual orientation. Understanding implicit bias can help address social determinants of health such as racism, homophobia, and transphobia.
Here’s an example: As part of a CDC-funded demonstration project on HIV inequities based on race, sexual orientation, and gender identity, the Louisiana Department of Health and local HIV organizations made extensive changes to address racism, homophobia, and transphobia at their sites. Changes included training new hires on racism and health equity and creating new staff positions to better serve LGBTQ+ communities and communities of color.
Boost access to non-HIV services. Clients who are reluctant to visit an HIV clinic may feel more comfortable seeking HIV testing, prevention, and care at a site that also provides primary care, dentistry, food assistance, etc. Offering HIV services alongside other health and social support services can help address HIV stigma and increase access to health care in general.
Partner with others. What if your organization can’t be a one-stop shop? Partnering with other agencies can help fill gaps in services and address additional social determinants of health like housing and economic stability. For example, KC Life 360 provides housing and employment navigation to people with HIV in Kansas City, Missouri, and partners with external agencies focused on job placement, transitional housing, and housing case management. These partnerships mean clients have ready access to a broader range of housing and employment support services than KC Life360 alone can provide.
Want to Learn More?
To learn more about social determinants of health, check out ETR’s Health Equity Framework (HEF). The HEF illustrates how health outcomes are influenced by complex interactions between people and their environments. The HEF website features an interactive tool, a video, and the article “The Health Equity Framework: A Science and Justice-Based Model for Public Health Researchers and Practitioners,” written by staff at ETR.
Additionally, take the Addressing Social Determinants of Health for HIV Prevention and Care course developed by ETR’s EVOLVE project team for free on CDCTrain!
How to access the course:
New to CDC TRAIN?
1. Create a CDC TRAIN account.
2. Join the HIVCBA Learning Group.
3. Launch the course.
Already on CDC TRAIN?
1. Launch the course.
Reilly O’Neal (she/her) is a contractor with ETR, helping write and update courses on HIV prevention and care. She has developed trainings and other content for PleasePrEPMe, HealthHIV, and the University of California at San Francisco and is a former editor of BETA at San Francisco AIDS Foundation. Reilly has worked in HIV and sexual health since 2006.
