Bill Weintraub

Does stigma cause AIDS?

11-8-2006

Just as for years gay leaders have proclaimed that homophobia leads to HIV infection, so have they claimed that the stigma of being gay causes men to acquire HIV.

And they've claimed that the stigma attached to HIV infection can also lead to MORE HIV infection.

But in a new study, published on the Plos Medicine website, researchers point out that the "actual evidence base" to prove a direct link between HIV-related stigma and the pandemic "is almost nonexistent."

"In spite of this lack of evidence, the idea is repeated like a shibboleth," say the authors. "With each repetition, its veracity appears to increase."

Sound familiar?

Homophobia causes AIDS.

Meth causes AIDS.

Depression causes AIDS.

Gender inequality, discrimination, poverty, what have you -- they're all claimed to cause AIDS.

In reality, there are very specific risk behaviors which lead to HIV infection.

And in the case of men who have sex with men, there's one risk behavior -- anal penetration.

Here's more from the study:

The argument for the link between HIV stigma and the global epidemic goes something like this: stigma undermines HIV prevention efforts by making a person afraid to engage in safe behaviour or seek testing for fear that these acts would themselves raise suspicion in the minds of others about the person's HIV sero-status. Stigma leads to fear, fear leads to unsafe behaviour, and unsafe behaviour leads to the spread of the infection in the population (Figure 1).

Figure 1. The Argument for the Link between the Stigma of HIV and the Global HIV Epidemic

Stigma --> Fear --> Unsafe Behaviour --> Infection

This line of reasoning about the relationship between stigma and the spread of HIV in the population is flawed in two ways. The first flaw is that it ignores the nonlinear dynamics of infectious disease transmission in populations. HIV spreads by exploiting a few human behaviours, predominantly sexual intercourse and injection-drug use. Both of these behaviours are associated with a high degree of cultural specificity with respect to who engages in them, who they engage with, and the periods of their lives during which they engage -- these are the factors that largely determine the spread of the infection. For this reason, the virus generally takes hold in subpopulations first, such as injection-drug users, commercial sex workers, men who have sex with men, and mobile populations.

Even if stigma does increase the risk of infection within high-risk groups, it could simultaneously slow the spread of infection from those groups to the general population. Objectionable as it may be to see a lethal infection spread in any part of a population, uncontained spread within a part of the population is better than uncontained spread within the whole population. It is plausible that a social control mechanism, such as stigma, could reduce opportunities for contact between high- and low-risk groups. All other things being equal, under these conditions the spread of the virus across the whole population would be slowed. We are thus suggesting an alternative hypothesis to the UNAIDS position.

The second problem with the claimed relationship between stigma and the spread of HIV is a measurement issue. To establish a causal link between HIV stigma and epidemic progression requires longitudinal data on rates of infection and levels of HIV stigma. Weaker, but nonetheless potentially persuasive, evidence could also be found in an observed correlation between levels of HIV-related stigma and rates of HIV infection across contexts -- such as between countries. Currently, no such evidence is available.

"No such evidence is available."

But there's plentiful evidence that anal penetration is responsible for MSM HIV infection.

Yet AIDS Inc ignores that information and designs its prevention programs around non-issues like homophobia and stigma.

The authors correctly point out that stigma can actually REDUCE the possibility for spread.

Does that mean we should stigmatize people with AIDS?

NO.

What it does mean is that we should focus on the risk behavior, and not canards like "stigma" or "homophobia."

And -- in the MSM community -- we have a right to be critical of those who've acquired HIV when they needn't have.

That doesn't mean making them wear a scarlet letter.

But the community needs to change its attitude towards people who "let" themselves get infected.

Because both the risk behavior and the virus are totally avoidable.

Bill Weintraub

PS

This is from UC Berkeley epidemiologist Dr. James Chin's forthcoming book on AIDS and political correctness:

This litany used by UNAIDS and most AIDS programs includes most of the socially and politically correct myths about major determinants of HIV transmission, but there is no epidemiologic support for these myths and misconceptions. Poverty is a socially and politically attractive hypothesis to account for high HIV prevalence, but available data suggest the opposite. As described in Chapter 5, persons in the top 20 percent for income in Kenya and Tanzania have HIV infection rates 2 to 3 times higher compared to persons in the lowest 20 percent -- probably because the wealthiest persons, both males and females, have a greater number of sex partners. Some of the richest countries in SSA have the highest HIV prevalence rates and most of the poorest countries in the world have the lowest rates. Poverty as a major determinant of HIV transmission is a glorious myth that is not easily dispelled even though there are no epidemiologic data to support this myth. I have challenged all students who have taken my class since the new millennium to provide me with data to support this myth and they have yet to come up with any.

In 1987, Jon Mann appropriately declared that the quest for effective treatment and a possible cure for AIDS was an inherent basic human right of all persons living with HIV. However, he went on to say: "Being excluded from the mainstream of society, or being discriminated against on grounds of race/ethnicity, national origin, religion, gender, or sexual preference, led [leads] to an increase of HIV infection."

From my perspective, discrimination clearly raises barriers to HIV/AIDS prevention and treatment programs, but discrimination is not a determinant of HIV risk behaviors and, thus, not a determinant of epidemic HIV transmission. This glorious myth was quickly and uncritically accepted by AIDS activists, and is the centerpiece of UNAIDS’ litany that poverty, discrimination, and lack of access to healthcare are major determinants of high HIV prevalence. Personally, I am 100 plus percent against poverty, discrimination, and lack of access to healthcare, but I also believe that even if "we" were able to eliminate these social and public health problems, we would not make much of an impact on the high HIV prevalence rates that are present in MSM, IDU and many SSA populations.

"we would not make much of an impact on the high HIV prevalence rates that are present in MSM, IDU and many SSA populations."

MSM = men who have sex with men = gay males

And for MSM, it's really simple.

No Anal

No AIDS

Bill Weintraub

© All material Copyright 2006 by Bill Weintraub. All rights reserved.

---