The Supreme Court ruled in June that limits on abortion care are constitutional.
The decision, Dobbs v. Jackson, overturned decades of settled precedent, and states across the country will now severely limit access to abortion, and many will ban abortion entirely.
Those of us who are HIV advocates know medical privacy and bodily autonomy are central to our collective liberation. Additionally, HIV advocates know protecting access to abortion care is racial justice in action.
Leaders of color within the HIV Racial Justice Now! Coalition remind us that “the HIV community has a moral obligation to advocate for abortion and reproductive health because these are racial and gender justice issues.”
The disproportionate impact
Abortion bans will harm Black and Latine people the most.
Our public policy and advocacy is grounded in the understanding that HIV is a disease of disparities linked to race, sexual orientation, gender identity and economic status.
Barriers to health care include stigma, discrimination, medical mistrust, safety and lack of access to affirming care. This impacts everyone, but sexual and gender minorities face greater health challenges due to lower levels of health insurance and access to regular health care compared to cisgender heterosexual people as well as inequities such as stigma and discrimination.
Due to factors such as health insurance coverage, a lack of transportation and childcare, inability to take time off from work, communication and language barriers, discrimination, and lack of trust in health care providers, communities of color are also disproportionately impacted by HIV prevalence and are more likely to experience worse health outcomes, including lower rates of viral suppression.
The sentiment remains the same for abortion services, as insurance restrictions, waiting periods, state-mandated counseling and various regulatory hurdles create logistical and financial barriers that make accessing care extremely difficult, especially for Black women and other women of color.
Additionally, the South bears a disproportionate HIV burden and abortion restriction as well. Geographically, Southern states bear the highest burden of HIV, accounting for 53% of new HIV diagnoses annually, even though just 38% of the U.S. population lives in the region. This is partially due to factors such as limited uptake of PrEP — preexposure prophylaxis, a medicine that prevents HIV — and a lack of testing availability and acceptability.
The same is true for abortion services. Southern states have or are considering a slew of restrictive abortion laws that make access to care extremely difficult.
We must be inclusive and reflective of populations and geographies disproportionately impacted, ensuring that there is an equitable allocation of human, material and financial resources devoted to the most impacted communities.
Prevention
According to the National HIV/AIDS Strategy, about 3 in 4 people who could benefit from PrEP are not receiving it and significant disparities in PrEP coverage persist based on race and ethnicity. There are clear gaps in diagnoses, care, treatment and prevention that contribute to these health disparities. This highlights the need to focus programs, practices and policies on communities of color and other populations that experience HIV disparities and larger impairments to accessing sexual health services.
With the state of contraceptive and primary care access in this country, abortion care providers are significant providers of many individuals’ sexual wellness care, whether or not they are receiving abortion care themselves. These providers are integral to our collective efforts to end the HIV epidemic.
