The Current State of the Epidemic:
Why We Need to Step Up Our Efforts

5. Poverty, homelessness and other social determinants are fuelling the epidemic

Although HIV is caused by a virus and exacerbated by stigma, its spread is also fuelled by many factors in our society, including poverty, homelessness, lack of social support, physical and sexual abuse, childhood experiences and lack of education. These social determinants of health can lead to powerlessness in relationships, lack of self-esteem, lack of a sense of community, and other health issues (e.g., addictions or mental health problems) that interfere with people's judgment or ability to protect themselves. A homeless young person who trades sex for a place to stay or a meal may not be able to negotiate safer sex. A woman whose immigration status or financial security is dependent on her partner may be limited in her ability to protect herself. An older gay man who is concerned about his ability to compete in a youth/body-focussed culture may forgoThe protection of a condom in order to have sex. Violence against women has a direct impact on their vulnerability. For example, women who are in abusive relationships may be forced to have unprotected sex.

Poverty and other social factors, such as the lack of flexible employment opportunities or adequate disability insurance coverage, also threaten the ability of people living with HIV to maintain their health. As noted earlier, many are unable to afford the high cost of prescription drugs or complementary therapies that are not covered by government or private drug plans. People who are inadequately housed also have difficulty maintaining treatment regimens.

Because social inequities fuel the epidemic, we must fight for social justice. To stop the spread of HIV and to improve care, we must address both the behaviours that put people at risk (e.g., unsafe sex and needle use) and the broader social determinants of health that make it difficult or impossible for people to make healthy choices or maintain their health.