The U.S. Department of Health and Human Services (HHS) has launched The HIV Challenge, a national competition to engage communities to reduce HIV-related stigma and increase prevention and treatment among racial and ethnic minority people. The HIV Challenge is part of a new partnership between the Office of the Assistant Secretary for Health (OASH) Office of Infectious Disease and HIV/AIDS Policy (OIDP) and the HHS Office of Minority Health (OMH).
Through this challenge, HHS is seeking innovative and effective approaches to increase the use of pre-exposure prophylaxis medication (PrEP) and antiretroviral therapy (ART) among people who are at increased risk for HIV or are people with HIV. The HIV Challenge is open to the public, and HHS will award a total of $760,000 to 15 winners over three phases. Phase 1 submissions are open from July 16, 2021, through September 23, 2021.
“HIV-related stigma is one of the reasons why prevention and treatment options, such as PrEP and ART, are underutilized,” said Assistant Secretary for Health, Rachel L. Levine, M.D. “The latest science shows that people living with HIV who take the proper medicine as prescribed and get and keep their HIV at an undetectable level do not transmit HIV to others.
The Department of Health and Human Services announced that the Office for Civil Rights will interpret and enforce Section 1557 and Title IX’s prohibitions on discrimination based on sex to include: (1) discrimination on the basis of sexual orientation; and (2) discrimination on the basis of gender identity. Section 1557 prohibits discrimination on the basis of race, color, national origin, sex, age, or disability in covered health programs or activities. The update was made in light of the U.S. Supreme Court’s decision in Bostock v. Clayton County and subsequent court decisions.
“The Supreme Court has made clear that people have a right not to be discriminated against on the basis of sex and receive equal treatment under the law, no matter their gender identity or sexual orientation. That’s why today HHS announced it will act on related reports of discrimination,” said HHS Secretary Xavier Becerra. “Fear of discrimination can lead individuals to forgo care, which can have serious negative health consequences. It is the position of the Department of Health and Human Services that everyone – including LGBTQ people – should be able to access health care, free from discrimination or interference, period.”
Discrimination in health care impacts health outcomes. Research shows that one quarter of LGBTQ people who faced discrimination postponed or avoided receiving needed medical care for fear of further discrimination.
Stigma and discrimination, such as homophobia and racism, impede engagement in HIV prevention and use of biomedical tools for treatment in both HIV-negative and HIV-positive gay and bisexual men, according to a Rutgers study.
The paper, published in AIDS and Behavior, examined the impact of stigma on HIV-related outcomes among gay and bisexual men in the U.S.
Despite recent advances in HIV prevention and treatment, and access to biomedical interventions that can hasten the end of the HIV epidemic, gay and bisexual men continue to be disproportionately affected by the virus.
As one of several Indian Health Service activities supported by the Minority HIV/AIDS Fund (MHAF) in Fiscal Year 2020, the Urban Indian Health Institute (UIHI) is currently leading a project focused on creating culturally attuned HIV education materials—including print, digital, and video formats—for both American Indian and Alaska Native patients and the healthcare providers who serve them.
UIHI , located in Seattle, Washington, works to provide information to and assist urban Indian-serving organizations to better the urban Indian community’s health nationwide. Seven out of 10 American Indians and Alaska Natives currently live in urban settings away from federally defined tribal lands. Since 2016, UIHI has led several projects that promote culturally attuned HIV prevention and treatment.
Among the new materials being developed under this project, in March 2020, UIHI released a short film, Positively Native , in which long-time HIV survivors Bill Hall (Tlingit), Shana Cozad (Kiowa), and Hamen Ides (Lummi) discuss their lived experiences with HIV stigma, discrimination, and advocacy. Along with the film, UIHI released an accompanying toolkit that includes a facilitator’s guide, discussion questions, and a presentation on the basics of HIV. The organization presented Positively Native to an audience of 38 people at the International Indigenous Pre-Conference on HIV/AIDS in July 2020.
Dr. Anthony Fauci said Tuesday the visibility LGBTQ people brought to themselves during the height of the HIV/AIDS epidemic helped change the tide for public perception.
Fauci made the remarks during the daily White House Coronavirus Task Force briefing when responding to COVID-19’s disproportionate impact on black Americans, saying the disease has “shed a light” on health disparities in the United States much like HIV/AIDS did with LGBTQ people.
“During that time, there was extraordinary stigma, particularly against the gay community,” Fauci said. “And it was only when the world realized how the gay community responded to this outbreak with incredible courage and dignity and strength and activism — I think that really changed some of the stigma against the gay community, very much so.”
Biomedical advances against HIV since the dawn of the epidemic have been nothing short of astonishing. An almost always fatal disease is now, for those with the privilege of access to treatment, a manageable chronic illness, treated with a single daily pill. A person who acquires HIV today has every reason to expect to live a normal life span.
