User:Siena1018/Discrimination against people with HIV/AIDS

HIV-related stigma:
[citations on existing wiki page:

Stigma is often enforced 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.]

People living with HIV/AIDS may also experience internalized stigma. Internalized stigma is when a person applies negative ideas or stereotypes about HIV towards themselves. This can lead to feelings of shame or isolation. Internalized stigma can increase the fear that a HIV diagnosis will be disclosed, and subsequently, increase fear of discrimination or lack of acceptance due to the HIV positive status. HIV-related stigma, and resulting discrimination, can negatively impact the mental health of people living with HIV.

Stigma towards people living with HIV is widespread. In 35 percent of countries with available data, UNAIDS reports 50 percent of people admitted to having discriminatory attitudes towards people living with HIV. The People Living with HIV Stigma Index (PLHIV Stigma Index) exists as a tool to collect evidence on the prevalence and impact of stigma and discrimination towards people living with HIV. The PLHIV Stigma Index was developed by GNP+, ICW, UNAIDS and IPPF in 2008, and is utilized in over 100 countries. Individual country reports of the PLHIV Stigma Index are available from 2016 and beyond.

People living with HIV face discrimination in many sectors, including healthcare, education, employment, and law enforcement. Discrimination takes the form of denial of services, lack of accessible services for key populations, and insufficient funding and scale for services. In conjunction with internalized stigma, HIV/AIDS stigma and discrimination make it more difficult for PLHIV to feel comfortable in obtaining the medical services they need.

HIV/AIDS and COVID-19:
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.

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.

The populations prioritized for the COVID-19 vaccine are recommended by the Center for Disease Control and Prevention (CDC), but each state determines it's own distribution schedule. Explicit prioritizations for people living with HIV or key populations impacted by HIV/AIDS have not been made.

Blood Bans (Siena):
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.

HIV/AIDS Disparities amongst the Incarcerated Population
As of the end of 2018, the black imprisonment rate was about twice that of Hispanics and more than five times the imprisonment rate amongst whites. Moreover, black males are more likely to be imprisoned with 2,272 inmates per 100,000 black men, in comparison to 1,018 inmates per 100,000 Hispanic men and 392 inmates per 100,000 white men. Incarcerated individuals have a much higher risk of having HIV than non-incarcerated individuals. The estimated global HIV prevalence for prisoners is 3%, whereas the estimated global HIV prevalence for adults in general is 0.7%. Additionally, women in prison have a higher HIV prevalence than men. Incarcerated individuals also have a high risk of transmission as well due to high-risk activity (i.e. unsafe and unsterile tattooing, needle sharing, and unprotected sexual activity). Needle sharing is much more prevalent in prisons because possession of needles in prison is oftentimes a criminal offense, causing clean needles to be scarce. Only about 30% of countries worldwide offer condoms for incarcerated individuals, but for the countries that do offer condoms, coverage and access is not reported. Moreover, these individuals have a harder time accessing critical HIV resources such as ART. Even if ART is offered, those with HIV may still lack the ability to get specialized care and specific ART regimens.

Access to Pre-Exposure Prophylaxis among marginalized groups
Marginalized groups also face barriers to accessing HIV/AIDS preventative care such as Pre-Exposure Prophylaxis (PrEP). Studies have shown that concerns about paying for PrEP and talking to healthcare providers about sexual behaviors have contributed to low PrEP use among young sexual minority men. Other structural barriers to PrEP use include limited knowledge of its availability, stigma surrounding HIV, and distrust of the medical establishment among minority groups due to years of discrimination within the medical field against marginalized groups. A poll conducted on the gay dating-app Grindr found a high prevalence of poor access to health insurance and lack of education about PrEP among respondents. Studies have found that cost concerns, mental health, substance use issues, concerns about hormone interaction, uncomfortable side effects, difficulty taking pills, stigma, exclusion of transgender women in advertising, and lack of research on transgender women and PrEP are all barriers to PrEP use among transgender women. Structural barriers to PrEP use among transgender women include employment, transportation, and housing insecurity/homelessness. A study of Black MSM in London found that instances of racism in spaces dedicated to gay men led to an avoidance of these spaces among the study participants, leading Black MSM to miss out on PrEP awareness that was disseminated via gay channels.