On March 29, the Postgraduate Institute for Medicine and HealthHIV conducted a webinar entitled "OUTcompetent: Cultural Competency and the Stigmatization of STDs, HIV, PrEP, and Mental Health." The webinar consisted of four panelists who discussed their experiences with stigma.
The panelists spoke on the impact that stigma has on access and adherence to care. Damon Jacobs, licensed family therapist and HIV prevention specialist, spoke about the emergence of PrEP. When it first appeared in the 2012 iPrEx trials, PrEP was largely unknown. Jacobs said, "I kept meeting young men who were becoming newly HIV-positive. They never knew that there was a pill. … And none of the agencies, organizations, or departments of health at that time would share that information."
Jacobs spoke about PrEP on Huffington Post Live the same year. Soon afterward, the article "Truvada Whores" appeared. "This was how a lot of people heard about Truvada for the first time" said Jacobs. "When the CDC last year reported that rates of STIs were escalating," said Jacobs, "the media really added to the backlash of the whole 'Truvada whore' thing … and, suddenly now, not only are we Truvada whores but we are carriers of the STIs."
Stephen Hicks, health equity and capacity building manager at the National Coalition of STD Directors ( NCSD ), discussed one patient's case study. Hicks said, "The patient says that he's straight but sometimes has sex with other straight men. He doesn't use condoms for anal sex because he states that his older partners prefer 'raw sex.' … The doctor approaches him about PrEP but the patient states that he doesn't really need it. He says that it's good for gay guys but not for him."
Adam Swanson, MPP, senior policy associate at the National Council for Behavioral Health, shared his personal experience with stigma. For Swanson, the bullying in elementary school was so bad that he attempted suicide. He was given psychiatric evaluations, family interviews with social workers and meetings with school counselors. But, ultimately, Swanson said, "The bullying that caused the problem in the first place was never addressed." In graduate school, the mental health office called the police on Swanson when he came in for help. The police proceeded to mock and laugh at him. Stigma like this "can result in a patient population that has been conditioned to protect itself through nondisclosure" said Swanson.
A recurring theme was the need to see patients as whole people. As Hicks said, "we also talk about additional focus areas like intimate partner violence, domestic violence, substance use, housing, employment, social support as well as sex work. These additional focus areas will and can affect someone's holistic health. So … we want to make sure that the tools that we create reflect that."
Venton Jones, program officer for LGBT Health and Wellness Initiatives at National Black Justice Coalition, mentioned the importance of addressing other health problems. "We have to also understand the health care workload—not just HIV but also of obesity, heart disease, the impact of poverty," said Jones.
Swanson said, "If we learn to listen with empathy and compassion without judgement we can change lives."
A number of other recommendations were made. Hicks noted that NCSD has posted an "optimal care checklist" on their website.
Jones mentioned that we must be search for and assist LGBT individuals in the correct communities. He said, "Black LGBT individuals live for the most part where other African Americans live, not in gay enclaves … and so being able to look for strategies to understand where to locate Black LGBT people and then finding strategies that relate and can be adapted to their cultural identities."
Jones also discussed the need to understand the complexities of discrimination, saying, "Create opportunities for staff as well as volunteers to be trained in order to understand social inequities that the Black MSM face as a subpopulation that is not just LGBT or not just Black, but ones that are in the intersection of living with those two identities."
Jacobs commented on ways to take back power. He said, "I talk about how I embrace being a Truvada Whore and it actually then became a social-media movement where a lot of us decided to take that name as the way to reject stigma." Jacobs also suggested questioning the choice of authority. "Do you give your authority to some idiot on a dating app," asked Jacobs, "or do you give your authority to your higher power or to your community or to your friends or your family who might love you and be really really proud of you for taking charge of your sexual health?"
