The first step to addressing stigma in any context is education and one may already be familiar with some basic information regarding HIV. HIV transmission occurs only through blood, breast milk, or fluids excreted from the genitals. We know that general touch, such as handshakes, fist bumps or even using a toilet seat after someone else will not transmit HIV from one person to another. More intimate touch such as hugs, cuddling, or kissing will also not transmit the virus.
Less well known is the incredible medical advancements that have been made in addressing HIV. In 2017, the Center for Disease Control and Prevention (CDC) acknowledged the ongoing research that demonstrated if a person with HIV has a viral load (the number of copies of the virus in a milliliter of blood) of 200 copies/ml or less, they effectively cannot transmit the virus to others through sexual interactions, this is known as “u=u” or undetectable equals untransmittable. Many individuals who are aware of their diagnosis and access medical treatment obtain viral suppression (defined as 200 copies/ml or less) through taking one pill once a day. Many tests done in medical clinics for HIV care test viral levels as low as 20 copies/ml and many individuals are undetectable at that level with the utilization of their daily medication. As a side note, if you have a patient who is a person living with HIV, and they report to you that their viral load was detectable, this typically a very distressing experience. It is important to note that the viral load tests used to monitor viral suppression are extremely sensitive, looking at viral load numbers sometimes as low as 20 copies/ml. What this means is that simply because someone is detectable on their regularly scheduled lab test, does not indicate that they are above the threshold (200 copies/ml) for the CDC’s u=u. So one question to ask is, do you remember what your viral load was on the results? This can open up the conversation to discuss u=u, in order to manage the patient’s distress and provide education.
Another medical advancement in HIV care is the medication delivery. Many individuals that remember the onset of the HIV epidemic, will remember the “medication cocktails” that patients were forced to take in an effort to slow the virus. At this point in time with medication for HIV, many people in the United States have the option for “one pill once a day,” this means that in order for the patients to achieve viral suppression, they only have to take one medication daily rather than multiple medications multiple times per day. The change in medication management for HIV allows patients to become increasingly adherent to their medication and managing the virus. Typically for a new patients, it takes about a month before their viral load tests demonstrate undetectable levels. However, other individuals will never be able to achieve viral suppression due to various factors that could include the progression of their disease, at confirmation of diagnosis or in general, or due to complications related to medication compliance. One of the more challenging parts of medication compliance with HIV is that if a person struggles with adhering to their daily medication, the virus can adapt and become resistant to that medication, rendering it ineffective if that person attempts to take it again. If the individual continues to struggle with medication adherence, they can end up significantly reducing their options for medications, especially in the category of “one pill once a day.” Medications for HIV continue to evolve, and options continue to grow. In 2022, an injectable medication was released that enables individuals to experience viral suppression for 6 months at a time with a single administration of the medicine (Becker, 2022).
There are also now options to support the prevention of transmission of HIV. In 2005, a post exposure medication, known as PEP (post-exposure prophylaxis), was released, in which this medication is available for individuals who might have been exposed to HIV in the last 72 hours. If taken within 72 hours of exposure to the virus, the person is at a significantly reduced risk for contracting the virus. The sooner the medication is administered after the possible exposure, the more effective it is (Center for Disease Control and Prevention [CDC], 2021). A few years later in 2012, pre-exposure prophylaxis or PrEP was approved. PrEP enables individuals who are at high risk for HIV transmission; such as transwomen and young gay and bisexual men, to take their own sexual health in hand and protect themselves from HIV transmission (CDC, 2022). However, many individuals who are at risk for HIV, such as young Black and Latino gay and bisexual men are not typically informed about these options through their medical professionals or from other sources within their community (Lelutiu-Weinberget & Golub, 2016). This is especially true in states that are more rural or with doctors who are less educated or less comfortable discussing sex or sexually transmitted infections. This is just a single example of how stigma gets in the way of HIV care.
There are many other examples of stigma around HIV, including people who are not tested regularly, due to discomfort on their part or on the side of the medical provider. Fear that the diagnosis will be a death sentence, such a horrific diagnosis that they would never be able to recover from. The truth is that from a medical standpoint the diagnosis is typically very controllable. The shame, disgust, and fear of the diagnosis is all part of the stigma, and is much more harmful to the newly diagnosed individual.
As health psychologists, we can help combat HIV stigma through educating ourselves, educating others, and by being willing to talk about what others are not. Even bringing it up, even if the patient does not want to discuss it, signals to the patient that you are willing to approach a topic that many refuse to discuss in a respectful way. In my experience, even receiving the diagnosis of HIV can be traumatizing. We can fight the stigma by demonstrating thoughtfulness, respect, and compassion with our patients who are living with HIV, as we would with any patient coming to us for care. As health psychologists, we also have the opportunity to educate not only our patients but also our medical colleagues. Being willing to discuss stigma and the mental health impact of a diagnosis with our medical colleagues might result in an earlier caught diagnosis or the opportunity to prescribe a PrEP to someone at risk. Our work can continue to fight against the stigma and promote positive change for everyone.
Becker, Z. (2022, December 22). After overcoming vial issue, Gilead wins FED approval for long-acting HIV injectable Sunlenca. FIERCE Pharma. https://www.fiercepharma.com/pharma/gileads-lenacapivir-approved-first-class-long-acting-hiv-injectable
Centers for Disease Control and Prevention. (2021, May 25). PEP. https://www.cdc.gov/hiv/basics/pep.html
Centers for Disease Control and Prevention. (2022, December 1). HIV Basics. https://www.cdc.gov/hiv/basics/index.html
Centers for Disease Control and Prevention. (2022, June 3). PrEP. https://www.cdc.gov/hiv/basics/prep.html
Lelutiu-Weinberger, C., & Golub, S. A. (2016). Enhancing PrEP access for Black and Latino men who have sex with men. Journal of Acquired Immune Deficiency Syndrome, 73(5), 547-555. doi: 10.1097/QAI.0000000000001140.
Porter, B., & Rose, L. (2021, May 19). Billy Porter breaks a 14-year silence: “This is what HIV-positive looks like now.” The Hollywood Reporter. https://www.hollywoodreporter.com/news/general-news/billy-porter-hiv-positive-diagnosis-1234954742/
WebMD Editorial Contributors. (2021, June 13). What is HIV? https://www.webmd.com/hiv-aids/understanding-aids-hiv-basics