Despite advances in prevention and treatment, people of color in the United States are at heightened risk for substance use and HIV because of underlying structural and social inequities. Although racism, stigma, and discrimination are known drivers of disparate substance abuse and HIV outcomes, public health efforts to advance research and support the systemic policy and programmatic changes needed to address racial and social inequities have been inconsistent in approach and implementation. In recent years, highly publicized miscarriages of justice and civil rights violations (e.g., murder of George Floyd and other national and international incidents of police brutality, disproportionate burden and impact of the COVID-19 pandemic on communities of color, and forced sterilization of women in immigrant and criminal detention facilities) have propelled systemic inequities and racial trauma to the forefront of public discourse, ushering in renewed attention to these long-standing issues.
Still, research examining the ill effects of racism, stigma, and discrimination on HIV and substance use outcomes, as well as potential evidence-based solutions, remain limited in their capacity to sufficiently advance health equity. There remains an urgent need to clarify how harmful structural racism is to substance use and HIV outcomes and how it, along with intersectional stigma and discrimination, uniquely affects different populations. For this research to be responsive, relevant, and culturally grounded, greater community engagement, including the inclusion of research perspectives from Black people, Indigenous people, and other people of color (BIPOC), should be prioritized.
In this AJPH special issue, we highlight the work of early career investigators who completed the HIV/AIDS, Substance Abuse, and Trauma Training Program. This is a mentored research training program funded by the National Institute on Drug Abuse. It provides multidisciplinary, state-of-the-art training to better equip early career investigators to advance National Institutes of Health–funded research that investigates and challenges practices in racialized systems (e.g., education, employment, health care, and criminal justice) that stymie public health efforts to achieve health equity. Central to this program is mentoring to support rigorous community-driven research with special attention to the challenges that new investigators, especially BIPOC, face that constrain opportunities and stifle creative approaches and solutions to our most pressing public health challenges.
The articles in this issue investigate a range of public health challenges, including community violence, racial trauma, HIV, substance use, and mental health problems, calling for a paradigm shift in the training, theoretical frameworks, methodological and intervention approaches, and policies used to achieve health equity.
(author introduction)