Dr Perry N. Halkitis: Health Care Disparities Grow From Structural Inequities

To effect change, we must address health care disparities beyond the individual level, says Perry N. Halkitis, PhD, MS, MPH, dean of the Rutgers School of Public Health and director of the Center for Health, Identity, Behavior and Prevention Studies.

Social stressors—discrimination, homophobia, racism, misogyny—create psychosocial burdens, so to create change, we can’t just address disparities on the societal level for individuals, says Perry N. Halkitis, PhD, MS, MPH, dean of the Rutgers School of Public Health and director of the Center for Health, Identity, Behavior and Prevention Studies; we must address them on social, structural, behavioral, and biological levels as well.

This video excerpt is the third entry in a series on individuals and international organizations working to bring local and global awareness to the ongoing HIV/AIDS epidemic, which is marking its 40th anniversary this year. For previous entries, click here.


Can you tell us about yourself and your work?

I'm Perry Halkitis. I am the dean of the School of Public Health at Rutgers University. For over 2 decades, my work has focused on infectious diseases, specifically HIV, and the intersection of infectious diseases with social and structural and behavioral determinants. And the syndemic, or the comorbidity, that often exists with the transmission of infectious disease, like HIV, with drug abuse and mental health.

I’ve primarily looked at these connections, and I've developed interventions, in the LGBTQ+ population, but not exclusively. And so that's been the focus of my work. Really community-engaged, activist-led, high-level scholarship trying to eradicate these disparities in our society.

How can we address the inordinate rates of drug abuse and HIV that contribute to health disparities within the LGBTQ community?

There are structural inequities that drive disparities. People don't wake up one morning deciding that they should have a drug addiction or they should acquire HIV or they should get COVID or they should be obese or they should smoke cigarettes, right? These are situations and health conditions that emerge in people's lives.

We have focused too much on the individual-level intervention, like how do we get people to stop smoking? How do we get people to stop drinking? How do we prevent people from acquiring HIV? My argument is that those kind of behavioral interventions are good, but insufficient, and that what we really need to do is think about what are the conditions that fuel these behaviors in people. Why is it that we see such high levels of psychopathology in LGBTQ people? Why do we see such high levels of drug use?

My argument is that for the LGBTQ population and other populations, which are discriminated [and] marginalized, there are these social stressors—discrimination, homophobia, racism, misogyny—that create psychosocial burdens in people's lives, that create stressors which engender risk. And as a result, they place themselves at risk for potential problems.

And so I think that if you want to effect a change, you need to effect the change on the social level, the structural level, the behavioral level, and the biological level, all in combination.

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