Where is Social Justice in our Box of Tools to End the Epidemics?

By Lucy Slater July 7, 2016

Margot Saner-Katz wrote in the New York Times several weeks ago (June 19, 2016) that the health of American children is improving sharply and the health gap between rich and poor children is shrinking. Reductions in death rates among children can likely be attributed to public health advances including broader public health insurance for women and children, and successful anti-smoking initiatives. But, she points out, their elders are not doing as well, and in recent months, we have seen headlines about the shortening lives of Americans due to drug and alcohol abuse and increased suicide rates. “Those are causes of death that may be less sensitive to health care interventions” she writes, and quotes David Cutler a health economist at Harvard: “The social part is the part that scares me.”

In the HIV world, it has almost become axiomatic that we “have all the tools we need to end the epidemic.” If we could universally implement Test and Start (or Test and Treat) for antiretroviral (ART) treatment for all infected individuals, and make combination prevention (include PMTCT, VMMC and PrEP) universally available, the HIV pandemic would rapidly begin to diminish and move toward a nightmare of the past.

But Saner-Katz highlights what we in the public health field all know, but perhaps do not acknowledge nearly enough: that ending disease cannot be achieved through biomedical intervention and public health policy alone. Social issues such as poverty, unemployment, homelessness, stigma, discrimination, racism, homophobia, and isolation, among others, are all part of what contribute to and sustain disease. And so, as public health practitioners, addressing social issues, promoting human rights, and advocating for social justice should just as completely be a part of who we are and what we do. NASTAD recently updated its mission statement to overtly recognize this fact and to reassert our commitment to social justice as a means for achieving health equity for all.

As public sector employees, we find ourselves in the interesting position of being accountable to government as much as we are to the communities we serve. In the HIV field, we have a proud history and years of experience working to maintain the interests of all our constituents and proactively and meaningfully engaging with civil society. But in too many instances, even at the highest levels, the public sector continues to overlook the connections between human rights and social justice with public health.

The UN High Level Meeting on HIV/AIDS came to a close last month with a Political Declaration on HIV/AIDS that was notably deficient in language recognizing the scope of the epidemic among key populations such as gay and bisexual men and other men who have sex with men, sex workers, people who inject drugs, and transgender people. And, the final Declaration largely avoided commitments to changing legal and policy frameworks that stigmatize and criminalize key populations and people living with HIV.

As public health practitioners, we know that we cannot use the tools we have to end the HIV epidemic if we are not able to name or count or reach the populations most at risk. We know those individuals and communities will not come to a clinic for PrEP or begin ARV therapy if they are discriminated against and stigmatized. We know these populations cannot or will not openly advocate for their health if their behaviors are criminalized. We have the tools to end the epidemic, but too often, that tool box is locked for key populations.  And that’s why at NASTAD we will continue to speak up and take action when these injustices occur.  We are committed to ensuring that we open the tool box and use the tools we have to end the HIV epidemic as we know it.

As public health practitioners, we have a public health and evidence-based rationale for enacting human rights and social change. And as public sector employees we are also in positions where we can bring that rationale to the ears of those who have power to make those changes. We should use it.