User:Alc306/Discrimination against people with HIV/AIDS

HIV-related stigma
Stigma is often perpetuated by discrimination, callous actions, and bigotry. HIV/AIDS stigma is divided into the following three categories:


 * Instrumental AIDS stigma—a reflection of the fear and apprehension that are likely to be associated with any deadly and transmissible illness.
 * Symbolic AIDS stigma—the use of HIV/AIDS to express attitudes toward the social groups or lifestyles perceived to be associated with the disease.
 * Courtesy AIDS stigma—stigmatization of people connected to the issue of HIV/AIDS or HIV-positive people.

Discriminatory practices in health-care settings
Discriminatory practices within the medical field have greatly impacted the health outcomes of HIV-positive individuals. In both low-income and high-income nations, there have been several reported cases of medical providers administering low-quality care or denying care altogether to patients with HIV. In a 2013 study conducted in Thailand, 40.9 percent of health workers reported worrying about touching the clothing and personal belongings of patients with HIV, despite possessing the knowledge that HIV does not spread through such items. In a 2008 study of 90 countries, one in four persons living with HIV reported experiencing some form of discrimination in health-care settings. Furthermore, one in five individuals with HIV reported having been denied medical care. Even more concerning is the impact HIV-related discrimination has had on HIV-positive women. According to the 2008 study, one in three women living with HIV have reported instances of discrimination related to their sexual and reproductive health within a health-care setting.

Another common form of discrimination within healthcare settings is the disclosure of a patient's HIV status without the patient's explicit permission. Within many countries, an HIV-positive status can result in social exclusion, loss of social support, and decreased chances of getting married. Therefore, concerns about potential breaches of confidentiality by health workers pose significant barriers to care for HIV-positive individuals. In a comprehensive study of 31 countries, one in five persons living with HIV reported instances of a health provider disclosing their HIV-positive status without consent.

These discriminatory practices within the medical field have resulted in the delayed initiation of HIV treatment among HIV-positive individuals. In New York City, men who have sex with men, transgender women, and persons of color living with HIV have all reported that stigma among medical providers was a major deterrent from entering or staying in HIV care. A 2011 community-based study found that the most widely reported barrier to care among HIV-positive individuals is fear of stigma within healthcare settings. HIV-positive individuals who have experienced significant HIV-related stigma are 2.4 times less likely to present for HIV care. Currently, as many as 20–40 percent of Americans who are HIV-positive do not begin a care regimen within the first six months of diagnosis. Overall, this perpetuation of HIV stigma has been detrimental to the health outcomes of HIV-positive individuals, as patients who begin treatment late in the progression of HIV have a 1.94 times greater risk of mortality in comparison to those who start treatment at the onset of diagnosis. Therefore, delayed HIV treatment due to fears of discrimination can have fatal consequences.

Blood donation restrictions on at-risk populations [made into sub-section]
Between 1970 and 1980, more than 20,000 HIV infections were attributed to contaminated blood transfusions. The lack of sensitive blood screening methods for HIV detection prompted the enactment of lifetime bans on blood donations from men who have sex with men (MSM), sex workers, and intravenous drug users, as these population groups were viewed to be at high risk of contracting HIV. At the time, this policy was viewed by health professionals as an emergency measure to prevent the contamination of the general blood supply. Multilateral institutions such as the World Health Organization actively promoted the enactment of lifetime bans in efforts to mitigate transfusion-related HIV infections. This ban was adopted by the United States, as well as several European countries in the 1980s.

The blood donation ban on MSM and transgender women, in particular, has provoked substantial criticism. Members of the LGBTQ+ community view these laws as discriminatory and homophobic. A significant criticism of the blood donation restrictions is that healthcare workers treat the LGBTQ+ community as a homogenous population that engages in similar sexual practices and behaviors. However, like any other population, MSM vary greatly in the number of sexual partners they have and in their engagement in high-risk sexual behaviors. Overall, the donation ban on MSM and transgender women has further exacerbated growing distrust of the medical system within the LGBTQ+ community, especially given the history of homophobia within the medical profession. As a result of these policies, LGBTQ+ individuals have felt substantial pressure to conceal their sexual orientation from medical providers and healthcare personnel.

Blood banks today utilize advanced serological testing technologies with close to 100% sensitivity and specificity. Currently, the risk of HIV-contaminated blood infection is 1 per 8-to-12 million donations, thus demonstrating the effectiveness of modern HIV screening technologies. Despite these significant laboratory advances, the lifetime blood donation ban on MSM remains in several Western countries. Today, medical organizations such as the American Red Cross and World Health Organization are highly critical of these lifetime bans on men who have sex with men, as the epidemiology of HIV has changed drastically in the last 40 years. In 2015, a mere 27% of novel HIV infections originated from the MSM population. In response to this epidemiological data, public health experts, medical personnel, and blood-banking organizations have called upon country governments to reform these outdated MSM blood donation policies.

Mounting public pressure has prompted countries such as the United States and United Kingdom to reform their MSM blood donation restrictions. In 2015, the United States substituted its lifetime ban for a 12-month deferral since last MSM sexual contact, although indefinite lifetime bans remain in place for sex workers and IV drug users. Despite these small steps in the right direction, the American Red Cross has recommended that the Food and Drug Administration (FDA) further revise its policy by adopting a 3-month deferral period for MSM, as this is the current standard in countries such as Canada and the United Kingdom. Overall, it is estimated that completely lifting the MSM blood donation ban could increase the total blood supply in the United States by 2-4%, which could help save millions of lives. Given the blood supply shortage during the COVID-19 pandemic, blood donation restrictions have recently become the subject of further criticism.

