Health Equity
Why It Matters
What is health equity? The goal of health equity is to eliminate barriers and increase access to the resources that promote and protect health for all people. To do this, health equity must address the disparities in health and determinants experienced by excluded or marginalized groups.
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Disparities are associated with differences in the social and structural environments. These differences are known as social determinants of health (SDOH).
Social determinants of health barriers are better indicators for health inequities than individual risk behaviors.
Why does health equity matter to stopping HIV in Iowa? We have made great strides in HIV prevention and care services in Iowa. Yet, some groups still experience disproportionate risks and outcomes such as higher rates of HIV diagnoses and poorer health outcomes among PLWH.
To stop HIV in Iowa, we must identify the causes of these disparities. Then, we must develop equity-focused strategies to address avoidable health differences adversely affecting marginalized groups.
Where We Stand Today
Disparities in Diagnoses
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About 85% of Iowa’s population is white and non-Hispanic. Historically Black/African American people, people of Hispanic/Latinx heritage, and men who have sex with men (MSM) are over-represented among people diagnosed with HIV in comparison to the sizes of their respective populations in Iowa.
A Note about Terminology: ​Throughout this page and the Stop HIV Iowa website, we use the following terms:
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Black/African American is inclusive of all people of African descent.
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Latinx is inclusive of all people of Hispanic and Latino heritage.
Description: Pie chart showing Iowa’s population proportions by race/ethnicity in 2020 compared to a pie chart showing how Iowa’s new HIV diagnoses in 2020 distributed by race/ethnicity. The comparison of the pie charts show the disproportionate percentage of Black, Latinx, and other people of color diagnosed with HIV compared to their total population percentage in Iowa overall. Read a longer description.
Description: Line graph showing the different reported exposure categories for HIV diagnoses over 10 years, from 2010- 2020. The graph shows how the number of HIV diagnoses for each type of exposure changed each year since 2010. Exposure types include: men who have sex with men (MSM), people who inject drugs (PWID), men who have sex with men who reported injection drug use (MSM/IDU), Heterosexual (exposure through heterosexual sex), and risk not reported. Over those ten years, MSM is the most prevalent exposure category. Read a longer description.
Disparities in Health Outcomes for People Living with HIV (PLWH)
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In 2020, 79% of diagnosed PLWH were virally suppressed. However, disparities exist in viral suppression rates among some groups.
Description: Bar graph showing the differences in viral suppression and retention in care for different races of people living with HIV (PLWH) in Iowa as of the end of 2020. The graph shows Hispanic/Latinx PLWH have the lowest rates of viral suppression and retention in care of all race/ethnicity groups represented. Read a longer description.
What We're Doing Now
The Bureau of HIV, STD, and Hepatitis developed a Health Equity Coordinator position and hired the first person to fill the role in May of 2017. The current Health and Racial Equity Coordinator, Akosua Dosu, was hired in August of 2020. Dosu is responsible for coordinating the bureau’s internal health equity improvement efforts as well as serving as a consultant for the bureau’s programs and their subrecipients throughout Iowa. As part of this position, the following have been completed or are in process:
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An 18 month, 38 session racial equity challenge was developed and attended by all bureau staff.
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Health equity scans have been completed with all Ryan White and Integrated Test Sites to identify strengths and opportunities for health equity among funding subrecipients.
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Quality improvement efforts have been implemented to evaluate and improve hiring and other HR practices.
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Trainings, presentations, discussion groups, book clubs, and other educational opportunities have been offered, including the Health Equity Spotlights.
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Anti-stigma efforts have been implemented that include state-wide marketing, health and service provider outreach, and legislative education.
Gaps, Barriers, & Challenges
Gaps
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Shortage of culturally responsive medical and support service providers
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There is a need to prioritize new strategies and improve existing interventions that address the racial and SDOH disparities identified in our data
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Lack of HIV support networks for people of color (POC) and/or lesbian, gay, bisexual, transgender and queer/questioning (LGBTQ) people
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Insufficient resources for formerly incarcerated folks
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Barriers and Challenges
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Stigma and discrimination (reinforced by legislation)
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Limited language and/ or literacy proficiency
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Lack of medical providers for LGBTQ people
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Substance use/mental health
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Housing instability
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Limited access to health services and information in rural areas
To stop HIV in Iowa by 2030, this focus area must:
In Iowa we have identified two priority areas for addressing these disparities and moving us closer to stopping HIV. The health equity focus area work group will identify equity driven strategies in the following areas:​
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Reduce transmission rates among Black/African American people, people of Hispanic/Latinx heritage, and men who have sex with men (MSM)
Current Diagnoses (2020) | Goal by 2025: 75% Reduction | Goal by 2030: 90% Reduction |
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51 diagnoses among men who have sex with men | 38 fewer annual diagnoses among men who have sex with men | 46 fewer annual diagnoses among men who have sex with men |
23 diagnoses among Black and other people of African descent | 17 fewer annual diagnoses among Black and other people of African descent | 21 fewer annual diagnoses among Black and other people of African descent |
5 diagnoses among people of Hispanic/Latinx heritage | 3 fewer annual diagnoses among people of Hispanic/Latinx heritage | 4 fewer annual diagnoses among people of Hispanic/Latinx heritage |
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Increase viral suppression among Black/African American and people of Hispanic/Latinx heritage
Current Viral Suppression (2020)* | Goal by 2025: 80% Viral Suppression | Goal by 2030: 90% Viral Suppression |
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71% (200/280) viral suppression among PLWH of Hispanic/Latinx heritage | Viral suppression among an additional 24 persons for a total of 224/280 PLWH of Hispanic/Latinx heritage** | Viral suppression among an additional 28 persons for a total of 252/280 PLWH of Hispanic/Latinx heritage |
72% (504/704) viral suppression among Black/African American people living with HIV (PLWH) | Viral suppression among an additional 59 persons, for a total of 563/704 Black/African American PLWH** | Viral suppression among an additional 71 persons for a total of 634/704 Black/African American PLWH** |
* % suppressed as a proportion of PLWH as of 12/31/2019 and alive at the end of 2020
** These numbers reflect the example of viral suppression through 2020. Since viral suppression is reported as a proportion actual numbers will change as the number of PLWH changes.
Resources
American Journal of Public Health, 2018
American Journal of Public Health, 2018
American Journal of Public Health, 2018
New York State Department of Health AIDS Institute for Health Resources and Services Administration HIV/AIDS Bureau
Process for Community Engagement
Engagement Focus
The health equity focus area team will work together with people, organizations, and communities to identify equity-driven strategies for the Stop HIV Iowa strategic plan. The health equity focus area is committed to the meaningful engagement of folks experiencing barriers to HIV prevention and healthy outcomes, specifically men who have sex with men, and Black and Latino populations.
Health equity will be prioritized in every aspect of the plan. Please visit the other focus area pages for more information about opportunities to engage in the process.
If you have ideas about how to increase health equity for ending HIV in Iowa, please share them with us!
There is “no wrong door” for collaboration with the community. You can choose the way that works best for you.
Get Involved
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Sign up for our Stop HIV Iowa email list.
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Send us an email directly!
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Attend a virtual event: The health equity focus area team will also host virtual events throughout the process to gather your input, including:
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a focus group for Black/African American and Latinx people
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a focus group for Transgender people
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virtual townhall(s), open to all Iowans
​If you are interested in participating in any of these events, contact Akosua Dosu, health and racial equity coordinator, at akosua.dosu@idph.iowa.gov.
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Submit your feedback directly through our online form.
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Schedule coffee or speak directly with one of our work group members! Fill out our short request form to set something up.