Here’s How Cities and Urban Settings Can Better Respond to HIV

Globally, 70% of people are projected to live in cities by 2050. Consequently, urban settings will play a vital role in addressing the HIV epidemic as well as broader health issues. A new report assesses the urban HIV epidemic and offers actionable recommendations to improve HIV responses.

Released to coincide with AIDS 2024, the International AIDS Conference (AIDS 2024) taking place this week in Munich, the report was produced by the IAPAC-Lancet HIV Commission on the Future of Urban HIV Responses. The International Association of Providers of AIDS Care (IAPAC) is also a main partner in the Fast-Track Cities initiative, a global effort of over 550 cities and municipalities, including many in the United States, that aim to end AIDS as a public health threat by 2030. Members of IAPAC and the Fast-Track Cities initiatives contributed to the report.

You can listen to a Lancet HIV podcast conversation about the report with IAPAC president and CEO José M. Zuniga, PhD, MPH, who served as chair of the IAPAC-Lancet HIV Commission, which comprises 52 commissioners.

The report is divided into seven key sections, each of which includes 10 recommendations that will help create an environment that an end urban HIV epidemics.

The seven sections in the report are:

1. Centering equity in urban HIV responses;
   
   
2. Realizing the right to health in urban settings;
   
   
3. Addressing urban social determinants of health;
   
   
4. Addressing syndemic conditions and comorbidities in urban settings;
   
   
5. Building urban health systems resilience;
   
   
6. Implementing urban data-driven accountability frameworks;
   
   
7. Modeling an end to urban HIV epidemics.

Below are a few samples of recommendations from three different sections:

Recommendations for centering equity in urban HIV responses:

• Prioritize involvement of communities in decision-making;
  
  
• Allocate resources for communities and populations disproportionately affected by HIV;
  
  
• Advocate equitable health resource distribution;
  
  
• Implement culturally competent and inclusive health care and social support services;
  
  
• Develop and enforce policies to eliminate HIV-specific and intersectional stigma.

Recommendations for realizing the right to health in urban settings:

• Advocate for and enforce the right to health in urban public health policy frameworks;
  
  
• Guarantee universal access to affordable, inclusive, high-quality HIV and health services;
  
  
• Empower marginalized populations vulnerable to HIV to assert their right to health;
  
  
• Implement policies that address income inequality;
  
  
• Establish monitoring mechanisms to track progress.

Recommendations for addressing urban social determinants of health:

• Deploy cross-sectional approaches to address housing, education and employment;
  
  
• Improve access to quality education and employment opportunities with living wages;
  
  
• Strengthen social safety-net programs to address socioeconomic disparities;
  
  
• Invest in programs to promote social cohesion and community engagement in health.

“The IAPAC-Lancet HIV Commission’s recommendations are aligned with the global goal of ending AIDS as a public health threat by 2030, with a particular emphasis on centering equity in urban HIV responses,” said Zuniga in an IAPAC press release about the report. “Addressing the unique challenges posed by urbanization, including social determinants of health, is vital to ensure that efforts to end AIDS as a public health threat are both sustainable and reflect the meaningful engagement of affected communities at every step along the journey in every city of the world.”

“Our work as the IAPAC-Lancet HIV Commission underscores the importance of integrating community voices and lived experiences into the urban HIV response. By doing so, we ensure that interventions are not only effective but also equitable and inclusive, leaving no one behind,” added commissioner Nicoletta Policek, PhD, the executive director of the European AIDS Treatment Group (EATG). “Across the Commission report’s seven sections and their accompanying recommendations, there is a recognition that affected communities are critical to the effectiveness of urban HIV responses, from shaping policies to delivering services and monitoring progress.”

“The resilience of health systems is crucial to sustaining HIV responses in urban settings that prioritize realizing the right to health for all individuals,” said commissioner Nombulelo Magula, PhD, a professor of Medicine at the University of KwaZulu-Natal Nelson R. Mandela School of Medicine. “The IAPAC-Lancet HIV Commission recommendations on health systems and the health workforce provide a road map for cities to strengthen their health infrastructures so that all individuals have access to the care and support they need.”

In related news, IAPAC collaborated with other group for Zero HIV Stigma Day 2024, which was marked July 21. And to read more reports and news from the ongoing International AIDS Conference in Munich, click #AIDS 2024. You’ll find headlines such as “The Next Berlin Patient: Another Man Cured of HIV After Stem Cell.”

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