The Policy and Advocacy Department at The Women’s Collective is lucky enough to be in the unique position of working to influence public policies from within a direct services organization. Our unique service-informed approach is a result of our work with women and girls living with or affected by HIV/AIDS. Through our efforts to support women to meet a range of self-identified needs, we learn about their struggles and their needs — and their voices drive and define our work. What we find, when working with these amazing women, is that their lives are about so much more than their HIV (as one of the members of our PLUS+ Network says, “I don’t live with my HIV, my HIV lives with me!”).
We’ve been “under construction” lately – spending some time revisiting and revising our policy priorities. In thinking about what’s important to us, as an organization, and to the women we serve, we find that there is an overarching theme to our work—the health disparities, or differences in health outcomes, faced by women, girls, and families.
In the District of Columbia, the life expectancy for African-Americans is 71.6 years, compared to 84.3 for whites. In the U.S., blacks are more likely to have a chronic illness or disability, and those with family incomes below 200% of the poverty level are 26% more likely to suffer from a chronic condition than whites.
HIV infection rate among some heterosexual women in D.C.’s poorest neighborhoods significantly increased from 6.3% to 12.1% from 2008 to 2010 — nearly doubling within two years. This rate is three times higher than their male counterparts at 4.4%.
Moreover, in a 2011 study of people living with HIV in the U.S., women and blacks had poorer health outcomes than other groups.
What we’ve found through our work is that in order to address these disparities, it’s not enough to consider health care access alone. In the 2011 study referenced above, though women and blacks were less likely to start ART, that difference does not fully account for disparate health outcomes.
That’s not to say that health care access isn’t important—it’s crucial that we make sure that all people, particularly women living with HIV/AIDS and women of color, have access to quality health care providers, comprehensive insurance coverage, and appropriate and affordable treatment options. But health care access is just one piece of the puzzle. It doesn’t explain the disparities across race, ethnicity, gender, or socioeconomic status. What does explain those disparities are the social determinants of health – namely, the social conditions in which individuals are born, grow-up, live, learn, work, play, and age – are the most important factors related to one’s health status.
When we look at the issues and barriers that are impacting women we serve and keeping them from getting tested, getting linked to care, staying in care, and achieving viral suppression, they go beyond health care access. And it’s clear to us that, particularly among women of color with low-incomes, we need to address several issues before we can “end AIDS” (or “end” anything, for that matter). Issues that impact women and their ability to access care include: poverty, housing barriers, lower educational attainment, high crime, substance use, mental illness, and gender-based violence. The inequitable distribution of these social conditions across groups contributes to persistent health inequities.More specifically, they pose psychological, emotional, and social barriers to HIV prevention, testing, and care for women and girls affected by HIV/AIDS. Broadening our collective approaches to reducing health inequities by addressing the social and structural conditions needed for good health for all is urgently needed now.
This blog is not just a forum for us to speak about HIV-related policy. It is a forum for us to speak about a multitude of issues affecting women and girls, with emphasis on women and girls of color. We look forward to continuing the discussion, sharing our stories, and highlighting issues that deserve energy and attention to ensure health equity for all.