As President Obama hosted African heads of state in Washington this past week, the global HIV/AIDS epidemic has been back in the news. But we shouldn’t need an international summit to remind us about HIV/AIDS. The epidemic is quietly raging here at home.
There are more than one million Americans living with HIV, and each year some 50,000 are newly diagnosed according to the Centers for Disease Control and Prevention (CDC). In 2010, more than 15,000 people in the United States died of AIDS-related causes.
"The stigma that certain populations encounter on a daily basis is the single biggest barrier to reaching them with preventative education and treatment."'
And the disease disproportionately impacts certain groups. In 2010, gay and bisexual men made up only 2% of the national population, but comprised 56% of Americans living with HIV. In 2010, African-Americans made up 12% of the population, but accounted for 44% of new HIV infections. The American AIDS crisis has not ended, it’s just become more deeply rooted, intertwined with poverty, racism, incarceration, and homophobia. HIV is embedding itself wherever people face poor health, and is a marker of broader injustices in the country today.
Clearly, the fight against AIDS in the U.S. is far from over, and prevention and treatment efforts are not reaching certain communities. It’s time to start talking about the reason why:
Stigma.
The stigma that certain populations encounter on a daily basis is the single biggest barrier to reaching them with preventative education and treatment.
Consider the discrimination widely faced by members of the LGBT community. By some estimates, as many as 43% of gay and transgender employees have experienced some form of workplace discrimination or harassment. And while laws prohibiting gay marriage are being repealed around the country, it is still legal in 29 states to discriminate against workers based on their sexual orientation.
This discrimination has serious consequences. LGBT teens who are rejected by their families for coming out are three times more likely to have unprotected sex. They are also three times more likely to use illegal drugs. These behaviors dramatically increase the probability of HIV infection. And, once infected, fear of ostracism keeps many from accessing life-saving treatment and preventative education. This is especially true where discrimination against LGBT people is widespread, and where health care services are lacking. Thus, the epidemic flares in areas where discrimination and inequality continue to rage. In the southern U.S., for instance, AIDS is a leading cause of death for gay and bisexual young men.
Discrimination against the LGBT community is only part of the problem. Stigma against those struggling with drug addiction has resulted in a longstanding federal ban on funding needle exchange programs, even though the CDC declares them the “safest, most effective approach” to preventing drug-related HIV infection. And systematic discrimination against racial minorities interferes with treatment. This is one of the reasons why Latino Americans have three times the HIV infection rate of white Americans, according to the CDC.
Of course, HIV itself is a disease that carries enormous stigma. An astounding 34 states have HIV criminalization laws, many of which make exposure a felony punishable by up to 25 years in jail. Beyond the obvious problem with conveying contempt for victims of HIV instead of compassion, these laws ignore science, criminalizing certain acts that have zero chance of transmitting the disease, like spitting and biting. A presidential HIV/AIDS task force found that, far from reducing the spread of AIDS, criminalization laws “undermine the public health goals of promoting HIV screening and treatment.”
At the Elton John AIDS Foundation, our grantees encounter stigma every single day. And every day, they work to fight it.
"The epidemic flares in areas where discrimination and inequality continue to rage."'
We do see progress. A few weeks ago, President Obama made it illegal for federal contractors to discriminate based on sexual orientation or gender identity. And earlier this year, Iowa became the first state to repeal its criminalization law. But the pace of change is sluggish -- more sluggish than it would be if we understood that stigmatization carries a cost paid in human lives.
A decade ago, when President Bush was confronted with the global suffering caused by HIV/AIDS, he started a program called the President’s Emergency Plan for AIDS Relief, which pledged billions of dollars in international aid. This effort, continued by President Obama, has saved an estimated four million lives abroad. At the U.S.-Africa Leaders Summit in Washington this past week, many heads of state expressed touching gratitude for U.S. assistance.
Internationally, the U.S. has taken on an outsized role in the fight against AIDS. We have proven that oceans aren’t too big a barrier for compassion. Nor are unfamiliar cultures, diverse religions, or lifestyles so different we could hardly imagine them.
Surely, then, the barriers here at home can be conquered, too.
Scott Campbell is executive director of the Elton John AIDS Foundation.