A newly released study from the U.S. Centers for Disease Control and Prevention found that poverty may be the most important risk factor for HIV infection among heterosexuals living in urban areas. The research, conducted in 2006 and 2007 in 23 high-poverty neighborhoods, focused exclusively on heterosexuals who do not use intravenous drugs—those who are not considered to be at highest risk of HIV. The result: HIV was detected in 2.4 percent, or 1 in 42 people living below the poverty line in those neighborhoods.
HIV is at epidemic levels in certain poor urban areas across the United States, defined by UNAIDS as a prevalence in the general populations of more than 1 percent. And, perhaps even more significant, poor people living in those cities were twice as likely to be infected as people with incomes above the poverty line in the same neighborhoods. This news is not entirely new, as health officials and others have long believed that poverty is a key driver of HIV. But there have been few, if any, large-scale studies to support this belief until now.
The study also concluded that there was no statistically significant difference in infection or prevalence by race or ethnicity among these inner city poor. That is, people of color are disproportionately affected by HIV/AIDS because they are more likely to be poor and not because of their race or ethnicity. The Black AIDS Institute explains in a statement that, “when other racial ethnic groups face the same social determinants of health as Blacks—the social and economic conditions within which they live and that impact their well being…their HIV rates rise to similar levels as those of Blacks, even for Whites, whose rate of infection is normally substantially lower than rates for both Blacks and Latinos.”
The racial breakdown of participants in the study shows how the demographics skew: 77 percent of the 9,000 participants in high-poverty neighborhoods were black, 15 percent were Hispanic, and only 4 percent were white. Indeed, black Americans are more likely to live in neighborhoods with concentrated poverty than other racial and ethnic groups. Researchers from the Brookings Institute found that nearly a third of poor blacks live in areas of severe social and economic distress in cities as diverse as Cleveland, New York, Atlanta, and Los Angeles.
Poverty also exacerbates the challenges of living with HIV. Unstable housing, food insecurity, and a lack of consistent access to quality health care make it very difficult to manage what has increasingly become a manageable disease for those with higher incomes and more resources. The cost of life-sustaining antiretroviral drugs can range from $10,000 to $15,000 per patient per year. The country’s struggling economy has taken a toll on government programs that provide this medicine to millions of people living with HIV and AIDS, most of them low-income. Hundreds of people are languishing on long waiting lists for the AIDS Drug Assistance Program, a government-run program in every state that helps subsidize the costs of medication.
People living in high-poverty neighborhoods face a number of other challenges as well, including high rates of violence, social isolation, poor infrastructure, high levels of incarceration, and a lack of HIV and sexual health literacy, all of which contribute to the epidemic in distinct and overlapping ways. An inability to meet basic health and nutritional needs worsens HIV, increasing the risk of contracting other infections and hastening the onset of full-blown AIDS. And as viral loads increase from lack of access to care, so does the risk of infection to sexual partners, thereby further fueling the epidemic.
The CDC’s new findings certainly emphasize the urgent need to boost HIV prevention and treatment efforts in disadvantaged communities. The Obama administration announced last week a new domestic AIDS policy that directs states and federal agencies to find ways to cut new infections by 25 percent, get more patients into treatment, and educate Americans about HIV. It also urges states to adopt community-level approaches to reduce HIV infection in high-risk communities through pilot programs, better assessment of community viral load, and promotion of more holistic approaches to health.
But the CDC study shows that the inextricable link between poverty and poor health outcomes will require more. We cannot talk seriously about preventing and combating the HIV epidemic in poor neighborhoods without substantial investments in antipoverty programs that connect those at risk to greater economic opportunity, education, and quality health care.
Alexandra Cawthorne is a Research Associate in the Poverty and Prosperity and Women’s Health and Rights programs.