July 4, 2008
I’m not going to put a lesbian in a position like that….
If you want to call me a bigot, fine.”
–Jesse Helms, in response to President Clinton’s 1993 nomination of Roberta Achtenberg as an assistant secretary at the Department of Housing and Urban Development.
Future students of 20th-century US history may puzzle over a section of the 1990 Hate Crimes Statistics Act. After mandating the federal government’s annual collection of data about “crimes that manifest evidence of prejudice based on race, religion, sexual orientation, or ethnicity,” the Act includes the following passage:
(a) Congress finds that:
- the American family life is the foundation of American Society,
- Federal policy should encourage the well-being, financial security, and health of the American family,
- schools should not de-emphasize the critical value of American family life.
(b) Nothing in this Act shall be construed, nor shall any funds appropriated to carry out the purpose of the Act be used, to promote or encourage homosexuality”
This section of the Act is the legacy of Jesse Helms, who died today at the age of 86.
When the Hate Crimes Statistics Act was being considered by the Senate, Helms played a leading role in efforts to block it because it included antigay violence among the crimes to be monitored by law enforcement personnel. Aware of the bill’s popularity and having failed to remove sexual orientation from it, Helms attempted to thwart its passage by introducing an amendment that its supporters would find unacceptable but politically difficult to vote down.
The Helms amendment would have added the following language to the bill:
“It is the sense of the Senate that:
- the homosexual movement threatens the strength and survival of the American family as the basic unit of society;
- State sodomy laws should be enforced because they are in the best interest of public health;
- the Federal Government should not provide discrimination protections on the basis of sexual orientation; and
- school curriculums should not condone homosexuality as an acceptable lifestyle in American society.”
Such tactics were typical of Helms, who regularly used his parliamentary skills to get his own way in the Senate. On this occasion, however, he was outmaneuvered by Senators Paul Simon (D-IL) and Orrin Hatch (R-UT), who proposed alternative language that was less antigay.
The Simon-Hatch amendment was approved before Helms’ amendment was considered, thus providing political cover for senators. By supporting the Simon-Hatch language, they could safely vote against Helms’ amendment without being labeled pro-gay and anti-family.
And that’s why the Hate Crimes Statistics Act includes statements about “the American family” and denials that it was intended to “promote or encourage homosexuality.”
Helms’ failure at preventing passage of the Hate Crimes Statistics Act was unusual. His mastery of Senate procedure, coupled with lawmakers’ fear of appearing pro-gay, frequently allowed him to succeed in enacting his anti-gay agenda.
When the US was first confronting the AIDS epidemic in the 1980s, for example, Helms was instrumental in preventing the government from funding effective prevention programs among gay and bisexual men. The Senate twice endorsed his amendments prohibiting federal funds for AIDS education materials that “promote or encourage, directly or indirectly, homosexual activities.” By constricting the scope of risk-reduction education, Helms’ actions were widely believed to have contributed to the epidemic’s rapid spread.
Throughout his 30-year tenure in the US Senate, Helms was consistently associated with antigay stands. Given this fact, as well as his longstanding opposition to racial equality and the race-baiting tactics he used in election campaigns throughout his career, it is a fairly easy matter to accept his invitation to label him a bigot.
Personal bigotry aside, however, Helms’ legacy includes the many institutional manifestations of heterosexism that he was able to implement during his years in the Senate. Through the laws he sponsored and those he helped to defeat, he created real hardships for sexual minorities while also fostering sexual prejudice in American society. And his efforts probably contributed to the spread of HIV in the United States and the infection and deaths of many gay and bisexual men.
On this Independence Day and the occasion of Jesse Helms’ death, it is fitting to note how personal bigotry combined with political power can enable one politician to do so much harm to so many people.
And, recalling the general unwillingness of elected leaders to stand up to Jesse Helms’ antigay campaigns over the years, it is appropriate to reflect upon the words attributed to Edmund Burke: “The only thing necessary for the triumph of evil is for good men to do nothing.”
December 13, 2007
Quarantine: Enforced isolation or restriction of free movement imposed to prevent the spread of contagious disease. (American Heritage Dictionary of the English Language, 4th edition).
Last Saturday, the Associated Press revealed Republican presidential candidate Mike Huckabee’s responses to questions about AIDS and homosexuality during his 1992 campaign for the US Senate. On the topic of AIDS, Mr. Huckabee stated:
If the federal government is truly serious about doing something with the AIDS virus, we need to take steps that would isolate the carriers of this plague…. It is difficult to understand the public policy towards AIDS. It is the first time in the history of civilization in which the carriers of a genuine plague have not been isolated from the general population, and in which this deadly disease for which there is no cure is being treated as a civil rights issue instead of the true health crisis it represents.
According to a Sunday AP story, Huckabee stands by his 1992 statement.
