By Michele Rountree and
Twenty-five years ago this month Magic Johnson, the professional basketball player, first publicly disclosed his positive HIV status. And one year ago, actor Charlie Sheen also evealed that he was receiving HIV treatment.
In order to gain a sense of urgency of the disease’s continued impact, it takes a public figure’s disclosure or an anniversary to make note of the accomplished progress as well as the significant amount of work remaining when combating HIV. But more of this is needed.
We need to end the stigma associated with HIV and reduce transmissions and AIDS-related deaths. Cities across Texas should replicate San Francisco’s “Getting to Zero” initiative, where a multisector consortium organizes events and leverages existing resources to achieve zero HIV transmission, zero HIV-related deaths and zero HIV stigma.
Imagine if Houston, Dallas or Austin started an Ending Stigma Committee charged with eliminating discrimination and prejudice against individuals living with the disease and those communities disproportionately affected by the disease. This is the work each Texas community must undertake.
Since the beginning of the HIV epidemic in 1981, approximately 1.9 million people have been diagnosed with HIV, and more than 698,000 individuals have died from AIDS-related complications. When diagnosed and treated early, HIV can be managed like any other chronic health condition.
When addressing transmission, individual behaviors are not complete predictors for susceptibility. Social and environment factors are interconnected and play a crucial role in the epidemic, in relation to the widening gap in health disparities. HIV infection has become a disease that affects mainly socially disenfranchised and marginalized populations. It has been determined that for every prevented HIV infection, the community is able to save an estimated $360,000 in lifetime treatment.
The research has been distinct: Poverty, discrimination, inequality and other social conditions are heavy influences on the facilitation of HIV transmission. African-American women account for 62 percent of new diagnoses, yet they consist of only 13 percent of the overall female population. If current prevalence rates continue, 50 percent of black men who have sex with men and 25 percent of Latino men who have sex with men in the U.S. will be diagnosed with HIV during their lifetime. Fifty-six percent of African-American transgender women will test positive for HIV. Unlike most diseases, HIV has a significant moral-stigma component, which can interfere with opportunities to systemically invest in the improvement of health for the entire community.
But the stigma continues. When recently speaking with an HIV-positive individual about whether there was a continuation of stigma attached to the status of having HIV, she shared: “In some ways, yes, in other ways, no. I wonder if stigma ever really goes away. I believe stigma lives in the heart, and if stigma loses one object to stigmatize, then it automatically looks for another object on which to bestow its stigmatizing gaze. One looks at an HIV-positive person and says, ‘Well, they got what they deserved’ when nothing could be further from the truth. Stigma thrives in misinformation.”
For those individuals who have suffered the most from stigma and disease, they remain some of the most hopeful. It is true that medications are now available that may finally stem the tide of the HIV pandemic when coupled with other prevention interventions. The Food and Drug Administration has approved the antiretroviral-based PrEP, which is a daily pill taken by individuals at risk of HIV infection. Studies have found that PrEP is 92 percent effective. Enhanced efforts must be directed at expanding knowledge of treatment options to medical professionals. The U.S. Centers for Disease Control and Prevention reports that 1 in 3 health-care providers are not aware of PrEP and its preventative benefits.
We all should thank Magic Johnson and Charlie Sheen for reminding the public that the fight against HIV is not over. This increased recognition shifts the attention of HIV prevention efforts to the majority of individuals receiving an HIV diagnosis who don’t have fame, money or media attention. Good health should be a right for everyone.
Rountree is an associate professor with The University of Texas at Austin School of Social Work. Whittington is a graduate student in the School of Social Work.
This opinion piece was produced for Texas Perspectives and represents the views of the author, not of The University of Texas at Austin or the Steve Hicks School of Social Work. A version of this opinion piece appeared in The Houston Chronicle.