Hiv/aids And Socioeconomic Status
Socioeconomic status encompasses not just income but also educational attainment, financial security, and subjective perceptions of social status and social class. Socioeconomic status can encompass quality of life attributes as well as the opportunities and privileges afforded to people within society. Poverty, specifically, is not a single factor but rather is characterized by multiple physical and psychosocial stressors. Further, SES is a consistent and reliable predictor of a vast array of outcomes across the life span, including physical and psychological health. Thus, SES is relevant to all realms of behavioral and social science, including research, practice, education and advocacy.
Hiv Statistics By State
Human immunodeficiency virus, or HIV, is a virus that weakens a persons immune system by attacking cells that fight off infection, specifically a persons CD4 cells. HIV is spread through body fluids such as blood. If HIV goes untreated and advances, it can lead to acquired immunodeficiency syndrome or AIDS.
Unlike most other viruses, when a person contracts HIV, they have it for life because the human body cannot fight off the virus entirely. HIV, however, can be controlled and its progression can be slowed significantly. There are three stages of HIV:
Impact On Communities Of Color
- Racial and ethnic minorities have been disproportionately affected by HIV/AIDS since the beginning of the epidemic, and represent the majority of new HIV diagnoses, people living with HIV disease, and deaths among people with HIV.37,38
- Black and Latino people account for a disproportionate share of new HIV diagnoses, relative to their size in the U.S. population .39,40 Black people also account for more people living with HIV than any other racial group â an estimated 479,300 of the 1.2 million people living with HIV in the U.S. are black.41
- Black people also have the highest rate of new HIV diagnoses, followed by Latino people â in 2019, the rate of new HIV diagnoses per 100,000 for Black people was about 8 times that of white people Latino people had a rate 4 times that of white people.42
- Black people accounted for close to half of deaths among people with an HIV diagnosis in 2019.43,44
- Survival after an AIDS diagnosis is lower for Black people than for most other racial/ethnic groups, and Black people have had the highest age-adjusted death rate due to HIV disease throughout most of the epidemic.45 HIV ranks higher as a cause of death for Black and Latino people, compared with White people.46 Further, HIV was the 6th leading cause of death for Black people ages 25-34 in 2019.47
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Hiv And Aids In Eswatini
KEY POINTS
- Despite its small population size, Eswatini has the highest HIV prevalence in the world and has been greatly affected by the epidemic.
- Although the epidemic is generalised, certain groups are particularly affected, especially those who are socially marginalised and criminalised. For example, the country has the highest HIV prevalence among sex workers in the world .
- Over the last decade, Eswatini has made great efforts to turn around its epidemic with improved access to HIV testing services and the provision of free antiretroviral treatment to those who need it.
- Eswatini has a dual epidemic of TB and HIV and has responded with successful dual test and treatment programmes.
- High levels of HIV stigma and discrimination in Eswatini remain major barriers to people accessing HIV prevention services.
Explore this page to find out more about populations most affected by HIV, testing and counselling, , antiretroviral treatment availability, , tuberculosis and HIV, barriers to prevention, and the future of HIV in eSwatini.
Eswatini, a small, landlocked country in southern Africa, has the highest HIV prevalence in the world, with 27.3% of adults living with HIV. In 2018, 7,800 adults were newly infected with HIV and 2,800 people died of an AIDS-related illness.1
Hiv/aids In The 1990s And 2000s
In 1991, the red ribbon became an international symbol of AIDS awareness.
In that year, basketball player Magic Johnson announced he had HIV, helping to further bring awareness to the issue and dispel the stereotype of it being a gay disease. Soon after, Freddie Mercurylead singer of the band Queenannounced he had AIDS and died a day later.
In 1994, the FDA approved the first oral HIV test. Two years later, it approved the first home testing kit and the first urine test.
AIDS-related deaths and hospitalizations in developed countries began to decline sharply in 1995 thanks to new medications and the introduction of HAART. Still, by 1999, AIDS was the fourth biggest cause of death in the world and the leading cause of death in Africa.
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Condom Availability And Use
One of key requirements for health departments receiving previous CDC prevention funding was to establish and maintain condom distribution programmes for people with HIV and people at high risk of acquiring it. Between 2012 and 2014, the most recent data available, these types of programmes distributed over 248 million condoms.69
Despite this, CDC reports a long-term decline in condom use among men who have sex with men from as early as 2005 . In 2016, it was reported that the greatest increase in sex without condoms was seen in young men, aged 18 to 24.70
Hiv Prevention Programmes In The Usa
In 2017, an estimated 38,700 people became newly infected with HIV.66
In an attempt to advance high-impact HIV prevention across the USA, between 2012 and 2017, CDC created a new prevention fund cycle for US $339 million. Grants were awarded to health departments that could demonstrate they were providing HIV prevention services to those with the greatest need. Services also had to show they used combined behavioural, medical and structural HIV prevention strategies.67
In 2019, CDC announced a new 10-year plan to end the HIV epidemic. The programme aims to reduce new HIV infections by 75% in five years and by 90% in 10 years. It focuses on Washington, D.C., San Juan , 48 counties and seven states that have a substantial rural HIV burden. Its key components are described as being diagnose, treat, protect, and respond the latter two components relate to HIV prevention. Protect relates to using evidence-based prevention interventions, while respond relates to detecting and responding to growing HIV clusters to disrupt chains of transmission, thereby preventing new infections.68
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The Future Of Hiv In Eswatini
In recent years Eswatini has made great progress in tackling HIV, particularly around the areas of treatment, PMTCT and reducing HIV incidence overall.
