Latesha Elopre, M.D., MSPH, is the director of Diversity and Inclusion for Graduate Medical Education in the School of Medicine and an assistant professor in the Division of Infectious Diseases at the University of Alabama at Birmingham
Q: One of the main focuses of your work has been addressing health inequities among populations who are underserved and disproportionately impacted by HIV. How did you become interested in this particular aspect of HIV research and care?
I became interested in this field because I had a family member who passed away from AIDS when I was nine years old. He was 28, he was Black and, unbeknownst to me, he was also gay. After that I began to understand social justice; it was a shame that he died without anyone really knowing who he was. Unfortunately, this stigma is still something we’re dealing with 20 years later. This compelled me to begin working with patients living with HIV in a clinic and continue researching the cultural and social factors contributing to the disproportionate impact HIV has on Black communities.
Q: Your research has focused on understanding and addressing the intersectional stigma and perception of accessing pre-exposure prophylaxis (PrEP) among Black Gay and Bisexual Men in the South. Can you explain the difference between individual-level barriers and structural barriers to PrEP and why they are important when it comes to increasing the use of PrEP?
I believe that it’s difficult to really understand the barriers unless you’ve heard the voices of those individuals who are disproportionally affected by the epidemic. I’ve had the opportunity to speak to young, Black and gay men, and ask them what it’s like to walk in their shoes for a day. On a daily basis, they undergo an overwhelming amount of stigma and oppression for being Black, gay and, sometimes, impoverished. It becomes very difficult for them to love and accept themselves, which I think is a process that just has to happen before you’re able to really access insights into your sexual health. One of the biggest things we need to work on from an individual level is to try to understand how we can abate some of the stigmas that are associated with the use of preventative treatments like PrEP.
In the South, there are a lot of structural barriers that make increasing the use of PrEP difficult, and I think that some interact in significant ways. For example, without Medicaid expansion, a lot of times these men don’t have insurance and accessing prevention services may not be a possibility. However, even the services that are available could be considered inaccessible because those looking to use these services may be put off by the fear of unintentionally disclosing their sexuality or other lifestyle factors associated with taking PrEP.
Q: The Department of Health and Human Services recently announced a plan to end HIV by 2030, which specifically targets 48 high-burden counties, along with San Juan, Puerto Rico, Washington, DC, and seven states with a substantial rural HIV burden. Nearly half (48%) of the highest-burden counties and most of the states are in the South. What needs to be done to make sure the South is able to meet this plan’s goals?
One of the biggest priorities should be state-level policy changes, like Medicaid expansion. If the goal is to end the HIV epidemic, we need to identify those populations that are most affected and make sure we provide services like preventative medication. However, it’s going to be difficult to have a true impact in a lot of these states that haven’t expanded Medicaid and therefore don’t have the financial means to adequately expand care.
Another priority, beyond policy change, needs to be to understand why HIV and almost every other chronic health condition disproportionately impacts certain communities. This has to do with discrimination and racism – things we often don’t like to address within our research and interventions. We have to also address the individual-level barriers that make it difficult for people to access care on all levels to see a true dent in the HIV epidemic in the South.
Q: How does visualizing HIV data help support clinical workers and other public health officials better engage with communities in the South?
I think it’s amazing. I’ve had the opportunity with our university-affiliated PrEP clinic to work and train with people across all levels of health care, from medical students to nurse practitioners to social workers. Right now, those health care providers looking to offer PrEP services may not understand how prevalent HIV is, especially depending on where you live and the prevalence of HIV in your county. However, having the ability to pull up a map and confidently locate those people who will benefit from being on PrEP speaks volumes. I have always loved the idea of GIS mapping because a picture really can speak a thousand words.
Q: The first-ever Southern HIV/AIDS Awareness Day is coming up on August 20th; what is your message to those impacted by HIV/AIDS in the South?
As a community, when we’re talking about HIV in the South, it’s time for us to come together, rise up, and really challenge the current systems that are in place to make sure the disenfranchised and their loved ones are able to get care. HIV may not directly affect you, but it’s likely affecting someone you know, someone you love, someone you care about, or someone you work with. We all need to rally together in a concerted effort to end the HIV epidemic in the South. I’m excited about where we’re at right now. I feel like there’s a lot of energy and focus. Hopefully, in the next few years, we’ll be able to actually turn the tide.