The trajectory of HIV has changed dramatically in just a few decades. Back in the early days of the epidemic, contracting HIV basically meant progressing to full-blown AIDS and death. Now, thanks to antiretroviral drugs and other therapies, individuals with HIV often can keep the virus at bay, avoid transmitting the virus to others and live a normal lifespan. But while HIV has moved from a guaranteed death sentence to a chronic condition that can be kept at bay, a permanent cure has, thus far, eluded researchers. So, why I am still finding that it is so troublesome for people to talk about HIV/AIDS?
If you blinked, you may have missed some of the ways HIV has changed. The science of HIV is constantly evolving, and what we knew (or thought we knew) just a few years ago is either incorrect, incomplete or in need of an upgrade. Every year we learn more about the virus, and research keeps giving us new tools to prevent, test and treat it. Again, why are we not talking about it? Is the stigma that real?
Let me introduce you to a woman we will call "Stephanie" (a fake name). She is a forty-year-old mother of four children. She lives in Harlem at an apartment building for people living with HIV, that has suffered for years under the weight of poor institutional staffing and meager funding. Her story reflects what can happen when a breakdown in the safety net meets a client facing multiple barriers. Her world effectively came to a halt with the incarceration of her daughter, but her challenges did not stop there. Diagnosed bipolar at 16, she had been struggling ever since with her mental health. HIV prevalence is much higher among women suffering from mental illness; the mental instability and debilitating stigma make them vulnerable to drug addiction and high-risk sexual experiences. After waiting an hour and a half past her appointment time, she was finally called in to see the doctor. "Your numbers," he said with deep concern, "aren't so good. Stress will wreak havoc on your immune system. You have to find ways to deal with what is going on without sacrificing your health."
It is a nebulous term for some: social determinants. But as you can see, her story demonstrates that poverty, family crises, unaddressed mental health issues, a broken and inefficient criminal justice system, and weak social support networks can be devastating to health. These issues, which confront significant numbers of people living with HIV, can severely undercut even the most promising of medical advances and scientific discoveries. You mean to tell me, you still don't want to discuss HIV?