On April 2, 2020, the Food and Drug Administration provided updated guidance regarding blood donation in response to the blood shortage caused by the COVID-19 pandemic. This change came following pressure from Democratic Senators and LGBTQ+ rights organizations such as the Human Rights Campaign and GLAAD to reduce the twelve-month deferral period for MSM and women who have sex with men who have sex with men. The updated guidance released by the FDA reduced the deferral period to three months, but did not meet activists' demands to base blood donation eligibility on individualized situations rather than "inaccurate stereotypes." On June 8, 2020, the American Red Cross implemented these changes made by the FDA and reaffirmed in their announcement of these changes their belief that sexual orientation should not affect blood donation eligibility. These changes catalyzed increased advocacy to end the ban against blood donations from MSM and transgender women entirely. The National LGBT Bar Association launched a “End the Gay Blood Ban” Campaign which called on the FDA to replace the current policy that singles-out MSM and transgender women with an individualized risk-based assessment, a policy currently used in countries such as Italy and Argentina. This policy would assess a potential donor's personal risk factors rather than their sexual orientation. On April 16, 2020, GLAAD issued an open-letter to the FDA from over 500 infectious disease and HIV specialists, public health professionals, clinicians, healthcare administrators, trainees and researchers calling for a reevaluation of the updated guidance and the elimination of the blood ban in its entirety.

Violence against persons living with HIV [expanding on this section]
'''HIV-related discrimination also comes in the form of violence and harassment, which negatively impacts people living with HIV in disproportionate manners. Much of HIV-related violence is connected to homophobic and transphobic misconceptions around the virus; media coverage furthered the association between AIDS and gay men, which incited unfavorable attitudes toward queer people. As a result, many HIV positive people chose to conceal their status to protect themselves from stigmatization and violence. HIV-related violence includes verbal, physical, and sexual abuse, economic and psychological harm, and shaming.'''

'''In the workplace, HIV-positive employees face exposure to violence and harassment due to their status being disclosed to their employers. Confidential, private HIV information may be released without consent due to mandatory HIV testing required by employers, which increases vulnerability to violence and stigmatization. In the 2007 case, Doe v. Department of Veteran Affairs of the United States, Doe claims that a physician released his medical history to patients and staff, which detailed his HIV positive status and marijuana usage, without his consent or knowledge, all of which was a violation of the federal Privacy Act, 5 U.S.C. 552a.'''

Discrimination that is violent or threatening violence stops a lot of individuals from getting tested for HIV, which does not aid in curing the virus. Violence is an important factor against the treatment of people afflicted with AIDS. When PLHIV, particularly women, develop an intimate relationship, they tend not to be able to disclose to their partners of the presence of HIV in their system for fear of violence against them; this fear prevents them from receiving financial support to seek out testing, treatment, and general support from medical professionals & family members. A study done on PLHIV in South Africa shows that out of a study population of 500, 16.1% of participants reported being physically assaulted, with 57.7% of those resulting from one's intimate partners such as husbands and wives. The available data show high rates of participants socially isolating themselves from both friends and family, in addition to avoiding the seeking of treatment at hospitals or clinics due to increasing internalized fears.

Effects of COVID-19 pandemic on people with HIV/AIDS
Inequities resulting from discrimination and stigma towards PLHIV can impact susceptibility to other public health threats. Discrimination in the housing, medical, and employment sectors towards PLHIV has helped to drive the COVID-19 public health threat in marginalized populations.[citation needed] '''Many of the groups most vulnerable to HIV infection, such as communities of color or individuals living in poverty, are also at increased risk of contracting COVID-19. PLHIV also appear to be more likely to live in the areas hit hardest by COVID-19. The Kaiser Family Foundation found that 15 of the 20 counties with the highest HIV prevalence in the nation were also ranked in the top 20 counties with the highest COVID-19 morbidity and mortality rates.'''

The effects of COVID-19 on people with HIV is still being studied. It is thought individuals of older age or with serious underlying medical conditions may be at greater risk for severe illness from COVID-19. This includes people with HIV who have comorbidities, a low CD4 cell count, or are not currently on effective HIV treatment. The Coronavirus Under Research Exclusion (CURE HIV-COVID) database collects information on outcome of COVID-19 in people living with HIV. According to the WHO, 23.1% of PLHIV hospitalized for COVID-19 succumbed to the disease, making HIV a risk-factor for severe illness or death due to the virus. The CDC, WHO, and other health organizations have recommended that PLHIV are given priority for COVID-19 vaccination, and the CDC has recommended additional vaccine doses for PLHIV with advanced disease or who are not taking medication to treat their HIV. The populations prioritized for the COVID-19 vaccine are recommended by the Center for Disease Control and Prevention (CDC), but each state determines its own distribution schedule. Explicit prioritization for people living with HIV were made by some states while others used the broader of "immunocompromised state", which can include PLHIV. or key populations impacted by HIV/AIDS have not been made.

At various points in the pandemic, hospitals were overwhelmed by the number of COVID-19 patients, some of whom required intensive treatments like invasive ventilation and extracorporeal membrane oxygenation (ECMO). '''As a result, there were serious concerns about the need to institute care rationing systems which would provide criteria for the prioritization of patients to receive medical attention and treatment. As there was little coordination between hospitals or guidance from local and state governments, many immunocompromised individuals, including PLHIV, were uncertain of the implications of these policies on their access to care. In March of 2020, the Office for Civil Rights in the Department of Health and Human Services filed a complaint against Washington and Alabama for their care rationing policies, citing them as discriminatory against individuals with disabilities.'''