University Professor Nabila El Bassel and Professor Louisa Gilbert from the Social Intervention Group at Columbia University School of Social Work share a message for World AIDS Day.
On December 1st, we will observe World AIDS Day for the thirty-seventh time. As part of our efforts at the Social Intervention Group to end the HIV/AIDS epidemic, we acknowledge and honor the millions of individuals infected or affected by HIV, and remember the lives of those we have lost. The 2024 theme, "Collective Action: Sustain and Accelerate HIV Progress," emphasizes increasing our determination to conquer HIV/AIDS worldwide.
While we have made tremendous progress towards achieving the CDC’s Ending the HIV Epidemic (EHE) goals in the United States, critical gaps remain, particularly in Black and Latinx communities disproportionately impacted by HIV/AIDS. Within these communities, there is a great urgency to address the unique needs of people who use drugs. Many vulnerable sub-groups exist among those who use drugs and each one deserves our focus and support, including men who have sex with men, transgender women, individuals engaged in sex work, and those involved with the criminal legal system.
As we think about this year's theme, we are reminded of the need to accelerate how we prioritize vulnerable populations who are not receiving access to testing, support, and care. Systemic inequities, stigma, racism, and structural barriers exacerbate disparities in HIV prevention and care. People who use drugs, particularly those from key HIV-affected sub-groups like those above, often face challenges accessing evidence-based prevention and treatment services in settings that also provide substance use disorder (SUD) treatment and harm reduction programs.
To close these gaps, we need innovative and data-driven community-engaged strategies that dismantle the silos between HIV and SUD care and address persistent racial and ethnic health inequities. One key approach to accelerating forward movement is engaging diverse community stakeholders across multiple sectors through coalition-building, and working with them to leverage integrated data sources in real time. These methods allow us to identify and strategically address barriers at the system, community, and organizational levels, each of which improves the delivery of and increases uptake of evidence-based practices (EBPs).
A number of EBPs have been proven to target the four pillars of the CDC’s EHE goals, which are "Screen and Diagnose," "Treat," "Prevent," and "Respond." These EBPs include syringe services programs that reduce HIV and HCV transmission (CDC, 2024); SUD treatment, including opioid use disorder medications that reduce HIV transmission (CDC, 2020) and other sexually transmitted infections (CDC, 2024); and expedited status-neutral HIV testing services that ensure linkages to prevention or treatment; pre-exposure prophylaxis (PrEP), which can reduce HIV transmission (CDC, 2024); and HIV treatment as prevention (CDC, 2024).
Despite the documented effectiveness of these EBPs, their uptake remains lower than optimal among people who use drugs from key vulnerable sub-groups, particularly Black and Latinx individuals. Food and housing insecurity, stigma, and structural racism are consistent barriers to access and engagement in care. Nonetheless, community engagement and mobilization have long been a cornerstone of public health efforts, particularly in HIV prevention. Grassroots initiatives have expanded access to the HIV Care Continuum and successfully advocated for harm reduction policies, PrEP, and antiretroviral therapy. However, these traditional models of community engagement, such as community advisory boards, have failed to make progress towards EHE goals.
In order to accelerate our progress in the fight against HIV/AIDS, we need a shift toward coalition-building, which offers a more inclusive, empowering, and impactful strategy. Coalition-building is a proven community engagement method that maximizes collective resources, reduces duplication of efforts, and enhances the deployment of EBPs. This approach builds on the success of initiatives like SIG’s HEALing Communities Study, which demonstrated the power of data-driven coalitions for addressing public health crises.
In our work at SIG, we remain committed to sustaining and accelerating our work in New York communities as well as globally, and empowering those communities to address the complex and interconnected barriers to HIV prevention and treatment as we work together to reduce health disparities and improve outcomes.
As we commemorate World AIDS Day 2024, we reaffirm our commitment to collective action. By embracing innovative, community-centered strategies and addressing systemic inequities, we can sustain and accelerate progress toward ending the HIV epidemic for everyone, but especially for those most vulnerable. Together, we honor the lives of those lost to HIV/AIDS by striving for a future free from this disease.
Nabila El-Bassel, PhD
University Professor, Willma and Albert Musher Professor of Social Work
Director of the Social Intervention Group at Columbia School of Social Work
Louisa Gilbert, PhD
Professor of Social Work
Co-Director of the Social Intervention Group at Columbia School of Social Work