Our Vision:

Health Equity

At Caracole, our vision is to be a relentless force for health equity.

We believe everyone deserves to be healthy—no matter who we are, what we do, where we come from, what we earn, how we look or who we love.

Health Equity = Quality of Life

Health equity is ensuring everyone can live the healthiest life possible. That requires high-quality living conditions and universal access to competent, affordable and culturally appropriate care.

Our health is often based on social, economic and environmental conditions. Stable housing, healthy food, adequate employment, transportation, access to medical care and being treated with dignity and respect are all factors we need to stay healthy.

People are marginalized when they experience unjust differences in how they are treated or services they can access. Major risk factors for health inequalities include:

Poverty
Racism
Gender and sexual orientation discrimination
Stigma, shame and disrespect
Racial, sexual, ethnic and immigration status
Language, communication, transportation, technology and education barriers
Neighborhoods and communities that are neglected, polluted or violent

Achieving health equity requires valuing everyone.

It requires actively acknowledging and reckoning with historical and contemporary injustices, prioritizing the needs of marginalized people, envisioning new ways of creating a shared sense of community, distributing resources and creating conditions that allow everyone to thrive. It requires structural changes in programs, services and governments. It is challenging, but it is not impossible.

Health Inequities and HIV

HIV prevention and treatment are better and more accessible than ever before. Also, medical case management and safe and affordable housing assists marginalized individuals with HIV to live long and healthy lives. But improved outcomes are not evenly distributed:

Those at highest risk for HIV infection include:

— Men who have sex with men

— People who inject drugs

— People involved in sex work

— People who are transgender

People of color are disproportionately affected by HIV in the US, accounting for 69% of HIV diagnoses.

— In 2018, Black/African American people accounted for 13% of the US population but 42% of the approximately 38,000 new HIV diagnoses in the United States and dependent areas.

— Hispanic/Latino people accounted for 27% of all new HIV diagnoses.

Homelessness and HIV are tightly linked. People who are homeless experience higher rates of HIV infection, have a more difficult time staying in HIV care and adhering to HIV medications, and experience worse health outcomes as a result of HIV infection.

— Black/African American people accounted for 40% of all people experiencing homelessness in 2019 and 52% of people experiencing homelessness as members of families with children, despite being 13 percent of the US population.

— People identifying as Hispanic or Latino are about 22 percent of the homeless population but only 18 percent of the population overall.

In 2010, the rate of diagnosed HIV among inmates in state and federal prisons was more than five times greater than the rate among people who were not incarcerated.
People who inject drugs accounted for 7% of new HIV infections in the US and 6 dependent areas in 2018.
In 2015, the American Psychological Association reported that rural communities have HIV prevalence rates approaching those of urban areas. Rural residents have higher rates of poverty, less access to general and specialized health care, and are less likely to have health insurance than city residents.
Individuals with a late HIV diagnosis are at increased risk for HIV-related morbidity and mortality and may have poorer response to antiretroviral treatment. This means they may get sicker, have more infections, and are more likely to die from an AIDS-related disease. Late diagnosis increases the risk that individuals unaware of their status may transmit HIV to others.
Most new HIV diagnoses are now highly concentrated in certain geographic areas. Of the total 3,006 counties in the US—Hamilton County along with 47 others accounted for more than 50% of the new HIV diagnoses in 2016 and 2017. These jurisdictions are prioritized in Phase I of Ending the HIV Epidemic in the U.S., along with Washington, DC; San Juan, Puerto Rico; and seven states with a disproportionate occurrence of HIV in rural areas.

It is a fact that the people who are marginalized in our communities are also most impacted by HIV.

Our Commitment

Caracole’s passion for equity is woven into who we are and what we stand for. Here are some of the practices we uphold in order to create a more equitable community:

Accountability: We challenge our biases and empower each other to do better. We measure what we do, we evaluate the data, and we continue to ask what— and who—are we missing?
Learning: We proactively seek out what works best for different people, recognizing and affirming their individuality and difference of experience.
Education: We help others understand what factors produce health, how to be more culturally humble and accessible, and why health inequities hurt us all.
Advocacy: We campaign for health care access, affordable housing, public transportation, harm reduction, decriminalization and anti-discrimination policies.
Communication: We look for opportunities for authentic dialogue and messaging to change the biased beliefs driving policies and practices that create disadvantaged communities.
Social Justice: We challenge racism, sexism, homophobia, stigma and wealth inequality where they occur and address them through dialogue and action.

When it comes to supporting communities, we all have a role to play. You, too, can learn, educate, advocate, communicate and seek justice.

Join with us. Be relentless.

Definitions

Health Disparities:
Preventable differences in the burden of disease, injury, violence, or opportunities to achieve optimal health that are experienced by socially disadvantaged populations.

Racial Disparities:
Harmful, inequitable and unjust outcomes created and perpetuated for specific groups of people, thru historical and contemporary discrimination in policies and practices.

Social Determinants of Health:
Conditions in the places where people live, learn, work, and play that affect a wide range of health and quality-of life-risks and outcomes.

Structural/Systemic Racism:
A system in which public policies, institutional practices, cultural representations, and other norms work in various, often reinforcing ways to perpetuate racial group inequity.

Morbidity:
Morbidity refers to being diseased or unhealthy. Higher morbidity means being sicker or having more adverse symptoms than others with a similar diagnosis. In HIV, this means more opportunistic infections, more organ failure, lower CD4 counts, etc.

Mortality:
Mortality is death rate in a population. In HIV this refers to how many people die of AIDS- or HIV-related disease.