However, the high HIV prevalence among the general population means the government will need to tackle many of the social and cultural problems that hamper the response. These include poverty, gender inequality and risky cultural practices that contribute to a high risk of HIV infection.120
Effective prevention initiatives and a greater focus on improving access to HIV testing facilities are also urgently needed, especially for men, young people and criminalised populations. The epidemic among key affected populations, particularly female sex workers and men who have sex with men, also needs to be addressed.
ART coverage shows adolescent boys and girls and men are lagging behind. Without increased testing and treatment enrolment among these groups, HIV incidence will not decline as quickly as anticipated.121 In addition, the decline in the proportion of pregnant women who are HIV-positive accessing ART must be reversed, or important gains is this area risk being lost.
The government needs to work harder to collect data and understand the complex needs of population groups most affected by HIV in order to develop adequate HIV programming. The dual epidemic of TB and HIV also remains a cause for concern.
How Are We Monitoring Progress In Canada
In February 2018, PHAC convened an expert working group meeting to discuss the measures within the HIV continuum of care for Canada. Based on a review of measures used internationally, the PHAC expert group recommended monitoring a four-stage continuum: Stage 1 the estimated number of all people living with HIV Stage 2 the number of all PLHIV who have been diagnosed Stage 3 the number on PLHIV who have been diagnosed and who are on ART and Stage 4 the number of PLHIV on ART who are virally suppressed .
Figure 1. Four-stage HIV continuum of care framework for Canada
This diagram shows the four-stage continuum Canada uses to measure the HIV continuum of care:
Stage 1 the estimated number of all people living with HIV Stage 2 the number of all PLHIV who have been diagnosed Stage 3 the number on PLHIV who have been diagnosed and who are on ART and Stage 4 the number of PLHIV on ART who are virally suppressed.
Data Sources
HIV estimates related to incidence, prevalence and the first 90-90-90 target were developed using HIV surveillance data reported by provinces and territories, estimated deaths among persons living with HIV, and back-calculation statistical modelling methods. Additional detail on these methods is provided in Appendix 1.
The development of estimates for the second and third 90-90-90 targets required additional information from the provinces and territories, including the following where available:
Data limitations and caveats
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New Hiv Infection Rates
New HIV infection rates have dropped over the years. The world has seen a 52% reduction in new HIV infections since the epidemic peaked in 1997. In 1997, 3 million people reported new HIV infections, compared with only 2.1 million in 2010 and 1.5 million in 2020.
This is because people in resource-poor countries now have significantly improved access to HIV treatments. Preventing vertical transmission of HIV, which refers to when the infection passes from a birthing parent to their fetus, has also contributed to lowering transmission rates. Additionally, the medical community has added new HIV prevention tools and methods.
However, the unequal distribution of HIV treatment and prevention strategies still leaves many vulnerable populations behind. Important barriers to improving access to care include stigma, discrimination, social inequities, and exclusion.
Before the COVID-19 pandemic, many people with HIV or at risk of HIV still did not have access to prevention, care, and treatment. The pandemic caused a greater disturbance in the distribution of health services in many countries. Some countries report a 75% disruption of HIV services.
According to UNAIDS, the Joint United Nations Programme on HIV/AIDS, the benefits of providing HIV services outweigh the risk of dying from COVID-19.
HIV spreads through contact with bodily fluids from people who have the virus. Bodily fluids that carry HIV include:
- blood
It is not possible to contract HIV through:
Structural And Resource Barriers
Although Eswatini is politically stable and uncrowded, and has good farming land, high HIV prevalence, unemployment and food insecurity mean many residents experience hardship and poverty.111
Eswatini is a lower-middle income country, however these factors, coupled with a weak business climate and low foreign investment, mean the country operates more as a low-income country.112
As a result many residents migrate, particularly to South Africa. This makes the delivery of ongoing healthcare services a challenge and complicates the way in which the countrys HIV epidemic is monitored.113
It also contributes to the lack of skilled healthcare workers in Eswatini, with staffing levels unable to meet demand in a significant number of health facilities. There is also an urgent need to expand the number of community-based peer and outreach workers who can specifically meet the needs of key populations.114
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Ses Affects Our Society
SES affects overall human functioning, including our physical and mental health. Low SES and its correlates, such as lower educational achievement, poverty and poor health, ultimately affect our society. Inequities in health distribution, resource distribution, and quality of life are increasing in the United States and globally. Society benefits from an increased focus on the foundations of socioeconomic inequities and efforts to reduce the deep gaps in socioeconomic status in the United States and abroad.
