Today is World AIDS Day, an annual occasion for raising awareness about HIV/AIDS, remembering those who have died, for people living with HIV to share their stories and for those who don’t to support and stand in solidarity with them. This year’s theme is “Get to Zero,” i.e. – to get to zero AIDS-related deaths and zero new infections by 2015.
Many changes need to take place in our society and globally for this goal to be reached. HIV testing needs to become a routine part of health care for all sexually active people (the CDC recommends that all people between 13-64 be tested at least once in their lifetimes for HIV). Access to HIV treatment needs to become far more widespread and equitable than it currently is. In the U.S., only half of people living with HIV are receiving any treatment for it, and only 28% have the infection under control with medication [Loop 21]. About 1 in 5 are unaware of their positive status.
And as I’ve written before, HIV/AIDS is a problem that intersects with and is exacerbated by societal oppressions and injustices like sexism, racism, classism, and anti-queer and anti-trans bigotry. Concrete examples from the U.S.:
- Women of color are at significantly higher risk of HIV infection than white women, even more so if they are poor and/or transgender. Black women are infected at fifteen times the rate of white women, and three times the rate of Latina women. Black women also make up over 50% of new infections in women. [CDC, PDF]
- Black people make up 14% of the U.S. population, but make up almost half of all people living with HIV and 44% of new HIV infections. The percentage of black men who have sex with men who are HIV positive is nearly twice that of white men who have sex with men. [CDC, PDF]
- Transgender people are at significantly higher risk of HIV infection than cisgender people, with some studies suggesting that over half of black trans women are HIV positive [TransHealth, PDF].
Disparities along lines of oppression and privilege apply not only to rates of infection, but also to access to treatment. Similar disparities in infection rates and care exist worldwide. As the Latina Institute puts it, HIV/AIDS is a “two-way road” of marginalization: ”
It is not only that our society marginalizes HIV-positive individuals, but that the most marginalized people in our communities are most likely to become positive.
Yes, it is important to get tested. Yes, condoms, condoms, condoms. But the truth is that some of us are at higher risk than others merely because of who we are and the communities in which we move. At particular risk for HIV are women of color,transgender folks, young women. In short, HIV is not simply a disease, but rather an indicator of marginalization and injustice in our society…In the end, AIDS is a disease of marginalization and injustice, and we will not see an end to AIDS without ending inequity.
As most of us know, HIV/AIDS is a global issue – a pandemic. By focusing on U.S. numbers, I don’t mean to be overly US-centric or imply that the U.S. matters any more than any other part of the world. But I think we tend to think of HIV/AIDS as a “third world” problem, and especially a black African problem. And there’s truth to the fact that most people living with HIV or AIDS are in the Global South – again in large part due to dynamics of power and privilege on an international scale, and due to oppressions like misogyny and poverty on local and national scales. But the reality is that the U.S. remains in the throes of an HIV/AIDS epidemic that is often invisible because most of its victims are marginalized in various ways.
An analysis by the Black AIDS Institute found that if black America were its own country, it would rank 16th in the world in the number of people with HIV — ahead of Ethiopia, Botswana, and Haiti. [CDC]
“A great amount of attention has been put overseas,” said Marconi, who’s also an associate professor at Emory University’s School of Medicine. “Especially in these economically challenged times, we tend to be myopic in our efforts in our charitable giving. People say, ‘I’m already giving towards the international HIV effort – I can’t see two epidemics happening.’ No one wants to believe that extreme poverty and neglect exist in such a rich and powerful nation as this one.” [CNN]
The invisibility of the American HIV/AIDS epidemic is even more heightened in devout Christian communities. American churches are often willing to talk about HIV/AIDS as an African problem, but unwilling to talk about it as a problem in their own congregations or communities. CNN, for example, ran a few articles this week on HIV/AIDS in the U.S. South, which has a higher rate of infections than other parts of the country, and where HIV/AIDS are highly stigmatized topics – that is, even more so than in American culture in general. This seems to be correlated to high rates of religiosity and the “Bible Belt” culture of the South.
Dealing with the epidemic in the South “is extremely challenging, because the stigma and discrimination is worse,” said Dr. Kevin Fenton…”There is less discourse around prevention, sexual health, comprehensive sex education in schools or having strong, community-based advocacy activities.” [CNN Also see: Pastor fights HIV stigma in rural town]
I think the tendency to conceptualize HIV/AIDS as only an overseas problem is a reflection of the very same oppressions that cause HIV/AIDS to disproportionately affect marginalized communities in the U.S. In both formulations the status quo in terms of power and privilege is maintained. HIV is constructed as an issue “over there” affecting poor, pitiable, ignorant black Africans who need to be rescued from their plight by knowledgeable and resource rich Americans (mostly white). This formulation falls in line with what’s expected in terms of racial, economic, and international political power dynamics. Similarly, the resistance in the U.S. against recognizing HIV as a very real and present epidemic in this country reflects the fact that the burden of HIV/AIDS is predominantly borne by people who are queer, trans, female, poor, and/or of color. There’s no way so many Americans would be unaware that we continue to have an epidemic on our hands if it were a disease that disproportionately struck down white, straight, middle class, etc., people.
And that casts the charity and goodwill of many conservative U.S. churches towards African “AIDS orphans” and other overseas people affected by HIV/AIDS in a less than flattering light. The patronizing nature of this sort of charity becomes clear when you factor in that it’s coming from the very same groups of Christians who complain and rage about the slightest bit of focused attention or resources spent on U.S. communities of color, LGBT people, women, or poor people (i.e., the groups disproportionately impacted by HIV/AIDS) as “reverse discrimination” and “divisive.” In both cases – paternalistically providing charity to black people “over there” and angrily demanding that the government withhold support and resources to marginalized people over here – the position of white middle class “mainstream” people as privileged over all others is insisted upon and maintained.
Of course, stigma and invisibility are not only the result of racism – they are also the work of ignorance and resistance, often religious, to talking about sex and sexuality within those communities most affected by HIV/AIDS (See, e.g., HIV AIDS and Black Churches: Ignorance can kill).
So this World AIDS Day, let’s think not only about the AIDS as a global problem, and how injustice on an international scale feeds that, but also about the forces that operate in our local and national contexts, wherever those might be, to produce higher rates of infection and lower rates of effective treatment in various communities.
If you are sexually active and don’t know your status, get tested! Folks living in the U.S. can find an HIV testing site near you by using AIDS.gov’s testing and services locator. Encourage people you know to get tested as well.
And check out some of these reads on World AIDS Day:
- On Twitter, ChrisMacDen shared about living with HIV. A must read..
- Indigenous Youth in Canada are launching National Aboriginal AIDS Awareness Week to address higher rates of infection among native youth.
- Black Women’s Health Imperative: What will it take to get Black women to Zero? A discussion.
- On The Issues magazine: Women HIV activists make Sex Ed a reality