What is health justice?
In our vision statement, we state that our work will help create a future where health justice is achieved for all people living with or at risk for HIV. But what is “health justice” exactly?
As it relates to our work, health justice is the result of everyone having what they need to live well with HIV, to prevent HIV, to prevent or cure hepatitis C, to prevent drug overdoses, and more.
Health justice is more than equality in health: It is about lessening the existing gaps in who has access to health. The health “disparities” that we see for people of color, people with less access to wealth, people who use substances and others will not exist when we achieve health justice.
If you think about who has access to “health” now, what comes to mind? Who gets to be healthy in our society—and who gets left behind?
Societal factors & health: Why we’re not always in control of our own health
Often times, people who have access to health hold privilege in things like class, race, ability, employment, gender identity, citizenship or sexual orientation. People who belong to groups that are not privileged, and that experience stigma or discrimination because of identity, end up experiencing worse health outcomes as a result.
Here’s a simplified example of how this plays out.
People of color in our society are more likely to experience poverty and economic disadvantage in the U.S. for a variety of reasons, many of them beyond the level of individual control. Systemic racism, discrimination in hiring practices, ingrained racism in the criminal justice system and school funding inequalities perpetuate systems that keep people of color at the bottom rung socioeconomically.
Socioeconomic disadvantage, combined with the chronic psychological stress caused by racism and discrimination, can lead to measurable deficits in health. Many people of color in our country grow up and live in areas where they don’t have easy access to high-quality, nutritious food, safe places to exercise and quality health care. This in turn leads to higher rates of obesity, cardiovascular disease and type 2 diabetes.
This type of injustice plays out again and again for all types of health conditions. Race and socioeconomic status have been found to affect many types of health conditions—everything from childhood asthma, to cancer, to hepatitis C.
Things beyond our control can affect HIV “risk”
Anyone who is exposed to HIV might seroconvert. It doesn’t matter what color skin you have or how wealthy you are.
Yet who is exposed to HIV—and how prepared people are to prevent infection if they might be exposed—is a product of big structural factors beyond our control in addition to our own individual choices and behaviors.
People that live in places that prohibit needle exchange and syringe distribution programs are more at risk for HIV since this results in increased needle sharing. Trans women of color experience profound structural discrimination, including barriers to affirming health care, employment, housing, and education. This may create HIV risk for trans women of color engaged in the sex trade. People seeking political asylum in the U.S. who may be fearful of deportation may avoid preventative health care, making it less likely that they have access to HIV care or PrEP.
Health justice and HIV
The HIV movement was built on the fight for health justice. Many activists, researchers, policymakers and healthcare providers fought against these big structural factors to gain access to experimental drugs, housing assistance for those with a disabling AIDS diagnosis, government support for prevention programs, and more.
We continue that fight today, and focus on achieving an end all sexual health and substance use disparities experienced by people living with HIV and people at risk for HIV. New prevention methods like PrEP and U=U are moving the needle closer to zero new HIV infections in San Francisco, and people living with HIV with access to medications and care are living longer.
At the same time, health inequities stemming from differences in class, race and sociodemographic characteristics continue to widen.
People without access to stable housing make up a larger and larger share of people diagnosed with HIV in San Francisco every year, and less than a third of people living with HIV who are experiencing homelessness are virally suppressed.
People of color, notably African Americans and Latinx individuals, continue to experience the highest rates of HIV infection in San Francisco, lower rates of engagement in care, lower rates of viral suppression and higher mortality rates.
We think about these disparities as injustices. We must demand expanded access to medical care, housing, and mental health services for all those who need it, and fight back to end institutional racism that exists not just in our public health system but also our educational, housing, and criminal justice systems.
Our commitment to health justice
San Francisco AIDS Foundation is doubling down on our commitment to achieve health justice for all people living with or at risk of HIV. Achieving health justice will bring health equity to all people, regardless of race, class or other things beyond our control.
Guided by a new five-year strategic plan, we will take bold action to reduce health disparities, so that race is not a barrier to health and wellness, substance use is not stigmatized, HIV status does not determine quality of life and HIV transmission is eliminated.
For more detail about our work, download our 2019 – 2024 strategic plan.