The stubborn stigma of HIV/AIDS
 

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posted Friday, November 30, 2012 - Volume 40 Issue 48

The stubborn stigma of HIV/AIDS
Public misperceptions hamper prevention and treatment efforts

by Shaun Knittel - SGN Associate Editor

About 34 million people worldwide are infected with HIV, the virus that causes AIDS, and 25 million more have died from it. While there's no vaccine, cocktails of powerful antiviral drugs called antiretroviral therapy (ART) can keep the virus suppressed and keep patients healthy. But no matter how long patients take ART, they are never cured.

That is where stigma enters the picture.

Stigma and discrimination are universally experienced by persons living with and affected by HIV/AIDS. The virus lurks in the body and comes back if the drugs are stopped. Scientists want to flush out these so-called reservoirs and find a way to kill the virus for good.

Stigma is perceived as a major limiting factor in primary and secondary HIV/AIDS prevention and care, and it interferes with voluntary testing and counseling, and with access to care and treatments.

Approximately one in five (19%) men who have sex with men (MSM) in 21 major U.S. cities is infected with HIV, and nearly half (44%) of those men are unaware of their infection, according to a new analysis from the Centers for Disease Control and Prevention.

In the study, young MSM and MSM of color were least likely to know their HIV status.

'This study's message is clear - HIV exacts a devastating toll on men who have sex with men in America's major cities, and yet far too many of those who are infected don't know it,' said Kevin Fenton, M.D., director of CDC's National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. 'We need to increase access to HIV testing so that more MSM know their status, and we all must bring new energy, new approaches, and new champions to the fight against HIV among men who have sex with men.'

ATTITUDES CHANGE SLOWLY
Public attitudes about HIV and AIDS have changed dramatically since the first AIDS cases were reported 30 years ago. But in many parts of the world, the stigma is still powerful.

AIDS-related stigma is not static. It changes over time as infection levels, knowledge of the disease and treatment availability vary.

The UN Joint Programme on HIV and AIDS launched the 2012 Global Epidemic Report on Tuesday and reported significant declines in new infections among adults and children, with high numbers of people placed on antiretrovirals.

Still the region most severely affected, sub-Saharan Africa has shown progress with about 1.8 million new HIV infections in 2011, compared with 2.4 million in 2001.

Between 2005 and 2011, the number of people dying from AIDS-related causes in sub-Saharan Africa declined by a third, from 1.8 million to 1.2 million.

However, while there have been victories in the treatment and prevention arena, fear, ignorance, and discrimination - including abusive treatment and violence - remain widespread in a number of countries.

In a recent survey, more than half of the people living with HIV in Zambia reported having been verbally abused as a result of their HIV status. One in five people living with HIV in Nigeria and Ethiopia reported feeling suicidal.

According to a nine-country study by the International Labor Organization and the Global Network of People Living with HIV, the percentage of people living with HIV who reported discriminatory attitudes among employers ranged from 8%in Estonia to 54% in Malaysia.

BLAMING THE VICTIM
As of this year, 60 countries have adopted laws that specifically criminalize HIV transmission, with about 600 convictions reported.

According to a global review this year, more than 40% of UN member states (78 of 193 countries) criminalize same-sex relations, with some permitting imposition of the death penalty for convictions under such laws.

Most countries have laws deeming some aspect of sex work to be illegal, and these are often used to justify harassment, extortion, and violence against sex workers, placing them at increased risk of HIV.

Some countries have reformed laws to decriminalize populations at higher risk: Portugal decriminalized drug possession and use in 2000, while in 2003 New Zealand adopted a law that decriminalized sex work.

A grassroots organization that aims to lower the HIV infection rate and neutralize the stigma associated with HIV/AIDS through education and awareness via social media and advertising has launched. The Stigma Project seeks to create an HIV-neutral world, free of judgment and fear, by working with both positive and negative individuals from all walks of life, regardless of their gender, sexual orientation, race, or background.

EXAMPLES OF EVERYDAY STIGMA
Here are some common beliefs and behaviors to avoid, and to urge others to avoid:

± Referring to asymptomatic HIV-positive people as 'having AIDS.'

± Presuming that because someone is HIV-positive, they're sick, contagious, or dying.

± Believing HIV can be contracted by casual contact or kissing.

± Using the word 'clean' when referring to negative HIV status, or combining drug-use behavior with HIV status, often referred to in online personal ads with the acronym 'DDF.'

± Dismissing, judging, or rejecting someone who is HIV-positive when they disclose their status.

± Perceiving HIV-positive people to be failures, promiscuous, or that they 'deserved' to become infected. ± Discussing someone's HIV status, rumored or factual, without their consent or knowledge. ± Refusing or resisting getting tested for HIV for fear of a positive result.



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