Commentary: Parallels between HIV, COVID-19 Reflect Persisting Health and Social Inequalities

The COVID-19 pandemic is disproportionately affecting communities of color, not because of biological factors, but because of deeply rooted social and economic inequalities, and that is reminiscent of the HIV epidemic, says a commentary in the Journal of the Association of Nurses in AIDS Care co-authored in part by University of Rochester School of Nursing alumni and faculty.

The seven-page paper, “Alarm at the Gate—Health and Social Inequalities are Comorbid Conditions of HIV and COVID-19,” examines the ethno-racial health disparities and social inequities exposed by both the HIV and COVID-19 epidemics. Black and African American people experience higher rates of HIV infection, despite no elevated engagement in “risky” sexual or drug using behavior than other racial groups. They are also less likely to receive HIV care, including antiretroviral treatment. Similarly national COVID-19 data reports that communities of color, specifically Black, African Americans and First Nation people, have increased risk of contracting COVID-19 and are more likely to die of the virus than their white counterparts. In New York City, Black, African American, and Latinx populations died at twice the rate of the white population.

Though the Centers for Disease Control and Prevention lists “race/ethnicity” as one of the risk factors for COVID-19, the World Health Organization asserts that social determinants of health – the conditions in which people are born, grow, live, work, and age – are factors that contribute to ethno-racial disparities in COVID-19 infections and deaths.

“While this paper examines inequalities in connection with COVID-19 and HIV, the larger message reflects pervasive health disparities and race-based injustices that continue to persist,” said Mitchell Wharton, PhD, RN, FNP-BC, CNS, an assistant professor of clinical nursing, and one of the paper’s co-authors with ties to the UR School of Nursing. Orlando Harris, PhD, FNP, MPH, an assistant professor of community health system at the University of California, San Francisco who earned his PhD at the UR School of Nursing in 2014, was the paper’s lead author. Natalie Leblanc, PhD, RN, MPH, an assistant professor in HIV prevention science and Harriet Kitzman Fellow in Health Disparities at the UR School of Nursing, was also a co-author.

The intersections of HIV and COVID-19 disease-related stigmas and the systemic racial inequity (i.e., housing, health care access, employment, and education) experienced by marginalized communities in the United States are directly related to the health disparities in cases and deaths related to HIV and COVID-19, write the authors. But lessons from the HIV epidemic may help mitigate the impact of the current pandemic through the implementation of public health policies and procedures. Among the recommendations offered by the paper’s authors:

• Public health education requires messaging that applies principles of cultural humility and risk communication.
• Public health and health care advances require an interdisciplinary approach that includes grass roots community-based perspectives.
• Integrating trainings on race, trust, and implicit bias into HIV and COVID-19 programming for all stakeholders is strongly recommended.
• Targeted studies that improve our understanding of the social and structural impact of COVID-19 are needed to effectively mitigate the virus’ negative effects on communities of color.
• We need to move toward a holistic way of thinking about health and disease that incorporates the social determinants and contributors to health.

Additional contributing authors of the paper included Kara McGee, DMS, MSPH, PA-C, AAHIVS, instructor for Duke University’s School of Nursing; Schenita Randolph, PhD, MPH, RN, CNE, assistant professor for Duke University’s School of Nursing; and Michael Relf, PhD, RN, AACRN, ANEF, FAAN, associate dean for Global and Community Health Affairs, Duke University’s School of Nursing, professor for Duke Global Health Institute.