In the United States, we understand HIV — the virus that causes AIDS — using a common narrative, one that gives us the impression that its deadliest chapters belong in decades past or distant places. It goes like this:
The disease emerged in the 1980s, cutting down young gay men in their primes and blindsiding scientists as they scrambled to unravel the virus’ mysteries. While AIDS initially whipped up mass hysteria among the general public, LGBTQ folks demanded equality, pushing to find treatments and a cure. AIDS activism and scientific research eventually led to the development of antiretroviral drugs, which tamed the plague by turning a death sentence into a chronic disease. Now, with the right medication, people with HIV can live long, healthy lives. The hysteria has died down, as most people realize viral transmission is preventable, and the infection is manageable.
One thing hasn’t changed, however: Just as it was in the 1980s, AIDS is still thought of as a disease of the “other.” Back then, it was a disease of gay men, a population cruelly marginalized by the general public. Today, it’s thought of as a disease of sub-Saharan Africa, where HIV prevalence is highest.
That narrative, however, doesn’t tell the whole story. Right here in our own backyards, the HIV epidemic continues to spread in the face of chilling indifference from those not affected. African-American MSM — men who have sex with men, who may or may not self-identify as gay or bisexual — have an HIV prevalence that exceeds that of any country in the world. In Swaziland, for example, 27 percent of adults are living with HIV/AIDS, but if current transmission rates hold steady, half of African-American MSM are projected to be diagnosed with HIV in their lifetime. Instead of taking this projection as a wake-up call to invest in lifesaving health policies, however, state and federal responses are poised to let it become a self-fulfilling prophecy.
Contrary to racist and homophobic stereotypes, data show that black MSM aren’t more likely to engage in risky sexual behavior, use drugs and alcohol, or withhold their HIV status from partners. So why are they burdened with higher HIV rates? The answer lies beyond mere behavior, embedded in policies and practices that disproportionately harm people based on race, sexuality, and geography.
After the introduction of antiretroviral drugs in the 1990s, schools started to turn away from safer-sex messages. Though condoms were proven to provide protection against HIV transmission, abstinence-only education downplays their effectiveness. Truly comprehensive sex education, on the other hand, teaches students multiple strategies for protecting their sexual health, including proper condom use. It also gives them the tools they need to negotiate sexual boundaries and recognize consent, making them less vulnerable to HIV and other sexually transmitted infections. Additionally, LGBTQ-inclusive sex education can offer a safe space to queer students, ensuring they receive nonjudgmental instruction that is relevant to their own lives.
Stigma can lead to silence where conversations should be — discussions in which children comfortably seek advice from trusted adults, or partners talk about safer sex and STD testing. Stigma can also make it difficult to seek care, whether it is making that initial doctor’s visit for an HIV test, asking a doctor to prescribe preventive medication, or picking up lifesaving antiretrovirals from a small-town pharmacy. On a more macro level, stigma can dictate societal priorities, as when homophobia funnels money away from effective HIV programs.
Effective HIV programs strive to make testing as easy and accessible as possible. Lack of awareness surrounding HIV status enables uninhibited transmission of the virus, whereas knowing one’s status or one’s partner’s status can motivate people to protect themselves with condoms and preventive medication. Unfortunately, roughly 15 percent of people with HIV don’t know they are infected — among black MSM with HIV, that proportion is slightly higher at 20 percent. Obamacare was supposed to make HIV testing more accessible, but many states opted not to expand Medicaid, denying Obamacare’s benefits to millions. African Americans were hit hardest by states’ refusal to expand Medicaid. Beyond Obamacare, the current president doesn’t seem interested in continuing his predecessor’s commitment to fighting HIV on the homefront.
The problems described above are especially pronounced in the South, which is disproportionately impacted by HIV, and where being gay is more difficult. The region’s sex education policies are infamously inadequate. Stigma surrounding sexuality and HIV might be worse than in other parts of the country. It was denied many of Obamacare’s benefits when most Southern states refused to expand Medicaid — nearly 9 out of 10 people who missed out on expanded Medicaid live there. And, when it comes to prevention efforts, federal dollars aren’t being lavished on the region in the way they are being distributed to other parts of the country, despite the region’s compelling need for funding. The efforts that helped dampen the AIDS crisis in cities like San Francisco and New York aren’t making their way to the South, and without these interventions, HIV can spread more freely. It’s no wonder that Southern black MSM bear the greatest burden of the nation’s HIV epidemic.
The U.S. AIDS crisis isn’t over. Until state and federal policies can meet the urgent need for better education, outreach, and health-care access, individuals can effect change in their own communities and take steps to protect their sexual health. Any Planned Parenthood health center can help you reduce your risk of transmitting or acquiring HIV. We offer condoms, HIV screening, education, and preventive medication, and can help connect you to treatment if you test positive for the virus.
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