Throughout the Ryan White HIV/AIDS Program’s history, providers have created affirming and accepting spaces for PLWHA to access care without fear of disclosure or discrimination. Providers increasingly have come to mirror the populations they serve and have extensive training in delivering comprehensive, culturally competent care. These steps forward help PLWHA transcend the stigma they encounter in their communities and, often, in themselves.
Changing with Change
As time passed, best practices for helping PLWHA overcome stigma emerged. These practices reflected that the epidemic had broadened in terms of the populations that were most heavily affected—and that the stigma PLWHA struggled with had changed, too. It was evident by the mid-1990s that racial and ethnic minorities, especially African-Americans and Hispanics, were suffering from HIV/AIDS at almost unfathomable rates. Infections among these populations were less concentrated among men who identified as gay or bisexual than they were among Whites, affecting higher rates of women and men who did not identify as gay or bisexual. PLWHA from these communities encountered not just stigma related to HIV/AIDS, but stigma also to race and ethnicity. In addition, their history with the dominantly White medical establishment had not always been a happy one, and very often they did not identify with—and indeed resisted—HIV/AIDS service organizations associated with serving gay men.
Enacted in 1999, the Minority AIDS Initiative (MAI) brought much-needed increased public attention to the epidemic among minorities and greatly increased the power of the Federal Government’s response to HIV/AIDS. The MAI provides resources to a number of Federal agencies and offices, each empowered to intervene against the epidemic on a different front. For the Ryan White HIV/AIDS Program, the MAI increased the level of resources available to serve minorities. This increased funding, in turn, increased the number of providers working in minority communities, thereby providing minority PLWHA with access to more culturally competent care. New MAI resources also empowered grantees and providers to create and implement population-specific interventions that mitigated the impact of stigma and other barriers to care.
Addressing stigma through the Ryan White HIV/AIDS Program has always been an endeavor in evolution. It has required understanding—and acting on—the fact that multitudes of PLWHA are not stereotypically “out” urban White gay men. The approaches to addressing stigma had to change as affected populations changed.
One simple and extraordinarily far-reaching practice for reaching sexual minorities who did not identify as such, as well as heterosexual PLWHAs, was to “de-brand” service organizations as “gay AIDS organizations.” This allowed PLWHA to avoid being identified as HIV-positive or as a sexual minority in the minds of people who saw them in or near the organizations that served them. Another important practice is seen in organizations such as the Whitman-Walker Clinic (now called Whitman-Walker Health) in Washington, DC, which uses mobile care centers to link hard-to-reach PLWHA with immediate and confidential access to testing, treatment, and care in their communities. Delivering services in this way helps to eliminate the need for PLWHA to go to an organization stigmatized as “gay-/AIDS-serving.”