In this MD Newsline exclusive interview, internist/HIV specialist Dr. Pete Thomas sits down for an interview with resident physician/public health professional Dr. Janelle Hadley to discuss how social determinants of health contribute to HIV prevalence and outcomes in the Black community.
Dr. Janelle Hadley:
What social determinants of health contribute to HIV prevalence and outcomes in the Black community?
Dr. Pete Thomas:
“I think what we have to come to terms with is that our patients are people. They do not operate in a petri dish. They come from communities, and they live in societies. So those societal factors impact their access to care, how they relate to the healthcare system, and their relationship with their providers.
There’s a well-known public health model called the social determinants of health. That model essentially says that someone’s health outcome is tied to their economic factors: housing, racism, sexism, etc. I think what happens, particularly in the African American community, is that there’s so many competing factors. For example, someone who is HIV positive may also have housing challenges, lack the support they need, and experience stigma.
HIV is not like having heart failure or diabetes. When you say you have HIV, there’s a stigma that’s placed on you, so even accessing care becomes an issue. ‘What do I say when I go to the clinic if I think I was exposed to HIV?’
So there’s so many factors and so many social, economic, and cultural factors that play a role in our lack of access to care. There’s also a lack of cultural competency, where our providers feel connected to us, and we feel connected to them. So that’s important too. It’s not just that our providers should be connected to us, but how well does the patient connect to the provider and the healthcare industry?
There’s so many social factors that impact the African American community, and it impacts how we access care within the healthcare industry and even the speed at which we do that. Right? Some communities are very well-versed. When something happens—they notice they don’t feel right, they have a headache, or a sore throat, or a fever—they immediately can access care.
I have patients who didn’t have time to deal with that. They were struggling to try to make ends meet and put food on the table for their family. Yeah, they had a fever. Yeah, they had a sore throat. Yeah, they didn’t feel well, but they literally could not focus on that. They had to focus on other things that at the time appeared to be more important.
What suggestions do I have? Well, one is, most of the centers of excellence around HIV treatment and prevention are places that have a multidisciplinary team put together. And that’s the hard part. Doctors like to be with doctors. But when we take care of HIV, we also need social workers, behavioral health workers, care coordinators, and ministers, or someone who can attend to a patient’s spiritual needs.
The really good places have those teams in place. You’re not going to get Ryan White funding just to have a doctor or a nurse practitioner or a physician assistant writing antiretroviral prescriptions. That’s not going to work. We know that. Out of the 86% of people [with HIV] that are diagnosed, only 44% are engaged in care. Where is the other 42%?
So the point is that a team of people is required to engage those folks in care. To say, we understand the stigma. We can’t dismiss it. We have to validate our patients’ concerns and experiences and say to them, ‘you deserve to live, you deserve to be cared for, and to be treated with respect.’ Outside of the multidisciplinary team, I think the respect issue is huge.”
Responses have been condensed and lightly edited.