“I still believe this today,” he said in a broadcast interview, that “we were acting more out of political correctness” in responding to the AIDS crisis. “I don’t run from it, I don’t recant it,” he said of his position in 1992. Yet he said he would state his view differently in retrospect.
When Huckabee expressed his opinion in 1992, scientific research had identified the human immunodeficiency virus as the cause of AIDS and it was well understood that, unlike many other communicable diseases, HIV could not be transmitted through casual social contact.
That message had been strongly reinforced the previous year when Los Angeles Lakers superstar Earvin “Magic” Johnson publicly disclosed his HIV infection. Indeed, in its November 18, 1991 issue that featured Johnson on the cover, Sports Illustrated included a special “For Kids Only” page that tried to explain the news to readers 12 and younger. Roughly half of that article stressed that HIV isn’t spread through casual social contact. After listing the many ways in which AIDS isn’t contracted, it summarized the message:
The truth is, AIDS is a disease that’s hard for young kids to get. It’s almost impossible for any kid to get AIDS from doing everyday things such as going to school. (p. 46)
There was no credible medical or public health argument in support of quarantining people with AIDS in 1992. Rejecting calls for quarantine and similar punitive measures wasn’t a matter of being “politically correct.” Rather, it was based on sound evidence about the nature of HIV.
Nevertheless, a substantial minority of the US public shared Huckabee’s view. In a 1991 national telephone survey that I conducted with funding from the National Institute of Mental Health, 34% of US adults agreed with the statement, “People with AIDS should be legally separated from others to protect the public health.” (By 1999, only 12% of survey respondents expressed such sentiments.)
What was behind this support for quarantine? For some people, it reflected an unfounded belief that AIDS could be easily transmitted. Their support for quarantine was part of a general fear of contact with HIV-positive individuals.
Such misapprehensions and fears are still around. A 2006 Kaiser Family Foundation national survey found that more than one third of Americans still didn’t know that HIV isn’t spread through kissing, and nearly one fourth didn’t know it can’t be spread by sharing a drinking glass. More than one fifth of the Kaiser survey respondents said they would be uncomfortable about having a coworker who is HIV-infected, and 30% of parents in the sample expressed discomfort at the prospect of their child having a teacher who is HIV-positive.
For others, however, support for quarantine was less about fear of HIV infection than it was about using the AIDS epidemic as an opportunity to express their preexisting prejudices against lesbians and gay men. In analyses of survey data from the latter half of the 1990s with my UCD colleague, Professor John Capitanio, I found that most heterosexuals continued to associate AIDS primarily with homosexuality or bisexuality, and this association was correlated with higher levels of sexual prejudice. In addition, although everyone who contracted AIDS sexually was blamed to some extent for becoming infected, gay and bisexual men were blamed more than heterosexual men and women. Moreover, sexual prejudice was correlated with both misconceptions about HIV transmission and discomfort with HIV-infected people.
This linkage of AIDS-related stigma and sexual prejudice highlights the relevance of Mr. Huckabee’s 1992 survey response on the topic of homosexuality:
I feel homosexuality is an aberrant, unnatural, and sinful lifestyle, and we now know it can pose a dangerous public health risk.
I can’t say whether Mr. Huckabee’s support for taking unnecessary punitive measures against people with AIDS was fueled by his negative attitudes toward homosexuality. However, sexual prejudice apparently has led many Americans to respond in a similar manner.
The fact that Mr. Huckabee is standing by his 1992 comments is disturbing in light of the continuing danger that HIV poses to gay and bisexual men in the United States. HIV infections appear to be increasing among young sexual minority men, the generation too young to have experienced the ravages of the epidemic during the 1980s and 1990s. Those men have reached sexual maturity during an era when homosexuality remains stigmatized, federal law explicitly delegitimizes same-sex relationships, and HIV researchers are advised to delete words pertaining to gay men and homosexuality from the abstracts and titles of their federal grant applications if they hope to be funded.
This situation recently led to a call for a new commitment to combating the spread of HIV among men who are gay, bisexual, or involved in sexual contact with other men (MSM). Writing in the Journal of the American Medical Association, three prominent AIDS researchers stressed the urgent need for leadership from public health officials and within the sexual minority community. Among other actions, they stressed the need to:
… call for the end of stigma toward MSM, which may mitigate the internalization of homophobia leading to sexual risk behavior. This need is particularly critical within racial and ethnic minority MSM communities that bear the stigma of homosexuality along with the discrimination faced by these minorities. Political leadership is also needed to advocate for legal domestic partnerships as a way to promote stable, longer-term MSM relationships. (Jaffe et al., 2007, p. 2413)
Unfortunately, even with such leadership, the prospects for a renewed commitment to implementing effective programs to stop the spread of HIV are bleak as long as serious contenders for national office still believe that quarantining people with HIV was a reasonable idea in 1992.
