How RWHAP Part B and ADAP Can Address Inequities in HIV Health Outcomes

By Delaney Tevis September 26, 2018

Social determinants of health are conditions—such as income, housing, and education—that are not directly related to health care but affect an individual’s risk for disease and health outcomes. Social determinants of health can lead to health inequities, or systematic disparities in the health status of different population groups (e.g., racial, ethnic, socioeconomic, gender, etc.). HIV is no exception. Consequently, RWHAP Part B Programs and ADAPs should act to intentionally provide holistic care that acknowledges the impact of social determinants of health on the clients they serve. 

Examining the demographic breakdown of all people living with HIV (PLWH) in the United States clearly shows how certain racial and ethnic groups are disproportionately affected by the disease. For example, according to the 2016 HIV Surveillance Report published by the Centers for Disease Control & Prevention (CDC), Black/African American individuals accounted for 44% of HIV diagnoses in 2016, while they only comprise 13% of the overall population. Similarly, Hispanic/Latinx individuals accounted for 25% of HIV diagnoses, despite only representing 18% of the total population. These disparities are also reflected in the demographics of RWHAP Part B and ADAP clients. According to the National RHWAP Part B and ADAP Monitoring Project Annual Reportin 2016 45% and 39% of all RWHAP Part B and ADAP clients, respectively, were Black/African American. Likewise, 20% of RWHAP Part B clients and 26% of ADAP clients were reported as having Hispanic/Latinx ethnicity. 

The Report shows that, in 2016, 81% of all ADAP clients were virally suppressed—which is much higher than the 49% of all PLWH in the United States who are virally suppressed. These numbers highlight important successes of the RWHAP Part B and ADAP. However, disparities in health outcomes still exist between different groups. While 85% of White ADAP clients were virally suppressed, only 80% of Black/African American clients were virally suppressed. Furthermore, only 77% of ADAP clients who earn less than 100% of the Federal Poverty Level (FPL) had a suppressed viral load. These differences may be reflective of various social determinants of health and structural barriers to care that clients face. 

As a result, it is essential that RWHAP Part B programs identify and utilize specific service categories that can aid clients who traditionally face social and structural barriers to health care. Examples of service categories that could help clients to overcome these barriers include mental health services, emergency financial assistance, food bank/home-delivered meals, housing services, and medical transportation services, among others. ADAPs can also help to address health inequities by adding medications to their formularies that treat comorbidities which disproportionately impact specific communities. For instance, Blacks/African Americans are at an increased risk for developing cardiovascular disease and type 2 diabetes, while Latinx persons experience significantly higher mortality due to hepatitis C (HCV) and could thus benefit from ADAP coverage of HCV medications. 

Finally, RWHAP Part B programs and ADAPs should continue strengthening their data systems to capture a more nuanced view of health outcomes among different client groups. Disaggregation of data is imperative so that jurisdictions can identify and target specific services to the clients who would most benefit from them. In doing so, RWHAP Part B programs and ADAPs have the unique capacity to target specific populations whose health outcomes are negatively impacted by social and structural factors and potentially help to decrease health inequities.