Building the Case for Localized Approaches to HIV: Structural Conditions and Health System Capacity to Address the HIV/AIDS Epidemic in Six US Cities
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Since the discovery of the secondary preventive benefits of antiretroviral therapy, national and international governing bodies have called for countries to reach 90% diagnosis, ART engagement and viral suppression among people living with HIV/AIDS. The US HIV epidemic is dispersed primarily across large urban centers, each with different underlying epidemiological and structural features. We selected six US cities, including Atlanta, Baltimore, Los Angeles, Miami, New York, and Seattle, with the objective of demonstrating the breadth of epidemiological and structural differences affecting the HIV/AIDS response across the US. We synthesized current and publicly-available surveillance, legal statutes, entitlement and discretionary funding, and service location data for each city. The vast differences we observed in each domain reinforce disparities in access to HIV treatment and prevention, and necessitate targeted, localized strategies to optimize the limited resources available for each city’s HIV/AIDS response.
KeywordsHIV Health system Policy Epidemiology
We acknowledge Jeong Eun Min and Emanuel Krebs for their early work in collecting information for this manuscript.
The Localized HIV Modeling Study Group is comprised of: Carlos Del Rio, MD, Hubert Department of Global Health, Emory Center for AIDS Research, Rollins School of Public Health of Emory University; Julia C Dombrowski, MD, Department of Epidemiology, University of Washington; Daniel J Feaster, PhD, Biostatistics Division, Department of Public Health Sciences, Leonard M. Miller School of Medicine, University of Miami; Kelly A Gebo, PhD, Bloomberg School of Public Health, Johns Hopkins University; Matthew R Golden, MD, Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington; Reuben M Granich, MD, International Association of Providers of AIDS Care; Thomas Kerr, PhD, BC Centre for Excellence in HIV/AIDS; Faculty of Medicine, University of British Columbia; Gregory D Kirk, PhD, Bloomberg School of Public Health, Johns Hopkins University; Brandon DL Marshall, PhD, Department of Epidemiology, Brown School of Public Health, Rhode Island, United States; Shruti H Mehta, PhD, Bloomberg School of Public Health, Johns Hopkins University; Lisa R Metsch, PhD, Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University; Julio S Montaner, MD, BC Centre for Excellence in HIV/AIDS; Faculty of Medicine, University of British Columbia; Bohdan Nosyk, PhD, BC Centre for Excellence in HIV/AIDS; Faculty of Health Sciences, Simon Fraser University; Bruce R Schackman, PhD, Department of Healthcare Policy and Research, Weill Cornell Medical College; Steven Shoptaw, PhD, Centre for HIV Identification, Prevention and Treatment Services, School of Medicine, University of California Los Angeles; William Small, PhD, BC Centre for Excellence in HIV/AIDS; Faculty of Health Sciences, Simon Fraser University; Steffanie A Strathdee, PhD, School of Medicine, University of California San Diego.
This study was funded by the National Institute on Drug Abuse (R01-DA041747); and the National Institute on Drug Abuse (P30DA040500).
Compliance with Ethical Standards
Conflict of interest
The authors declare that they have no conflict of interest.
This article does not contain any studies with human participants or animals performed by any of the authors.
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