Enhancing Benefits or Increasing Harms: Community Responses for HIV Among Men Who Have Sex With Men, Transgender Women, Female Sex Workers, and People Who Inject Drugs, Baral et al., Journal of Acquired Immune Deficiency Syndrome (2014)

The authors evaluate studies from the past 15 years to determine the successes of community-level strategies to reduce HIV risk, and how prevention science should take these into account. This study shows that over time, social and epidemiological scientists have increasingly recognized the significant association between HIV infection risk and “social determinants” such as lack of social support, public abuse, stigma, and targeting by law enforcement. Prevention strategies that address these community-level issues have been most successful in reducing HIV risk and transmission.

Accordingly, effective “End the Epidemic” plans will include concrete efforts that dismantle these structural barriers to a healthy life that transgender, gender non-conforming individuals, sex workers, and people who inject drugs continue to experience. Community-level risk factors include economic inequality, racial disparities, political power, religion, gender, and behavior--all of which can limit or facilitate an individual’s access to treatment and risk of transmission or acquisition. Some affected populations, such as MSM, have received a lot of support and attention at the community level while others, such as sex workers and PWID, seem to be pushed aside due to politics or perceived risk of association.