What role do stigma and stereotypes play in the transmission of HIV?
What do you think about when you hear HIV/AIDS? Be honest! Do you have dramatic pictures of sickly, scraggy, suffering people in your head? Or do you picture Tom Hanks in his movie Philadelphia? Many of you reading this article probably will. You do not have to be ashamed or blame yourself. This is not directly your fault. HIV is still a taboo topic, faced with irrational fears and surrounded by a lot of myths all around the world.
I must admit that I myself was very surprised when I treated my first HIV-positive patient in hospital … he simply did not fit into my perception of an HIV-positive person (sickly, pale and thin).
Where do we stand with AIDS?
HIV was first isolated in 1983 in the Pasteur Institute in Paris. HIV – Human Immunodeficiency Virus – is a virus that can (but does not have to) eventually lead to AIDS – Acquired Immunodeficiency Syndrome – which is characterised by a series of opportunistic infections and tumours. Being HIV-positive, however, is not a direct predestination for an early death. Due to intensive research and advances in medicine and pharmacology, we are now able to drastically curb the effects of HIV. This means that even if we are not able to directly treat HIV we can increase the quality of life of the affected people; they can work, do sports etc. In Germany everyone in thousand employees is HIV-positive. Two-thirds of the HIV positive people work. With the right medication HIV positive people are even able to get children in a natural way.
Still faced with stereotypes…
Despite these advances, many HIV-positive people and their families still face social problems in the form of discrimination and social isolation. This can be explained by the still existing stereotypes and stigma connected to the topic. First of all, HIV is often equalled with AIDS, which is the terminal stage of HIV. Therefore, many people often directly link HIV with sickness and death. Secondly, there are still large knowledge gaps concerning the transmission of the virus. For example, many people still think that they can infect themselves by hugging, kissing or sharing a drink. This discrimination affects both the physical and mental health, as well as the material security, of HIV-positive patients and their families.
I have talked to several of my HIV-positive patients and they have recounted many daily situations where they were judged because of their disease, even if they claim to live a perfectly normal life. Interestingly they particularly reported about stigma and stereotypes in the health sector. For example, they reported that nurses treated them derogatorily.
“Whenever AIDS has won, stigma, shame, distrust, discrimination and apathy was on its side. Every time AIDS has been defeated, it has been because of trust, openness, dialogue between individuals and communities, family support, human solidarity, and the human perseverance to find new paths and solutions.” - Michel Sidibé, Executive Director of UNAIDS 
The case in Germany…
In 2013 there have been 3.200 new infections in Germany. According to the Robert Koch institute, there is a total of 83.400 HIV positive people currently living in Germany. Germany has one of the lowest infection rates in Europe. Nevertheless, an estimated 13.200 individuals in Germany are not aware of the fact that they are HIV. This is more than 1 in 8. In 2013 1100 individuals were diagnosed HIV-positive after the vindication of a severe immune defect.
Appallingly this trend is explained by the fact that many people do not let themselves be tested for HIV because of fear of social isolation, feelings of guilt and the uncertainty of the arrangement of the disease with family and friends. A late diagnosis, however, can complicate and reduce the success of a therapy. It is true that the infections and disease can be treated, but the immune system is weakened an unable to fully regenerate. But an unrecognised infection is not only an individual problem; it increases the risk of the propagation of the virus.
For the future…
Stigma is the major barrier to the active response against HIV/AIDS. We can only tackle this epidemic if we break the silence and we eliminate the chiraptophobia. We need to talk. Intensive exchange and collection of information and education are the basis to fight the lack of knowledge and unease linked to HIV. We must strip ourselves from prejudices that have been born out of ignorance and fear. HIV-positive people will also play an important role in this change; they have to be included in the dialogue.
But we also must talk about sex in general. We have to strengthen sexual education particularly in schools so that we pass new perceptions and insights on a social and medical basis, promote safer sex and increase the awareness of sex-linked problems.
By breaking the ignorance and silence we will be able to win the fight against HIV!