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Does HIV stigma drive infection?
by Frank Pizzoli
2013-05-09

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"The constant drumbeat of crisis around HIV gets tiresome," says John Peller, vice president of policy, AIDS Foundation of Chicago. Yet infections among gay men are rising.

In accepting a GLAAD Media Award for "How to Survive a Plague," activist Peter Staley said, "Gay men are only about 2% of the U.S. population, but we're the fastest growing group of new infections, 63% of total infections in recent years. Why aren't these numbers shocking us?"

The U.S. Centers for Disease Control (CDC) says if current trends continue 50% of African-American men who turned 18 in 2009 and have sex with men will be HIV+ by age 35. Fifty-four percent of all men who have sex with men will be HIV-positive.

Responses to rising infections focus on reducing stigma and increasing talk.

Chicago's AFC launched "How Are You Healthy?" embracing a holistic approach to men's health. "We really got guys talking about health in general, including HIV," Peller says.

AFC also looked closer at men receiving and requesting services. "We found HIV stigma played a role," Peller explains. Those who brought internalized homophobia, "gay stigma," to HIV infection were less adherent on treatment. They lacked social supports before infection, a circumstance that continued, sometimes worsened, after infection. "Now they felt isolated for two reasons, being gay and infected," Peller explained.

Nationwide, Needle Prick Project founder Tyler Curry wants "to get people talking about HIV again. Not just gossiping but honest talk that doesn't stigmatize us." It's a "modern conversation" about HIV, as his mission states, "what it means to be HIV positive and what it will take to protect each other today."

Curry, 29, lives in Dallas. He tested HIV positive in 2012 and was radicalized.

"Since my positive test result, dating sure has been interesting. I've faced lots of rejection, stony cold receptions from others. All because we can't talk about it," Curry says.

"After I forced a conversation during a buddy brunch, I learned that half the guys around the table were infected. Yet there we sat all that time. Silent." His posse dished everything—politics, sex, religion—to the dirtiest detail "but we never discussed HIV as it pertained to our everyday lives," Curry said.

Curry's online project, http://www.getpricked.or, breaks the silence between positive and negative guys by allowing real guys with real HIV to offer testimonials and their photos.

"My generation feels safely removed from the HIV epidemic. And why shouldn't we? People like me can go on treatment and live healthy lives and no one would be the wiser. That is, unless we all start talking to one another. Then these statistics become actual faces, real people, not just CDC numbers," Curry stresses.

Dialogue must focus on "HIV prevention as a shared responsibility," says Sean Strub, founder of POZ magazine and more recently The Sero Project.

HIV criminalization laws block shared responsibility, fuel stigma, and may result in more infections.

To ease stigma and bring laws into line with current science, U.S. Rep. Barbara Lee has re-introduced the "Repeal Act," which asks state attorneys general, state public health officials, people living with HIV, legal advocacy and service organizations to review laws, policies and cases that impose criminal liability on people living with HIV.

"These laws are based on bias, not science. These laws breed fear, discrimination, distrust and hatred, and we've got to modernize them. That's exactly what this legislation would do," Lee said upon re-introduction.

Current HIV statutes send "a message to people who are negative or don't know their status that protecting them from acquiring HIV is someone else's job," Strub explains. He's referring to criminalization laws that require knowledge of one's HIV status in order to be held liable. Street translation: "don't test, escape arrest" which creates "an illusion of safety that results in more HIV transmission," Strub says.

Sustaining the illusion of safety is the de-emphasis by service organizations which no longer provide supportive networks—a needed resource according to AFC research—for the infected and, in the process, thwart misinformation and stigma.

Lambda Legal's HIV Project Director Scott A. Schoettes says that "If public health officials rely primarily on the scare tactics of two decades ago, they will just lose credibility and increase stigma and discrimination."

"It would be more effective to fund supportive networks of people with HIV, empower people with HIV, which results in lessened stigma," Strub says. Like Curry's online efforts which create dialogue between positive and negative individuals.

Aaron Laxton is creating dialogue.

Laxton, 33, is a St. Louis HIV activist, and like Curry is on the Advocate's current list of 40 Under 40.

Laxton says his mission is to "simply live my life in such a way that shows other people living with HIV that it is possible to be happy and healthy and HIV positive."

Laxton underscores a generational shift.

"People are forgetting about the plague era, the pain, loss and destruction that AIDS left behind in the gay community. People no longer think that HIV is a problem. We have been told that we can take medications and that will keep us healthy. No one tells you, however, that the newest class of medications to treat HIV cost over $3,000 a month," he points out.

To bring back dialogue and awareness Laxton started on day four of his diagnosis to chart his journey. Viewers can see the results at www.youtube.com/laxtona .

On HIV prevention and other messages, Laxton observes that "as a community we are desensitized. We're told that we should be concerned about everything and in turn that makes it hard to be concerned with anything. I think that it is very telling of where we are in the fight to end HIV/AIDS."

Lambda Legal's Schoettes thinks the tough question is why more people aren't aware or don't really seem to care. Besides AIDS fatigue, "our response, or lack of adequate responses, is tinged by issues of race, socio-economic class, immigration status, and disparate levels of access to care."

As one online guy wrote in an email for this article: "Know your status and be truthful about it. Being HIV-positive is fine but needs to be communicated."


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