Those of us working in HIV prevention have always believed that the spread of the virus was largely due to stigma around sex and sexuality, and that the only time we’d see any sort of difference was when society started engaging on the matter more openly. But, it wasn’t until the 2009 report on the correlation between the spread of HIV and stigma the Dominican Republic that we could claim it as a fact.
The implications of this report illustrated how social attitudes create an environment which propels the spread of HIV: stigma affected treatment toward people living with HIV; this has consequences for access to sexual health services and the way they are administered by health professionals, or rather, denied; stigma consequently affected at risk individuals’ willingness to seek HIV-related services, including testing. Stigma, therefore, drove the spread of this virus.
This is evident when observing the prevalence of HIV among African-American women in the United States (U.S.). According to the Centers for Disease Control and Prevention (CDC), of all women diagnosed with HIV in 2014, most new infections were attributed to heterosexual sex and an estimated 62% of women diagnosed were African-American.
CDC attributes this trend to the fact that “the greater number of people living with HIV (prevalence) in African-American and Hispanic/Latino communities and the fact that people tend to have sex with partners of the same race/ethnicity”. New infections among injectable drug users both men and women were relatively low.
What this implies is that somewhere along the line, the men these women are having heterosexual sex with are having unprotected sex with other men. Because if prevalence among African-Americans increasing the risk of HIV among black women, and black men who sleep with men remain most affected by the virus, then there are heterosexual men sleeping with men.
While the LGBTQ community has made massive legal strides in the U.S. in recent years, religious condemnation of same-sex relationships remains rife. Religion continues to be a cornerstone in African-American communities as it played a significant role in the liberation of black people. Faith-based leaders often site the spread of HIV among the greater African-American population to support anti-gay rhetoric.
This misinformation breeds stigma, creating an environment of where people are scared to engage the matter beyond the pulpit. They are not discussing facts; and the fact of the matter is, according to a 2005 study, sex with a partner who had a history of incarceration was a key driver of HIV infections among newly diagnosed African-American women.
A 2002 review of HIV in U.S. prisons states that in 1997, there were less than 35,000 inmates living with the virus on any given day; and that in the same year, just under 150,000 of those released had HIV. Infection among inmates in prisons is more than five times greater than the rate among people who were not incarcerated, according to the CDC. Yet, HIV-prevention interventions in prisons are limited to testing and treatment.
Those of us who believed that stigma around sex and sexuality drove the spread of HIV were right; that’s what the facts showed. But, even with facts staring us in the face, we continue to let hysterics dictate our response to the pandemic.
Angelo C Louw is the Advocacy Officer at Studies in Poverty and Inequality Institute (SPII) and former HIV prevention campaigner at loveLife, South Africa’s largest youth HIV intervention. He is currently a Fulbright/Hubert H. Humphrey Fellow based at the University of Maryland. He writes in his personal capacity.