It's widely accepted that HIV is spread from one person to another via sexual intercourse, childbirth, or the sharing of needles. But a deeper look into the complex intricacies of social customs and interactions reveals HIV infection is also being perpetuated by the teachings, policies, and beliefs of a handful of ingrained and established aspects of our society; institutions which have had a sweeping impact on our viewpoints and actions.
In the beginning of the HIV epidemic, a lack of knowledge and understanding of the disease and how it spread were blamed. But today, misplaced morals and judgmental policies keep the disease alive and well, and place the masses at risk for HIV.
These are the many institutions of HIV infection.
Abstinence-Only Educational Programming
Although studies have shown no indications that abstinence-only education programs can reduce the risk of contracting HIV or other STIs, many conservative public institutions continue to focus on abstinence as the sole method for safe sex because of its ties to religion.
Furthermore, teaching abstinence until marriage is often exclusionary and discriminatory towards LGBT youth, which comprises the most at-risk population for HIV, in regions where same-sex marriage is illegal.
These young people are left without an education on how to negotiate safer sex practices because, under abstinence-based programming, any sex that an LGBT person may have is considered wrong or unhealthy.
HIV Criminalization Laws
When HIV was an almost-certain death sentence, laws were enacted to reflect the severity of infection to deter people from spreading the disease. Thirty years later, HIV is now a chronic but manageable diagnosis, yet people living with HIV are still commonly treated as criminals.
Studies show the criminalization of HIV has led to many people being unjustly prosecuted, regardless of the actual risk of transmission, because their status is seen as an inherent sign of guilt, because of HIV-related stigma and laws based on outdated and erroneous information about risk and transmission.
The Association of Nurses in AIDS Care issued a position statement last fall, declaring that current HIV laws and policies promote discrimination and must be reformed. ANAC maintains that placing the sole burden of disclosure with criminal consequences can and has discouraged people from getting tested and accessing care, and that "most arrests and prosecutions under these HIV criminalization laws are tantamount to human rights violations."
Although society at large may consider an HIV-positive person disclosing his or her status before intimate sexual contact "the right thing to do," it is in fact the responsibility of all parties to take proper precautions to prevent STI transmissions and to inquire about their partner's HIV status.
Socially Conservative Public Officials
From the early days of the AIDS crisis, when Ronald Reagan was president, to current efforts by Texas State Rep. Stuart Spitzer, conservative politicians have spent three decades thwarting advocates' efforts at HIV prevention. While claiming to serve the best interests of all their constituents, too many politicians have appealed to the moral musings of their voting base, pressure from party bosses, and are beholden to the pursestrings of financial backers.
Defunding HIV prevention programs, limiting healthcare options and failing to publicly recognize increasing infection rates are just a few ways in which socially conservative public officials have aided in the spread of HIV.
Fear-Based Safe Sex Campaigns
With proper education, there is no need for fear. But many HIV service organizations still rely on scare tactics to deter people from engaging in risky behavior. This instills fear of something resembling HIV, and leads to ignorance of the potential risks inherent in other sexual activity through the use of "healthy" sexual stereotypes in media nessaging.
Unfortunately, HIV infection can come in the form of the hottest body, hidden behind the most handsome face, or be from the most refined background.
Besides stigmatizing the many people who are otherwise living healthy, happy lives with HIV, these fear-based campaigns do little to prevent the spread of the disease.
Sex-Shaming Service Providers
Whether it is an entire organization or an individual doctor, many healthcare service providers have become out-of-touch with the generation that is most at risk. From lifestyle judgment to PrEP-shaming, doctors who take the conservative approach to medical care have left some patients at risk.
LGBT people within reach of metropolitan or urban parts of the U.S. can often avoid these providers and find a doctor more suitable to their needs. But for those in more rural areas, where conservative values are more common, their options are limited and there's a far greater chance they will be denied the services and proper care they need.
Antigay Religious Institutions
An LGBT child raised in an environment where the teachings of an antigay church holds sway may never be exposed to modern methods of protection from STIs during same-sex intercourse. This child will grow up in the shadows, in danger of engaging in destructive behavior because of a divergent self-image, sexual frustration, and self-hate.
In the United States, many conservative Christian churches teach that any kind of sexual activity other than marital intercourse between a male and a female is sinful, so the medical consequences of any LGBT sexual activities are quickly condemned as God's punishment. This institutional belief has put many LGBT young people at-risk for infection from multiple STIs, and without any medical or emotional support if they do become HIV-positive.
The institution of idealism is possibly the greatest cause for continued HIV infection. Whether you think that young gay boys should just know better, men should always wear condoms, or that everyone should get tested and "do the right thing," human nature has always and will always allow for human error.
This attitude manifests itself in lofty, idealistic attitudes toward a very real life and death crisis.
Idealism can result in shame, misplaced arrogance, and obstructive thinking. When it comes to HIV, the way to reduce infection and eradicate stigma triggered by idealism is to adopt and espouse a realistic perspective towards problem-solving, basing responses to actual behaviors instead of fantasy-world wishful thinking or heavy-handed moralistic responses.
And given the history of HIV transmission, the glacial response by government and medical leaders, and at long last, the turning tide of treatment, nothing short of reality will do.