Social and structural determinants of health influencing HIV risk and participation across the HIV care cascade

Key take-home messages

• Social and structural factors can shape HIV vulnerability, acquisition, and transmission risk among individuals and across populations.
• Social and economic disenfranchisement of neighbourhoods (i.e. neighbourhood disadvantage) is one of the most robust correlates of HIV risk. It negatively impacts participation across all stages of the HIV care cascade.
• There is a multifaceted and interrelated range of social and structural factors exacerbating the HIV epidemic that impact participation across the HIV care cascade; housing instability and stigma are common barriers.
• HIV stigma and discrimination in health care settings create major barriers to HIV prevention, care, and treatment adherence, particularly among marginalized populations. Addressing these issues through targeted interventions and policy changes is crucial for improving health outcomes.
• Health care providers should consider housing instability as a critical factor in managing HIV prevention and treatment, especially for people who use drugs. Stable housing is a critical factor in improving HIV care outcomes. Interventions such as the “Housing First” approach have improved housing stability, health outcomes, and viral load suppression among people experiencing homelessness.

• Epidemiology and Determinants of Health
  • Determinants of Health
• Determinants of Health
  • Housing
  • Employment
  • Food security
  • Income
  • Education
  • Social support
  • Health services
  • Stigma/discrimination
  • Abuse
  • Other
• Population(s)
  • General HIV+ population
  • General HIV- population
• Prevention, Engagement and Care Cascade
  • Engagement and Care Cascade
  • Prevention
• Engagement and Care Cascade
  • Linkage/engagement in care
  • Retention in care
  • Treatment
• Prevention
  • Sexual risk behaviour
  • Drug use behaviours/harm reduction
• Testing
  • Testing
• Health Systems
  • Governance arrangements