By Dr. Sandra Melvin
JA Guest Writer
In the late 1970s and early 1980s, a virus that had previously appeared sporadically around the world began to spread throughout the United States. This disease primarily affected gay men and by the late 1980s, HIV/AIDS had become a household term and the number one threat to public health. According to the Centers for Disease Control and Prevention, despite significant progress, the global AIDS epidemic is far from over: 1.7 million people around the world were infected with HIV in 2019, bringing the total number of people living with AIDS today to 38 million. Black people account for a higher proportion of new HIV diagnoses and people with HIV, compared to other races and ethnicities. Racism, HIV stigma, homophobia, poverty, and barriers to health care continue to drive these disparities.
Today, one of the main factors negatively impacting our ability to effectively respond to the HIV/AIDS public health issue is stigma. Stigma is one of the greatest barriers to testing and treatment for people living with HIV. It also creates obstacles to prevention. People may not want family, friends, and neighbors to know that they are visiting an HIV/AIDS provider for testing or treatment. In rural communities with limited anonymity, people may not seek care at all. People living with HIV often internalize the stigma they experience and begin to develop a negative self-image. They may fear they will be discriminated against or judged negatively if their HIV status is revealed. Stigma is not new to public health, nor is it unique to HIV/AIDS. History provides several examples of “prejudice, discounting, discrediting, and discrimination” directed toward persons who are ill or perceived to be ill.
Studies show that stigma associated with multiple factors (e.g., HIV, mental illness, sexual preference) both disadvantages the stigmatized and is a major source of stress in their lives. If stigma is a significant source of stress and social disadvantage, one might expect it to have substantial effects on population health, similar to other social determinants, such as socioeconomic status (SES), social relationships (i.e., social support), and racism or discrimination. As we work to reduce health disparities, we must take into account the effect that racism, discrimination, and stigma have on health outcomes for minority, disadvantaged, and underserved communities in Mississippi. For this reason, the Institute for the Advancement of Minority Health works with communities to provide access and availability to HIV resources, including HIV testing and linkage to care and increase awareness about HIV stigma. We do this by:
• Delivering provider education and training related to HIV stigma and misconceptions
• Using telehealth and other remote care delivery models to provide increased access to treatment
• Using mobile vans to deliver prevention, testing, and treatment services directly in communities
Overcoming stigma is not so much a decision as a process, one that involves training of the community and health care providers, increasing education and awareness, time, and patience.
December is HIV/AIDS Awareness Month and is a time to raise awareness and reflect on the impact this epidemic has on Mississippi communities and the world. To request HIV/AIDs educational information or to request self-testing kits, contact the Institute for the Advancement of Minority Health at iamh@advancingminorityhealth.org or (769) 572-5263.
Dr. Sandra C. Melvin, DrPH, MPH is chief executive officer of the Institute for the Advancement of Minority Health.
