Are we close to ending HIV? Part III: Overcoming social stigma and discrimination
By Julie Jordan
Published April 4, 2019
Public health is striving to make new HIV diagnoses rare, but there is another threat to ending HIV [video] that is often overlooked which operates on a societal level in our daily lives. Persons at high risk for HIV are less likely to get tested for HIV because of stigma and discrimination surrounding the virus. HIV stigma and discrimination occur everywhere because of false ideas which began to spread in the 1980s when the virus started.
According to the Centers for Disease Control and Prevention, HIV stigma is negative attitudes and beliefs about people living with HIV. It begins with fear of getting HIV. Many people still do not understand how HIV is transmitted, and they’re afraid of acquiring the virus.
HIV discrimination refers to the unfair and unjust treatment of someone based on their real or perceived HIV status. This is the action that results from stigma.
Understanding what HIV is and how it is transmitted is the first step to combatting stigma.
HIV attacks the body’s immune system and interferes with its ability to fight infections, creating vulnerability to opportunistic infections or cancers, by targeting CD4 cells (T cells) which help the immune system fight off infections. If untreated, once a person’s CD4 cell count goes below 200, they are in the third and final stage of HIV known as acquired immune deficiency syndrome, or AIDS.
Since the late 90s, the most widely-available and effective treatment for HIV is antiretroviral therapy, or ART. If ART is taken as prescribed, it can reduce the viral load—the amount of HIV in the blood—to an undetectable level called “sustained viral suppression.” Once sustained viral suppression is reached, the risk of transmitting HIV through sex is reduced to almost zero. And quality of life is greatly improved.
Most people with HIV do not progress to AIDS anymore due to ART. Many individuals with HIV are living normal and healthy lives with sustained viral suppression thanks to ART.
HIV is transmitted most often through vaginal and anal intercourse and sharing supplies, like needles, for injection drug use. HIV cannot be transmitted through saliva, sweat, tears or closed-mouth kissing. It cannot be transmitted by insects or pets. And it cannot be transmitted by sharing toilets, food or drinks.
Those with the greatest risk of acquiring HIV are gay and bisexual men, African Americans, Latinos, injection drug users and transgender individuals. However, anyone engaging in the behaviors above has a greater risk of acquiring HIV.
How can you help stop HIV stigma and discrimination to help make new diagnoses rare?
- Educate yourself. Review the facts above and research HIV further to answer any lingering questions you might have. Fear is reduced as knowledge grows.
- Clarify misconceptions about what HIV is and how it is spread if you hear false information.
- Set a good example to dispel incorrect fears of HIV transmission through benign activities like sharing food or giving a hug.
- Gently correct those who might refer to someone with HIV as “sick.” Because of the advances in treatment, HIV is no longer a death sentence. Instead, HIV positive individuals can live normal, happy lives.
- Be supportive of friends with HIV and those at greater risk for the virus when they pursue and continue treatment.
- Celebrate friends with HIV who have achieved sustained viral suppression.
- Get tested for HIV frequently and support those who do the same.
- Take PrEP, use condoms and encourage others to do the same.
When a person opens up and informs a friend they have HIV, the appropriate response is concern they are getting treatment, or offering to help them find treatment.
Partners of individuals with HIV should take PrEP and use condoms, but if their partner is taking ART regularly as prescribed and has achieved sustained viral suppression, there is almost zero risk of transmitting the virus.
The more comfortable individuals with HIV feel about telling others their status, the greater the likelihood of making new diagnoses rare. Encouraging friends to be proactive about getting tested for HIV will also help end HIV.
Below is a history of HIV since the virus began. Together, let's reach the next milestone of making new diagnoses rare.
A brief history of HIV adapted from the CDC:
- In 1981, a report described Pneumocystis pneumonia in previously healthy, gay men in LA. This is the first official reporting of what will be known as the AIDS epidemic.
- Between June 1, 1981, and September 15, 1982, CDC received reports of 593 cases of acquired immune deficiency syndrome (AIDS). Death occurred in 243 cases (41%).
- In 1989, the Guidelines for Prophylaxis Against Pneumocystis carinii Pneumonia for Persons Infected with the Human Immunodeficiency Virus became the first HIV-related treatment guideline published by the U.S. government.
- By 1992, AIDS was the number one cause of death for US men aged 25-44. That same year, the CDC says a CD4 (T cell) count below 200 is AIDS.
- Age-adjusted death rates from HIV infection in the U.S. declined 47 percent from 1996 to 1997, the first decline since the virus began in 1981. The decline in AIDS deaths was primarily due to antiretroviral therapy.
- In 2011 CDC issues interim guidance to health care providers on the use of pre-exposure prophylaxis (PrEP) as an HIV prevention strategy among men who have sex with men. And, CDC reports that drugs to treat HIV can also reduce HIV acquisition. And, treatment of HIV shown to reduce transmission nearly 96%. And, of the 1.2 million people living with HIV, 1 in 5 do not know they are infected and 1 in 4 are taking HIV medicines regularly and have their virus under control.
- CDC estimates that 1 in 2 gay/bisexual black men, 1 in 4 gay/ bisexual Latino men, and 1 in 6 gay/bisexual men will be diagnosed with HIV if current trends continue. 1/11 white MSM. The overall lifetime risk of HIV diagnosis in the United States is 1 in 99.
- CDC releases study showing if PrEP use increases in high-risk populations, almost 20% of the estimated 265,330 new HIV infections expected to occur through 2020 could be prevented.