Appendix 1 Additional Detail Related To Canada’s Modelling Method
Reference: Yan, Ping Zhang, Fan and Wand, Handan . Using HIV Diagnostic Data to Estimate HIV Incidence: Method and Simulation. Statistical Communications in Infectious Diseases: Vol. 3: Iss. 1, Article 6.
The statistical modelling method that was used to estimate the number of new HIV infections in Canada is based on a back-calculation method that combines HIV and AIDS diagnostic data with data on the proportions of recent infections among newly diagnosed individuals . The model estimates the time trend in the number of past HIV infections, up until the present time since surveillance data can only record the date of diagnosis and not the date of infection . From this trend in past HIV infections, the model then projects forward to calculate the expected number of HIV diagnoses . The back-calculation method used for incidence estimation in Canada is similar to methods used in the European Union, the USA, and Australia.
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People Living With Hiv
San Francisco has one of the largest populations of people living with HIV in the United States with an estimated 15,811 people living with HIV .
Of the total number of San Franciscans living with HIV/AIDS at the end of 2020, 8,950 were living with HIV ever classified as AIDS. AIDS is a late-stage HIV disease defined by a low count of CD4 cells or an opportunistic infection .
As of December 2020, 71% of people living with HIV in San Francisco were over age 50 .
Why Is Hiv Important
HIV is a preventable disease. Effective HIV prevention interventions have been proven to reduce HIV transmission. People who get tested for HIV and learn that they are infected can make significant behavior changes to improve their health and reduce the risk of transmitting HIV to their sex or drug-using partners. Recent scientific advances have demonstrated that early initiation of antiretroviral therapy not only preserves the health of people living with HIV but also reduces their risk of transmitting HIV to others by 93%.3
It is estimated that 91% of new HIV infections in the U.S. are transmitted from people not diangosed or diagnosed but not in care.4
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Rate Of New Infections
Per surveillance reports from UNAIDS, it is estimated that there were 38 million people living with HIV globally as of the end of 2019. Of these, approximately 1.7 million were newly infected.
These remain sobering figures, in part because infection rates are not declining at the pace needed to effectively end the epidemic. In fact, between 2010 and 2019, new infections around the world have decreased by about 23%, but a number of “hotspots” around the world experienced an increase.
In Russia and parts of Eastern Europe and Central Asia, the rate of new infections are reported to be increasing due in part to the lack of access to HIV-specific care and treatment.
Meanwhile, in countries like South Africa, which accounts for 7.5 million of the world’s HIV cases, an estimated 200,000 new infections occurred in 2019 despite impressive declines in the previous decade.
Even in the United States, the annual incidence of infections remained stagnant for many years until the widespread use of pre-exposure prophylaxis and other preventive measures gradually reduced the rate from 50,000 in the early part of the century to just under 40,000 today.
Emerging Issues In Hiv
As the number of people living with HIV increases and more people become aware of their HIV status, prevention strategies that are targeted specifically toward HIV-infected people are becoming more important. Prevention work with people living with HIV focuses on:
- Linking to and staying in HIV medical care, starting treatment, and getting virally suppressed
- Increasing the availability of ongoing HIV prevention interventions
- Providing prevention services for their partners
It is also important to foster wider availability of comprehensive services for people living with HIV and their partners through partnerships among health departments, community-based organizations, and health care and social service providers.
Public perception in the United States about the seriousness of HIV has declined in recent years. There is evidence that risky behaviors may be increasing among uninfected people, especially gay and bisexual men. Pre-exposure prophylaxis is a way to prevent becoming infected with HIV by taking a pill. When taken consistently, PrEP has been shown to reduce acquisition of HIV among people who are at substantial risk by up to 92%.6 Ongoing media campaignsparticularly those emphasizing HIV testingand HIV prevention interventions for uninfected people who engage in risky behaviors are critical. Efforts to diagnose people infected with HIV, get them virally suppressed, and provide prevention and support services are also vital.
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People With Diagnosed Hiv In 44 States And The District Of Columbia 2019*
* The 44 states are AL, AK, AZ, AR, CA, CO, CT, DE, FL, GA, HI, IL, IN, IA, LA, ME, MD, MA, MI, MN, MS, MO, MT,NE, NV, NH, NM, NY, NC, ND, OH, OK, OR, RI, SC, SD, TN, TX, UT, VA, WA, WV, WI, and WY. Had 2 viral load or CD4 tests at least 3 months apart in a year. Based on most recent viral load test.
Populations Most Affected By Hiv In The Usa
The HIV epidemic in the USA has impacted some groups more than others. These groups, sometimes referred to as key populations, can be grouped by transmission category (for example, but also by race and ethnicity, with people of colour having significantly higher rates of HIV infection over white Americans.11
A complex set of economic and socio-economic factors drive risk to these populations, including discrimination, stigma, poverty and a lack of access to care.12 Sexual networks also present a major risk factor as populations at a high risk of HIV tend to have sex with people in their own communities.
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