EPIDEMIOLOGY AND SOCIAL: ViewpointThe same lesson over and over: drugs alone will not get us to 90--90--90Cohen, Jennifera,b; Pepperrell, Tobyc; Venter, Willem Daniel FrancoisbAuthor Information aDepartment of Global and Intercultural Studies, Miami University, Oxford, Ohio, USA bEzintsha, Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa cFaculty of Medicine, Imperial College London, United Kingdom. Correspondence to Jennifer Cohen, PhD Economics, Department of Global and Intercultural Studies, Miami University, 501 E High Street, Oxford, Ohio 45056, USA. E-mail: email@example.com Received 11 October, 2019 Revised 16 January, 2020 Accepted 27 January, 2020 AIDS: May 1, 2020 - Volume 34 - Issue 6 - p 943-946 doi: 10.1097/QAD.0000000000002494 Buy Metrics Abstract Addressing social determinants of health (SDH) has far greater potential to improve the real-world effectiveness of HIV treatment than expensive, incremental changes in antiretroviral therapy. The ADVANCE study demonstrates that SDH is more impactful than medication regimen on health outcomes. Younger patients and unemployed patients experience heightened precarity, which can have pervasive effects on adherence and suppression. Enhanced adherence counselling can help socioeconomically precarious patients maintain suppression, but in order to improve treatment effectiveness and population health, we should move beyond the short-term solution of helping patients ‘cope’ with insecurity toward tackling the underlying factors that lead to precarity. Data on intention-to-treat populations are critical to this effort, yet medical researchers and publications continue to obscure the influence of SDH by focusing on per-protocol populations. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.