Combating Stigma: by Lydia Karch

Over at the school of public health, I work part-time recruiting subjects for several different studies looking at HIV risk and acquisition in men who have sex with men (MSM) in Atlanta. One of these studies looks specifically at the difference in risk between African-American and white MSM in Atlanta, and so I have spent a fair number of weekend nights out at bars and nightclubs in the city, approaching eligible young men and wheedling them into taking our screening survey. In general people are no ruder than they would be to any stranger collaring them on the street and asking intrusive questions about their sexual habits, and the club managers and owners are very friendly and accommodating, offering us stools or water or letting us stand inside the lobby when it’s cold outside. Very recently, however, a co-worker and I were asked to leave a club where we had always been welcome in the past because, as the owner put it, we were “bumming people out” with our talk of HIV and safe sex. People came to the club to party, he explained, not to feel bad or guilty about having fun.

 Because this is a customer service job, and the customer is always right, I apologized profusely and thanked the manager, promising to have my boss call him to work things out in the morning. My co-worker and I left, but on the way home my snarky public health conscience kept telling me that I should have made a crack about the San Francisco bath houses and tried to make the manager feel guilty for turning a blind eye to an undeniable problem. Wasn’t that my job, as a public health professional and advocate? Didn’t I have some sort of responsibility to try to get people to face dangerous health practices, even when they didn’t really want to see? Wasn’t that what caused so many problems way back in the beginning?

 According to the most recent CDC data, young (13-29) African-American MSM account for more new HIV infections than any other age and racial MSM sub-group; the number of new HIV infections in this group increased by 48% from 2006 to 2009, with 11,400 estimated new infections in 2009 (CDC 2011). Clearly, something is happening with this sub-population to cause rising infection rates coupled with complacency and lack of concern or awareness. Are they unconcerned because they are young, or not well-informed about their risks? Do they just not care? Is HIV not frightening enough for a generation that grew up with ARTs? And how do you address all of these obstacles? How do you reach out to a group that doesn’t want to hear or talk about a problem that they don’t want to see?

 African-American women also face a high risk of HIV infection; they are 15 times more likely than white women to become newly infected, and three times more likely than Latina women. The vast majority (85%) of these women acquire the virus through heterosexual contact, producing the Oprah-endorsed scare of men living on the “down low” and infecting innocent wives. But surely there must be other factors at play to produce 5,400 new cases among African-American heterosexual women in 2009. After all, there were only 2,400 new cases among African-American heterosexual men in the same year. Are there really that many African-American men leading double lives? Or is something else going on to explain the discrepancy, like meth or other drug use? Something that would be more embarrassing to disclose on a questionnaire than heterosexual sex?

I guess the big, overarching question I have related to these readings is: how do you deal with all of the stigma that not only surrounds HIV, but so many of the behaviors and practices that put people at risk for HIV? And how much does that stigma feed into the perceived “risk” of these groups? Are injecting drug users (IDU) more at risk because of what they do, or how they are treated and cared for? How can someone who wants to help combat the stigma speak out in ways that are helpful and not alienating or frightening?

 Sources:

2011. CDC. “HIV among African Americans.” http://www.cdc.gov/hiv/topics/aa/index.htm

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