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Structural Factors and the National HIV/AIDS Strategy of the USA

Part of the Social Aspects of HIV book series (SHIV,volume 4)

Abstract

The United States of America’s (USA) first-ever comprehensive, National HIV/AIDS Strategy (NHAS) was released in July 2010 and delineated three goals: reduce new HIV infections, increase access to care and improve health outcomes for people living with HIV and reduce HIV-related disparities and health inequities. Increased attention to the social and structural factors influencing disease risk and affecting health outcomes is deemed essential to achieving the NHAS goals. Employing the broad taxonomy of ‘environment’ and ‘social context’, this chapter reviews the major structural interventions called for in the initial 2010 release of the NHAS and its subsequent update in 2015, providing examples that highlight the HIV epidemic among Black men who have sex with men, the community in the USA that is currently most disproportionately affected by the HIV epidemic. The review documents both positive movement toward the NHAS goals as well as instances where progress has been insufficient. The authors conclude that a systems science approach will be required to address the ‘upstream factors’ that contribute to poor HIV outcomes, including social disadvantage and social inequity.

Keywords

  • HIV/AIDS
  • Stigma
  • Structural Interventions
  • Disparities
  • Social Determinants of Health

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  • DOI: 10.1007/978-3-319-63522-4_9
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Notes

  1. 1.

    Prior to the passage of the Affordable Care Act, eligibility for the US Medicaid program was based on a number of factors including: income, household size, disability and family status. Prior to the ACA, people living with HIV had to manifest end-stage disease (i.e. AIDS) to be considered eligible for Medicaid. For states that have opted to expand Medicaid eligibility under the ACA, household income is now the only qualification.

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Correspondence to Ronald O. Valdiserri .

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Valdiserri, R.O., Maulsby, C.H., Holtgrave, D.R. (2018). Structural Factors and the National HIV/AIDS Strategy of the USA. In: Kerrigan, D., Barrington, C. (eds) Structural Dynamics of HIV. Social Aspects of HIV, vol 4. Springer, Cham. https://doi.org/10.1007/978-3-319-63522-4_9

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  • DOI: https://doi.org/10.1007/978-3-319-63522-4_9

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-63521-7

  • Online ISBN: 978-3-319-63522-4

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