Structural Inequities, HIV Community-Based Organizations, and the End of the HIV Epidemic

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Abstract

Community-based organizations (CBOs) are integral to achieving the goal of Ending the HIV epidemic (EHE). Their familiarity with and proximity to communities position them to effectively implement strategies necessary to address determinants of health through their formal and informal medical and social services. However, structural inequities have contributed to the demise of many organizations that were instrumental in early responses to the HIV epidemic.

We define structural inequities for HIV CBOs as systems in which policies, institutional practices, organizational (mis)representations, and other norms work to produce and maintain inequities that affect CBOs’ ability to survive and thrive. In this discussion, we describe the organizational threats to grassroots HIV CBOs and the risks to livelihood and longevity, including examples.

The invaluable role of HIV CBOs in EHE and their role in responding to existing and novel infectious diseases like COVID-19 should not be overlooked. Recommendations to promote structural equity are offered. (Am J Public Health. 2022;112(3):417–425. https://doi.org/10.2105/AJPH.2021.306688 )

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Most cited references 28

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Structural racism and health inequities in the USA: evidence and interventions

Zinzi D Bailey, Nancy Krieger, Madina Agénor … (2017)

The Lancet, 389(10077), 1453-1463

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Closing the health equity gap: evidence-based strategies for primary health care organizations

Annette J. Browne, Colleen Varcoe, Sabrina T. Wong … (2012)

Introduction International evidence shows that enhancement of primary health care (PHC) services for disadvantaged populations is essential to reducing health and health care inequities. However, little is known about how to enhance equity at the organizational level within the PHC sector. Drawing on research conducted at two PHC Centres in Canada whose explicit mandates are to provide services to marginalized populations, the purpose of this paper is to discuss (a) the key dimensions of equity-oriented services to guide PHC organizations, and (b) strategies for operationalizing equity-oriented PHC services, particularly for marginalized populations. Methods The PHC Centres are located in two cities within urban neighborhoods recognized as among the poorest in Canada. Using a mixed methods ethnographic design, data were collected through intensive immersion in the Centres, and included: (a) in-depth interviews with a total of 114 participants (73 patients; 41 staff), (b) over 900 hours of participant observation, and (c) an analysis of key organizational documents, which shed light on the policy and funding environments. Results Through our analysis, we identified four key dimensions of equity-oriented PHC services: inequity-responsive care; trauma- and violence-informed care; contextually-tailored care; and culturally-competent care. The operationalization of these key dimensions are identified as 10 strategies that intersect to optimize the effectiveness of PHC services, particularly through improvements in the quality of care, an improved 'fit' between people's needs and services, enhanced trust and engagement by patients, and a shift from crisis-oriented care to continuity of care. Using illustrative examples from the data, these strategies are discussed to illuminate their relevance at three inter-related levels: organizational, clinical programming, and patient-provider interactions. Conclusions These evidence- and theoretically-informed key dimensions and strategies provide direction for PHC organizations aiming to redress the increasing levels of health and health care inequities across population groups. The findings provide a framework for conceptualizing and operationalizing the essential elements of equity-oriented PHC services when working with marginalized populations, and will have broad application to a wide range of settings, contexts and jurisdictions. Future research is needed to link these strategies to quantifiable process and outcome measures, and to test their impact in diverse PHC settings.

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Organizational Niches and the Dynamics of Organizational Mortality

Jitendra Singh (1994)

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Author and article information

Journal

Title: American Journal of Public Health

Abbreviated Title: Am J Public Health

Publisher: American Public Health Association

ISSN (Print): 0090-0036

ISSN (Electronic): 1541-0048

Publication date Created: March 2022

Publication date (Print): March 2022

Volume: 112

Issue: 3

Pages: 417-425

Affiliations

[1 ]At the time of the writing of this essay, Alyssa G. Robillard was with the Institute for Families in Society, University of South Carolina, and Palmetto AIDS Life Support Services, Columbia, SC. Carmen H. Julious is with Palmetto AIDS Life Support Services. Stacy W. Smallwood is with the Department of Health Policy & Community Health, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro. Mark Douglas was with My Brothaz HOME Inc, Savannah, GA. Bambi W. Gaddist was with South...

Article

DOI: 10.2105/AJPH.2021.306688

PubMed ID: 35196039

SO-VID: ca0c0734-c81a-460d-ac7d-8e260bb113bd

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