In 2006, with support from HAB, the National Minority AIDS Council created a 2-day workshop called “Addressing Barriers—One at a Time,” designed to educate service providers about strategies needed to address HIV/AIDS-related stigma in their communities. The workshop included five modules featuring participant training exercises.33 This intervention evolved based on input from a diverse cross-section of service providers.
In addition, several HAB Special Projects of National Significance (SPNS) Initiatives have shed new light on keys to addressing stigma among specific populations. For example, four SPNS Initiatives identified ways to enhance the effective use of peers for this purpose. They are:
- Demonstration and Evaluation Models that Advance HIV Service Innovation Along the United States-Mexico Border (conducted 2001–2005);
- Outreach, Care and Prevention to Engage HIV Seropositive Young MSM of Color (conducted 2004–2009);
- Enhancing Linkages to HIV Primary Care and Services in Jail Settings (conducted 2007–2012); and
- Enhancing Access for Women of Color Initiative (conducted 2009–2014).
Barbara Aranda-Naranjo is director of the Division of HIV/AIDS Training and Capacity Development Branch at HAB. She stresses that without peers, many PLWHA served in these initiatives “would neglect their medications to avoid disclosure [and] show up to clinics later after this disease is much more advanced.” HRSA disseminates this and other important lessons learned from SPNS Initiatives through training materials created as part of the Integrating HIV Innovative Practices (IHIP) Program, designed to help providers serving PLWHA more easily replicate and benefit from the insightful research findings of SPNS grantees.
A Persistent Foe
A Kaiser Family Foundation study indicates that the proportion of the population that believes there is “a lot of discrimination” against PLWHA changed little over the 20-year period from 1986 to 2006.34 More than 20 percent of participants in the Kaiser Family Foundation’s 2012 Survey of Americans on HIV/AIDS responded that a person could contract HIV by sharing a drinking glass with an HIV-positive person, and that “AIDS is a punishment for the decline in moral standards.”35 Consider these data in the context of the fact that an estimated 35 to 45 percent of PLWHA with newly diagnosed HIV infection develop AIDS within 1 year after diagnosis, representing late entry into care.36 This startling statistic begs the question: For how many of these individuals is stigma a primary barrier to early testing and care?
HIV/AIDS has never been just a disease; it has always been about more than physiology. HIV/AIDS cannot perpetuate itself through the water supply or through tainted food, and it can’t spread unseen like an exotic airborne virus. Instead, AIDS depends on people for its survival. It has a voracious appetite for ignorance and stigma, both often fueled by fear. Nearly 30 years ago, a courageous young boy in Indiana fought back against stigma, and millions of others have followed his lead. Not just PLWHA have battled against stigma; so have their supporters, mothers and fathers, lovers and friends—the people who have been privileged to take care of them.
The Ryan White HIV/AIDS Program both draws inspiration from and gives power to our collective commitment to eradicate the effects of HIV/AIDS stigma. In doing so, the Program has saved thousands upon thousands of lives and moved America closer to realizing its National HIV/AIDS Strategy goals.