In his thoughtful new memoir Love Is the Cure, Elton John remains commendably hopeful about the end of AIDS, rarely lapsing into frustration over the constant setbacks that plague HIV activism. On one topic, however, John recognizes a nearly infuriating lack of progress:
It is stigma that keeps us form doing what is necessary to end this epidemic. It is stigma that keeps us from confronting reality. To end AIDS, we must end stigma. It’s the single biggest obstacle to stopping the global epidemic. I’ve seen how people’s lives can be ruined because of it. I’ve seen how society’s response to the AIDS epidemic can be warped by it.
Ever the optimist, John then adds the coda that “I’ve also seen how, with time and effort, stigma can be alleviated.”
Alleviated, yes. Solved, no. The stigma today is certainly less brutal than in early years of the AIDS panic, when homophobia and toxic misinformation combined to hinder the government’s response to the emerging epidemic. In those days, the stigma was vicious and unalloyed: Public officials wanted gay AIDS patients quarantined or shot, while mainstream columnists called for them to be forcibly tattooed. As understanding of the disease grew, the shrillest hysteria was quelled, and the realization that AIDS was not an exclusively “homosexual disorder” largely quieted those eager to use the disease to justify their homophobia.
But the stigma never really disappeared; it simply took a different shape. Even in progressive Western countries, HIV still carries a certain ignominy, a kind of Scarlet Letter of presumed promiscuity. Parents use the disease as a scare tactic to keep their kids chaste; educators conjure it as a looming peril of sexual exploration. It’s a logical impulse—and a terribly damaging one. So long as we evoke HIV as a form of comeuppance, those already infected will live in a shadow of shame—and, even worse, those at risk of infection will avoid learning their status, the one thing that could help to wipe out AIDS in our lifetime.
All this, of course, seems counterintuitive. HIV is bad: It’s an expensive, complicated, dangerous disease, and everyone should be encouraged to avoid contracting it. But just because a disease is bad doesn’t mean that its sufferers did something wrong. The impulse with HIV, as with any STI, is to blame the victim, to view the disease as the predictable result of some terrible lapse in judgment. For many, HIV instantly raises the specter of unprotected sex, that pinnacle of licentious irresponsibility—or, even worse, of unprotected gay sex. Everyone, especially gay men, knows that unprotected sex can lead to HIV; don’t those who refuse to heed the warnings deserve whatever punishment comes their way?
That, at least, is the subtext of much public conversation about HIV. And it’s a subtext that must cease if we are to have the sort of open and honest conversation that could bring the infection rate down to zero. That’s a lofty goal, but we’ll never reach it as long as we’re too nervous or ashamed to speak frankly. No other disease carries with it such opprobrium: not diabetes, not heart disease, not lung cancer, not any other condition widely seen as a result of irresponsible behavior. Only HIV is imbued with this victim-blaming undercurrent—an inevitable consequence, I suspect, of its connection with sexual activity.
If we want to teach people about HIV, if we want to encourage everyone to get tested, we can’t treat the disease like a cosmic punishment for immoral behavior. No one deserves to get HIV, and all HIV-positive people deserve to be treated with dignity and respect, no matter how they contracted the virus. No one should be told that HIV will destroy their lives, or that testing positive for HIV is a catastrophic moral failing. As the head of a major international HIV/AIDS foundation, John is speaking from experience when he describes stigma as “the single biggest obstacle” to ending AIDS. Scaring people witless about HIV doesn’t prevent new infections or help treat existing ones. It merely prolongs the fraught, frightened stigma that surrounds the disease—a stigma that has already taken far too many victims.
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