Through a J.E.D.I. Lens

Through a J.E.D.I. Lens (Vol. 1 Issue 4): Exploring HIV/AIDS Research and Socioeconomic Barriers

By Jálin B. Johnson, director of the Office of Equity & Inclusion at the Salk Institute, and Dmitry Lyumkis, associate professor and Hearst Foundations Developmental Chair at the Salk Institute.

Each year in December, the world recognizes World AIDS Day, a time when we show support for people living with HIV and remember those who have died from AIDS-related illnesses (UNAIDS, 2024). At the Salk Institute for Biological Studies, advocacy and contribution to life-changing discoveries in this area are a part of our research priorities year-round.

In June of 2024, joined by San Diego Mayor Todd Gloria, we had the opportunity to address the community as a part of the annual Salk Science & Justice Series. The theme, “The Science & (In)Justice of HIV/AIDS,” brought together scientists and thought leaders alongside community members invested in advocacy and innovative science.

Salk Associate Professor Dmitry Lyumkis also spoke at the event. His team’s research goal is to understand and interconnect the complex roles proteins play in human diseases. Major efforts are underway to understand the structure, function, and evolution of proteins in the HIV replication cycle. Lyumkis determined atomic structures of protein assemblies called “intasomes” from HIV and related viruses, which enable HIV to establish infection in host immune cells. These structures, and complementary functional data, further our understanding of the molecular hallmarks of infection and, importantly, provide direct chemical blueprints for improving antiviral therapies used to treat people living with HIV/AIDS.

Antiretroviral therapy has greatly improved the treatment of HIV/AIDS, but drug resistance is becoming an increasingly widespread and critical issue that needs to be addressed. Drug resistance arises because HIV strains develop mutations that make the virus resistant to current therapies. To this end, the multidisciplinary team in Lyumkis’ lab is now working to define and mechanistically explain how drug resistance emerges, forecast emergent drug-resistant mutations, and identify potential opportunities for personalized therapeutic interventions that anticipate drug resistance to treat people living with HIV.

Like many infectious diseases that proliferate in the United States, socioeconomics, income inequality, and access to medical care and housing have an impact on treatment and care for those infected with and living with HIV/AIDS.

Research published in Lancet Public Health reports that “Substantial evidence exists of socioeconomic inequalities in the prognosis of chronic diseases. In Europe and the USA, socioeconomic factors such as poverty, low income, and low education level have been associated with poorer outcomes for several diseases, including cancer and cardiovascular disease.” Likewise, the researchers note that HIV leads to a disease that disproportionately affects those with socioeconomic disadvantage. Within the US, “in people with HIV receiving antiretroviral therapy, lower levels of socioeconomic status (as indicated by lower education level, unemployment, homelessness, or household poverty) are associated with having poorer virological and immunological outcomes.”

When focusing on barriers that have historically made an impact on treatment and care, we must consider how to bridge the gap between science, epidemiology, and public policy. Fostering effective communication, collaboration, and mutual understanding between these diverse disciplines allows for advocacy across communities. This allows for breakthrough scientific discoveries that are made in the lab to also be communicated into an accessible language, translating concepts into applicable action items for community organizers, policymakers, and the general public.

When looking through a J.E.D.I. lens, we considered the following -

• Organizations like the Health Resources and Services Administration’s Ryan White HIV/AIDS Program provide a comprehensive system of HIV primary medical care, medications, and essential support services for low-income people living with HIV who are uninsured and underserved.
  
  According to HIV.gov, in 2022, nearly 90% of Ryan White HIV/AIDS Program clients receiving HIV medical care were virally suppressed. This is an important part of ending the HIV epidemic because people who take HIV medications and maintain an undetectable viral load can live long and healthy lives and will not transmit the virus to their HIV-negative partners through sex.
  
  How might the pairing of advocacy and science make HIV medications more accessible to historically underserved populations?


• The Department of Veterans Affairs (VA) is the largest single provider of medical care to people living with HIV/AIDS in the US. The VA provides services such as screening for risk of HIV infection, testing for those at risk, giving providers access to the best available information about HIV, and supporting research to improve clinical care.
  
  How could advancements in the science surrounding testing and early detection better support our veteran community and their health providers?



• According to a 2020 study published in BMC Public Health, knowledge, tools, and resources needed to end the HIV/AIDS epidemic currently exist. Despite successes, HIV remains a glaring example of health inequity in the US, frequently concentrating in socially disadvantaged groups with epidemic rates only in certain types of communities—those with high numbers of marginalized individuals, including, but not limited to, non-Hispanic Black, Latinx, low income, gay, and transgender communities.
  
  How might scientist-driven outreach into these historically marginalized communities help to provide additional information and resources to those facing “multilevel barriers to engagement in existing HIV prevention approaches, including poverty, incarceration, unemployment, and distrust of providers?”

Following the funding –

• CDC funding opportunity: “Capacity Building Assistance for HIV Prevention Programs to End the HIV Epidemic in the United States.” The US Centers for Disease Control and Prevention announced the competitive availability of fiscal year 2024 funds to implement a capacity-building assistance program to strengthen the capacity and improve the performance of the nation’s HIV workforce.
• The President’s Emergency Plan for AIDS Relief is the US Department of State’s initiative to help save the lives of the more than 39 million individuals living with HIV/AIDS around the world. The initiative was launched in 2003 with strong bipartisan support sustained across four presidencies and 10 US Congresses.