Health Justice: A Framework for Mitigating the Impacts of HIV and COVID-19 on Disproportionately Affected Communities

Sirry Alang, PhD; Oni Blackstock, MD, MHS


Am J Public Health. 2023;113(2):194-201. 

In This Article

Abstract and Introduction


Health crises have a disproportionate impact on communities that are marginalized by systems of oppression such as racism and capitalism. Benefits of advances such as in the prevention and treatment of HIV disease are unequally distributed. Intersecting factors including poverty, homophobia, homelessness, racism, and mass incarceration expose marginalized populations to greater risks while limiting access to resources that buffer these risks. Similar patterns have emerged with COVID-19.

We identify comparable pitfalls in our responses to HIV and COVID-19. We introduce health justice as a framework for mitigating the long-term impact of the HIV epidemic and COVID-19 pandemic. The health justice framework considers the central role of power in the health and liberation of communities hit hardest by legacies of marginalization.

We provide 5 recommendations grounded in health justice: (1) redistribute resources, (2) enforce mandates that redistribute power, (3) enact legislation that guarantees support for people with long-haul COVID-19, (4) center experiences of the most impacted communities in policy development, and (5) evaluate multidimensional effects of policies across systems. Successful implementation of these recommendations requires community organizing and collective action.


Communities marginalized by structural inequities often experience a disproportionate burden of disease. This is true for HIV and for COVID-19. About 1.2 million people are living with HIV in the United States, with almost 35 000 new infections each year.[1] In 2019, Black Americans accounted for 44% of new HIV diagnoses, although they comprise 13% of the US population. Latino/a/x Americans make up 18% of the population but account for 30% of new cases.[1] Rates of HIV infection are high in communities harmed by structural racism and other forms of oppression.[2–4] Evidence from a systematic review of studies worldwide suggests that people living with HIV have an elevated risk of contracting severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the cause of COVID-19, and that they have a higher risk of COVID-19 mortality compared with persons who are not HIV-positive.[5]

HIV and COVID-19 coinfection is likely to increase, and communities hit hardest by systemic oppression such as poverty, racism, homophobia, transphobia, misogyny, homelessness, addiction, residential segregation, food insecurity, mass incarceration, and so forth will continue to bear most of the burden of these public health crises.[3,4] Here, we identify comparable pitfalls in responses to HIV and COVID-19 in the United States. We also offer the health justice framework as the central component of our recommended strategies for mitigating the long-term impact of the burdens of the HIV epidemic and COVID-19 pandemic on communities marginalized by structural inequities.