The World Health Organization has released new guidelines on HIV prevention, blaming institutionalized homophobia and criminalization of LGBT people for the spread of HIV, at least in part. And it makes a lot of sense: when you're in a situation where you're criminalized, shunned by your family and unable to keep a job without being fired for just being gay, it's understandable that you might stop caring what happens to you. People turn to risky behavior when there's nothing left to live for and no chance at genuine happiness.
The report says:
Criminalization, and legal and policy barriers play a key role in the vulnerability of MSM and transgender people to HIV. More than 75 countries currently criminalize same-gender sexual activity. And transgender people lack legal recognition in most countries. These legal conditions force MSM and transgender people to risk criminal sanctions if they want to discuss their level of sexual risk with a service provider. They also give police the authority to harass organizations that provide services to these populations.
Long-standing evidence indicates that MSM and transgender people experience significant barriers to quality health care due to widespread stigma against homosexuality and ignorance about gender variance in mainstream society and within health systems. Social discrimination against MSM and transgender people has also been described as a key driver of poor physical and mental health outcomes in these populations across diverse settings. In addition to being disproportionately burdened by STI and HIV, MSM and transgender people experience higher rates of depression, anxiety, smoking, alcohol abuse, substance use and suicide as a result of chronic stress, social isolation and disconnection from a range of health and support services.
People in poorer countries and in poorer areas of the US have the worst situations in terms of HIV prevention. Usually there is so much social stigma and fear of being beaten on the streets or murdered or worse that people in poorer or rural areas often hide in the closet. Some can't even come out to family members because they often participate in the bashing. Same with cops and other law enforcement people. Even doctors and other health care professionals are guilty of this. From the report, again:
From a health systems’ perspective, MSM and transgender people may delay or avoid seeking health, STI or HIV-related information, care and services as a result of perceived homophobia, transphobia, ignorance and insensitivity. MSM and transgender people may be less inclined to disclose their sexual orientation and other health-related behaviours in health settings that may otherwise encourage discussions between the provider and patient to inform subsequent clinical decision-making. Providers are likely to feel biased when their own cultural, moral or religious leanings are incongruent with a patient’s reported sexual orientation, behaviours or gender identity. Additionally, enquiry into the level of knowledge among physicians, nurses and other health care providers on MSM and transgender-related health issues has shown that the clinical curriculum, particularly in low- and middle-income countries, do not address these knowledge gaps.
LGBTs are so scared to talk to health care providers about HIV because that could very well be yet another situation in which they are treated with disrespect and hatred. The fact that LGBTs reflexively react this way seems to me to suggest this is a form of abuse by our society. We as LGBTs have gotten so used to just staying quiet and out of the way and being forced into our little closets for the good of heteronormative society that even when presented with major health risks, nothing can make us feel safe or determined enough to confront homophobia and bigotry face to face again. We forgo information on our health just to keep ourselves safe.
Do I even need to say that this is a problem?
The recommendations they have to help with these issues include but are not limited to:
1. Legislators and other government authorities should establish antidiscrimination and protective laws, derived from international human rights standards, in order to eliminate discrimination and violence faced by MSM and transgender people, and reduce their vulnerability to infection with HIV, and the impacts of HIV and AIDS.
2. Health services should be made inclusive of MSM and transgender people, based on the principles of medical ethics and the right to health.
In order to help prevent the spread of HIV, our governments must not only stop discriminating against us, but they must also enact antidiscrimination laws and our health care services must be LGBT inclusive. I would even say (though it's not in the report) that we need more LGBT-specific health centers. With so many issues over HIV and STDs and with so many unique situations faced by transgender people that really require knowledge outside of what doctors and nurses already deal with on a daily basis all over the world, I would think it would be very helpful to have something to cater to LGBT health specifically, including those concerns, and mental health as well.
Another recommendation which ties into LGBT-specific health centers is this one:
Offering community-based HIV testing and counselling linked to care and treatment to MSM and transgender people is suggested over not offering such programmes.
This would also be important even for rural areas in the US. Making it easier to receive testing and counseling, when you live in an isolated place, could be a lifesaver. Especially when you could remain anonymous.
Implementing sex venue-based outreach strategies to decrease risky sexual behaviour and increase uptake of HIV testing and counselling among MSM and transgender people is suggested over not implementing such strategies.
Outreach is helpful. When they're too scared to come to you, you should come to them. And this is going on in many areas, people are just too scared to get out and seek help. And other times they live in areas where transportation to another city is too difficult and they're too poor or too closeted to try it. This again ties into the idea that homophobia exacerbates this problem. Not only does homophobia keep someone closeted and in fear but if a law like ENDA were enacted people could sustain a job and afford transportation to a city that has better testing and counseling. LGBTs are losing out on many different levels.
And we must remember that an increase in HIV among gay men results in an overall increase in HIV. The poorest and most socially shunned communities in the world will always have the highest number of infections whether they're straight or gay, cisgender or transgender. Or in other words, ending homophobia and discrimination and criminalization of LGBTs will lead to better health for everyone.
The importance of homophobia in the spread of HIV can't be overstated. As the report bluntly tells us:
Stigma and discrimination create barriers to many public services and, as such, undermine public health, human rights and the response to HIV.