Introduction vital HIV prevention and treatment, as

Introduction

 

HIV related stigma has
since accompanied its explosion in the 1980s, when it was identified in the gay
population in America (Avert, 2017). At the start of the epidemic, HIV was
negatively associated with the LGBT population. Headlines calling the disease ‘the
gay plague’ were not infrequent, demonising the community (Shilts, 1987).  HIV in 1982 was denoted as the ‘Gay Related
Immune Deficiency’ (GRID), singling out homosexual individuals and condemning
them for this disease (Gander, 2017). 
Stigma is defined as ‘a mark of disgrace associated with
a particular circumstance, quality, or person’ (Oxford English dictionary,
2005). Discrimination and stigma act as barriers in communities, impeding HIV
prevention, treatment and support. Discrimination against those living with HIV
are borne out of ignorance and stigmatising attitudes towards sexuality and
lifestyles (UNAIDS, 2014). This essay will explore ways to reduce stigma
towards those living with HIV.

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Equal rights, decriminalisation of
same-sex marriage and employment equality have been some of the barriers the
LGBT community has had to overcome (CNN, 2017). Unique to the LGBT community,
these challenges feed homophobia and enable the justification of
discrimination. Discrimination and fear of violence prevents LGBT people from
accessing vital HIV prevention and treatment, as they fear judgment from the
public. (Anish et al., 2008). Same-sex sexual behaviour is still criminalised
in seventy-eight countries, and there are clear health disparities between these
healthcare systems (ILGA, 2017). Although this is a decrease from 1990,
homosexual acts are still punishable by death in thirteen countries, an
increase from nine in 2006 (UNAIDS, 2016). Men who have sex with men are
twenty-four times more likely to contract HIV compared to adults in the general
population (UNAIDS, 2016). Stigma and homophobia forces individuals to hide
their sexuality from employers, health care professionals and even family in
order to protect themselves. The inability to reveal sexual behaviour due to societal
pressures can lead to late HIV diagnoses or even misdiagnoses, potentially
resulting in delayed treatment, leading to consequential poor mental, social
and physical health. The lack of social relationships due to reduced trust and
stigma towards those living with HIV can lead to depression, causing vulnerable
individuals to turn to other means of coping which are dangerous to health,
such as substance abuse (Global Men’s Health and rights, 2012). Due to
continued discrimination, the HIV epidemic is not being addressed and an
increasing number of individuals in both high-income and low-income countries
are at risk of contracting HIV due to a lack of education, criminalisation,
cultural views, risk of violence and prejudice, which all act as obstacles
(Smit et al., 2012). Externalised and internalised stigma feed into the vicious
cycle, exacerbating the epidemic as individuals fear being tested, or refuse to
disclose their status, due to anticipated stigma and worries of social
marginalisation. Internalised stigma prevents many individuals from disclosing
their HIV status to new sexual partners which is enabling the spread of the
disease amongst the community (Hutchinson, 2017).    

 

Homophobia and sexual stigma has
led to poorly funded, misdirected, inaccessible and neglected national
programmes in many countries (amfAR, 2012). Lack of governmental prioritisation
for HIV testing means that the framework is inadequate in many countries. Furthermore,
contracted cases of HIV in the LGBT community are hugely underreported and
inconclusive in many cases, resulting in misinformed schemes that are not
far-reaching enough and implemented in isolation not meeting needs (UNAIDS,
2013). Many initiatives focus on the medical needs of this group but fail to
change behaviour and attitudes towards HIV positive individuals (Reidpath et al,
2005). As a consequence, little is being done to change public improve
preventative measures. A prevention is always more effective than treatment,
especially since there is no cure for HIV (WHO, 2013). However, changes are
slowly being made: in the US, initiatives targeting gay and bisexual men in social
spaces will be reaching 50,000 people at a high risk of contracting HIV (Global
Men’s Health and rights, 2012). Self-testing HIV kits are also being more
widely marketed, featuring on a BBC One documentary. These kits allow people to
test themselves in the comfort of their own homes, allowing high risk
individuals to regularly test themselves (BIOsure, 2018). Campaigns are being
used alongside testing measures to target individuals, normalise HIV testing
and incorporate it into routine medical care (Chow, 2010). These campaigns aim
to change attitudes and behaviours destigmatising same- sex sexual activity (CDC,
2016). By changing societal stigma, vulnerable individuals will be able to
access healthcare provisions, improving the quality of life of those in LGBT
communities.

 

Alongside improving access to
routine HIV testing within the LGBT community, educational schemes inculcating
behavioural change to protect against HIV have also been implemented (Parker et
al., 2002). Improved access to condoms and lubricants provided by community-based
organisations have had a positive impact, allowing people to educate themselves
about the spread of HIV and halt the rise of the disease (Gallant, 2004). South
Africa currently has the largest condom distribution programme and was able to
double the number of condoms distributed in a year (UNAIDS, 2016). India has
been a successful example of how location-population approaches which engage
beneficiaries lead to a decrease in new reported infections (UNAIDS, 2016).
Mozambique, through educational programmes, has increased the number of
voluntary circumcisions from only 100 recorded in 2009 to 200,000 in 2015 (UNAIDS,
2016). Combination HIV prevention has been proven successful in many countries,
linking sexuality education and health services with condom and PrEP provision (World
Health Organisation, 2017