The time has come to admit three simple facts in the battle against HIV:
– The condom only message is an abject failure and has been for decades.
– HIV disproportionately impacts gay and bisexual men and transgender women in this county, this state and this country.
– Stigma, based in outdated understandings of HIV transmission, is driving this epidemic and resulting in new infections.
The fact is there is no excuse for the epidemic to be hitting as hard as it is in our county. Ingham has the highest HIV prevalence rate outside Detroit. One in five people diagnosed with HIV in the county is between 13 and 24. Forty percent of the identified cases of HIV in Ingham county are in people under the age of 30. Nationally, 10 percent of gay and bisexual men and transgender women are infected with HIV; 20 percent of Black college aged gay and bisexual men and transgender women are infected. At current transmission rates, half of college age gay and bi men as well as transgender women will be infected by age 50. For Black gay and bi men and transgender women, half will be infected by age 35.
So why is HIV so prevalent? The answers are complicated – a mix of flawed educational policies like abstinence-only sex education, outdated information about HIV which creates an illusion of a disease that no longer stalks us in the way it did in the 80s, and a flawed funding system that subsumes basic information with a flawed construction that people with HIV need to be treated as vectors, and the scientific ignorance of individuals which drives stigma, reduces HIV testing and ultimately results in more new infections.
Right now, 75 percent of HIV prevention funding from the federal government must be spent on teaching those of us who know we are living with HIV how to prevent transmitting the virus – even though studies have shown time and again that it is people living with HIV who are unaware of their status that are responsible for the majority of new infections. On top of that, while science has shown that many risk reduction options are significantly more effective at preventing HIV transmission than condoms, our state government has said clearly it will not fund any educational program that does not have condoms as the core element of messaging.
The failed construct of “sero-sorting” (which is where a person has sex only with persons of the same HIV status) is the only risk reduction option less effective than condoms. Pre-Exposure Prophylaxis (PrEP), a daily dose of anti-HIV drugs; post exposure prophylaxis (PEP), a 28-day course of anti-HIV drugs after an exposure; Treatment as Prevention, which is where a person living with HIV uses treatment to keep their virus undetectable; and sexual position choice based on HIV status are all more effective than condoms. In fact, there has never been a documented case of HIV transmission from a person with a suppressed virus and PrEP is 99 percent effective in prevention infections.
Self-reported condom use 100 percent of the time results in a 70 percent reduction in risk of transmission of HIV. Using condoms inconsistently has no protective effect at all. And half of men who have sex with men have consistently reported they do not use condoms since 1988.
So what’s the answer?
In the 80s and 90s, it was the gay community that rallied together to address the AIDS crisis – we supported those dying, we fought for access to drugs, we changed the way the healthcare system dealt with us, and we developed innovative prevention strategies. We did it because the government wouldn’t; and we are going to have to do it again today. The reality is, queer lives matter less; and queer people of color matter even less to our government.
But to do that, we are going to have to stop treating HIV like the disease we knew in the early day of the epidemic. A person diagnosed with HIV today has every reason to expect to live a normal life span if they have access to medical care and medications. HIV is not the hyper-infectious monster we have been taught to believe; in fact, it is an incredibly difficult virus to transmit.
This means gay organizations have to stop seeing HIV as something separate from the gay community. This means we need to do educational programs that present the clear scientific facts about HIV transmission and risk reduction that the government does not want us to talk about. And it means we have to develop sex education programming for young queer men and transgender women that is not focused on heterosexual activity.
We have the knowledge to stop this epidemic. But to do that, the gay community is going to have to stop shoving HIV-positive people specifically, and HIV in general, into a viral ghetto and face the epidemic head first with facts, with education and with conversation.