Yet with such astonishing success in treatment, why is HIV stigma worse today than ever before? Why do so many long-term survivors, including many who were exceptionally open about their HIV-positive status for years, find they must now keep it a secret, sometimes going deeply into closets they thought they had left for good years ago?
Many people—especially those who do not have HIV—find these questions startling. That’s because they remember the days when one had to wear a spacesuit to visit a person with AIDS in a hospital or was afraid to eat in a restaurant with gay waiters or refused to touch a person they thought might have the virus.
Black people make up 12 percent of Pennsylvania’s population of about 12.8 million people. But they accounted for 49 percent of HIV diagnoses in 2018 — and to Rep. Brian Sims that’s “racist as hell.”
“A racist system produces a racist result. You don’t need to look at the data to know that,” Sims, D-Philadelphia, said Wednesday, adding, “If medicine only reaches people who look like me, in a state that doesn’t look like me, we’re doing something wrong.”
Jeannine Peterson, CEO of Harrisburg’s Hamilton Health Center, speaks during a Capitol press conference on Wednesday, 2/5/2019 (Capital-Star photo by John L. Micek)
Sims, one of two openly gay House members, was one of several lawmakers and public health advocates who were on hand during a Capitol press conference Wednesday for the 21st annual observation of National Black HIV/AIDS Awareness Day in Pennsylvania.
National Black HIV/AIDS Awareness Day (NBHAAD) is February 7. NBHAAD is a day to increase awareness about HIV among blacks/African Americans and encourage people to get involved in prevention efforts, get tested, and get treatment if they have HIV.
HIV diagnoses have fallen in recent years among black/African American women (25% decline from 2010 to 2016) and heterosexual men (26% decline). Diagnoses among young black/African American gay and bisexual men (aged 13 to 24) decreased 5%. This good news shows that the nation’s HIV prevention efforts are helping reduce HIV infections among some blacks/African Americans.
Although the latest data show progress, we must continue our efforts. In 2017, nearly 17,000 blacks/African Americans received a new HIV diagnosis. Blacks/African Americans accounted for 43% of all HIV diagnoses in the United States and 6 dependent areas,** despite making up 13% of the U.S. population. Also, from 2010 to 2016, HIV diagnoses increased 40% among black/African American gay and bisexual men aged 25-34.
Both relationship-specific and structural factors influence whether coupled gay men living in New York City choose to use pre- and post-exposure prophylaxis (PrEP/PEP) for HIV prevention. Some men – particularly those in monogamous relationships – felt that discussing PrEP and PEP in the context of a relationship could threaten the relationship by raising issues of trust, while others felt that it had the potential to enhance sexual health and satisfaction.
Stigma from the gay community and healthcare providers around promiscuity also presented barriers to PrEP uptake. This qualitative research was conducted by Stephen Bosco, Dr Tyrel Starks and colleagues at City University New York and published in the Journal of Homosexuality.
Gay and bisexual men accounted for 66% of all new HIV diagnoses in the US in 2017. It is estimated that 35-68% of these infections happen within the context of a long-term relationship. This indicates that coupled gay men have the potential to benefit significantly from biomedical prevention strategies, such as PrEP (taken on an ongoing basis) and PEP (taken shortly after a suspected infection). However, only 7% of the potential 1.1 million gay and bisexual men who could benefit from PrEP were prescribed it in 2016. Black and minority men in the US remain most at-risk for HIV infection, while also having the lowest rates of PrEP uptake.
Stigma did not create AIDS. Yet it prepared the way and speeded its ravaging course through America and the world. First stigma delayed understanding of the disease: it’s a gay cancer, it’s a punishment from God, they brought it on themselves, so who cares? Then stigma delayed government action, research, and assistance for the sick and dying. Stigma made people afraid to get tested for HIV and treated. Stigma made people ashamed, isolating and alienating them from friends and family. Stigma cost people jobs, professional standing, housing, a seat on an airplane or in a dentist’s chair. Stigma made many afraid to live, and want to die. But then it began to make some brave people very angry and AIDS activism was born. The activists quickly realized that to end AIDS we must end stigma.
AIDS activism did more to fight the stigma on being gay or having AIDS than any other social force. In this way, AIDS activism, like the civil rights movement, became a great moral movement of our time, defending the innocent, restoring dignity to the violated, giving hope to the desperate, and reviving faith in the disillusioned. AIDS activism gave LGBT people courage, dignity, and power they had never held before. It inspired many to stand up and proudly proclaim who they are and who they love. Twenty-six of the world’s most advanced countries now recognize gay marriage and today a gay man openly married to another man is a prominent candidate for President of the United States.