Today is World AIDS Day.*
It has been three decades since the first young gay men started getting Kaposi’s sarcoma. Many people, including me, have never lived in a world where sex couldn’t kill you. 33 million people across the globe are currently living with HIV?
So, uh, why do we still stigmatize people with HIV/AIDS?
Stigmatizing a disease is pretty much the stupidest public-health choice ever. I know, I know, it’s sex and God help us if we don’t end up trying to control what’s going on in everyone’s knickers. I mean, think of what might happen if we didn’t! People might start having happy, mutually enjoyable sex lives that are (gasp) slightly different from our own!
Admittedly, there is one obvious source of the stigma around AIDS: it kills. People really do not like diseases that kill; many people may want to avoid getting tested because they don’t want to know, and avoid people with HIV because they are afraid of contracting it by fucking magic. However, AIDS is no longer an automatic death sentence. With luck and retrovirals, a HIV-positive patient may well survive long enough to die of something else. Many don’t ever develop AIDS.
Scaremongering abstinence-only sex education aside, HIV is not necessarily going to kill you; however, you have to know about it early for best results in the treatment. That’s why regular testing for HIV is so important, particularly for people in high-risk groups, such as sex workers, men who have sex with men and people who inject drugs. There is no reason to be afraid of contracting AIDS; there is reason to responsibly manage your health.
However, the source of the stigma is deeper (after all, no one skips mammograms because they don’t want to know). For many STIs, the biggest stigma is for women and is around being a Slutty Dirty Slut Person Who Sluts About The Place Being Slutty. However, in the United States, three-quarters of people currently living with AIDS are male, and their stigma is primarily a male-oriented one.
Even today, AIDS is still primarily considered a “gay disease”– just ask any of the charmers who call it “God’s plague on homosexuals” (lesbians must be God’s chosen people then) or explain that gay is an abbreviation for “Got AIDS Yet?” Even more liberal-minded sorts may consider HIV to primarily be the business of queer men and, if they think of it, IV drug users.
Of course, the whole “AIDS=gay” thing is completely wrong. Thirty percent of men living with HIV did not contract it from sex with men (including more than ten percent who got it from heterosexual sex). The majority of people who have HIV or AIDS are men who have sex with men, but there is a very significant minority that isn’t, and anyone can get AIDS.
But even beyond that, the association of HIV/AIDS and homosexuality has a huge stigma effect for men. Gay and bi men who are closeted or on the downlow may fear to get tested because someone might know. Straight men will not get tested, because, hey, they don’t have to get tested, they’re straight. Besides, if you get tested, you’re like a gay man, and as we all know being gay is absolutely the single worst thing that can happen to a man bar none and impugns his masculinity for forever and a day, amen.
You can see the effects of this stigma in socially conservative regions of the USA, such as the South. The South has among the highest rates of death from AIDS in the United States. Andrew Skerritt, an expert on AIDS in the South, attributes the high death rates to “a conspiracy of hypocrisy, shame, false morality, cowardice and political opportunism.” Pastors won’t encourage condom use because they think it will encourage people to have sex. People are afraid of being tested because someone might see them, or of contracting HIV because they (far too often rightly) fear getting shunned.
As a doctor at San Francisco General’s HIV/AIDS ward says, “We have the medications. You can survive HIV, no problem. But can you survive the stigma?”
The stigma around HIV/AIDS infections has even worse public policy implications. Particularly in the South, AIDS awareness is an afterthought, with no billboards or PSAs reminding one of the importance of using condoms or getting tested (as odd as that seems to someone like me, who grew up in one of the counties with the highest rates of AIDS infection in the US, and correspondingly got HIV education starting in kindergarten). 34 states and two territories criminalize exposing someone to HIV; some people have gotten sentences of up to 30 years, even for consensual behavior without HIV transmission. Clean needle programs are somehow still controversial.
Imagine if we took the same policy about lung cancer. Some people get lung cancer through making stupid decisions and smoking, the same way that some people get HIV through making stupid decisions and having promiscuous sex with untested partners without condoms. However, many people get lung cancer through pure shitty luck, the same way many people get HIV through pure shitty luck– just ask hemophiliacs, Isaac Asimov, people who contracted HIV through rape, or even people whose True Love Waits purity rings didn’t protect them from a partner without similar ethics.
In either case, the consequences would be terrible for individuals. A decrease in testing rates for fear you have the horrible sickness. Hiding their disease from their families, friends or jobs for fear of shunning or exclusion. A decrease in self-worth because you know you have the sickness everyone loathes, and you wonder what you did to deserve it.
But AIDS is not a Scarlet A of sexual sin. It is an illness. It is an illogical public health policy to treat it otherwise.
*Sharp-eyed people may note that this is going up, in fact, the day after World AIDS Day. I got distracted by Gargoyles halfway through drafting it. But nevertheless it got itself started on World AIDS Day, so I’m counting it.