On the compounding manifestations of racism shaping the US HIV/AIDS epidemic: why ending the HIV epidemic must address these factors for success

作者：Xiao Zang, Yi Sui, Sam Bessey, Tri Minh Van, Hansel Tookes, Brandon D. L. Marshall, Bohdan Nosyk, on behalf of the Localized Economic Modeling (LEM) group · 发表于：AIDS · 年份：2025 · DOI：10.1097/qad.0000000000004289 · 被引用次数：1 · 研究领域：HIV/AIDS Research and Interventions、Adolescent Sexual and Reproductive Health、LGBTQ Health, Identity, and Policy

OBJECTIVE: Growing racial/ethnic inequities in healthcare access and racially segregated sexual mixing contribute to persistent disparities in HIV incidence in the US. We aim to examine the extent to which eliminating racial/ethnic inequities in healthcare access could reduce disparities in HIV incidence and its interaction with assortative sexual mixing. DESIGN: A mathematical model. METHODS: We used two independently developed HIV transmission models to estimate HIV incidence among Black, Hispanic/Latino, and White/Other MSM and the corresponding incidence rate ratios (IRRs) comparing Black and Hispanic/Latino to White/Other as a measure of disparity in the four "Ending the HIV Epidemic (EHE)" counties in Georgia. We compared three scenarios: status quo; equal service access across racial/ethnic groups with reported assortative sexual mixing by race/ethnicity; and equal service access with random sexual mixing. We standardized both models to enhance comparability. RESULTS: Under the status quo, both models projected a reduction in overall HIV incidence but persistent racial/ethnic disparities, with an IRR as large as 8.3 between Black and White/Other MSM. Compared to the status quo, providing equal health service access resulted in a modest reduction in IRRs with reported assortative sexual mixing in 2030, but yielded a much greater reduction when sexual mixing was at random: IRR reduced by up to 38.8% and 58.3% between Black and White/Other MSM in the two models. CONCLUSIO...