# # # # #
For the Associated Press article about Mr. Huckabee’s 1992 questionnaire responses, see A. DeMillo. (2007, December 8). Huckabee wanted to isolate AIDS patients. San Francisco Chronicle.
For the JAMA editorial, see H. W. Jaffe, R.O. Valdiserri, & K.M. De Cock. (2007). The reemerging HIV/AIDS epidemic in men who have sex with men. Journal of the American Medical Association, 298, 2412-2414.
For more discussion of research on the link between sexual prejudice and HIV-related stigma, see G. M. Herek & J. P. Capitanio. (1999). AIDS stigma and sexual prejudice. American Behavioral Scientist, 42, 1130-1147.
December 1, 2006
Since AIDS was first detected in the United States in 1981, the HIV pandemic has been shadowed by an epidemic of stigma.
In the early years, it wasn’t uncommon for people with AIDS (and those simply suspected of being sick) to lose their jobs and homes and to be shunned by their family members and former friends.
These manifestations of stigma were first directed mainly at gay men, but they soon extended to all people with HIV. Children with AIDS, like Ryan White in Kokomo (IN), were barred from school. The Ray family in Florida, whose three hemophiliac sons were infected with HIV, was burned out of its home.
Those who took care of people with AIDS and HIV — partners and spouses, family members, health care workers, volunteers — experienced what social scientists call a courtesy stigma, a kind of guilt by association.
Entire communities were subjected to stigma. In the epidemic’s early years, Haitians routinely faced HIV-related discrimination in the United States, regardless of their health status. Many gay men feared being quarantined, a concern not as outlandish as it might seem today: Whether or not to separate people with AIDS and members of so-called “risk groups” from the “general population” was a topic of public debate.
Even in 1991, ten years after the first AIDS case was documented in the United States, one third of the respondents to my national telephone survey of American adults believed that people with AIDS should be legally separated from others to protect the public health.
There was even talk of branding people with AIDS. In a 1986 New York Times OP/ED piece, William F. Buckley, Jr., proposed that “Everyone detected with AIDS should be tattooed in the upper forearm, to protect common-needle users, and on the buttocks, to prevent the victimization of other homosexuals.”
AIDS stigma has declined in important ways since the 1980s. By 1999, my national surveys showed that only about one American in ten supported quarantine for people with AIDS.
But that same year, one fourth of the public believed that people who got AIDS through sex or drug use have gotten what they deserve. One person in five felt afraid of people with AIDS, and more than one in four felt uncomfortable at the prospect of being around someone with AIDS.
AIDS stigma remains a reality today. If we hope to eradicate it, we must understand how it operates in individuals and in society as a whole.
First, the individual level. Stereotypes and prejudices against people with HIV have two main psychological sources. One source is fear — fear of disease, of contagion, and ultimately, of death. Fear motivates many people to avoid those who have (or are suspected of having) HIV. It makes them willing to support laws and policies that would separate people with AIDS from the rest of the population. It makes them unwilling simply to be around people with HIV, to share a drinking glass with them, to hug them.
The ignorance that propels fear-based prejudice remains surprisingly widespread in the United States. In my 1999 national survey, one third of the respondents incorrectly believed they could get HIV from donating blood, 41% believed they could be infected from being coughed on or sneezed on by someone with the virus, and half believed it was possible to become infected by sharing a drinking glass with a person with AIDS. A 2006 Kaiser Family Foundation national survey found that more than one third of Americans still don’t know that HIV isn’t spread through kissing, and nearly one fourth don’t know it can’t be spread by sharing a drinking glass.
The second main source of individual prejudices surrounding HIV and AIDS is preexisting prejudice against the groups linked to AIDS in popular perceptions. AIDS-related prejudice has always been a vehicle for expressing hostility toward the members of those groups — injecting drug users, Haitians and other immigrants, and especially gay and bisexual men. These linkages remain strong. Even as the face of AIDS has changed, much of the US public still thinks of it as a gay disease, and public opinion about HIV continues to be strongly influenced by prejudice against the gay community.
The good news is we can deal with individuals’ prejudices. We can combat fear with information. In the 1980s, AIDS education programs routinely addressed misapprehensions about casual social contact by explaining how AIDS cannot be spread. There is a clear need to restore that component to our AIDS information campaigns.
Eliminating the prejudices that predate AIDS — based on sexual orientation, race, ethnicity, gender, drug use, and poverty — poses a greater challenge. But confronting those prejudices is something we can and must do.
It’s also necessary to recognize how AIDS stigma operates at the societal level.
Stigma is not simply an individual expression of prejudice. Anyone can feel prejudice against another individual or group, but that is not necessarily stigma. Stigma is the endorsement and legitimation of a particular prejudice by society as a whole. Stigma persists because it is woven into the fabric of society. It is part of society’s infrastructure.
Thus, we cannot end AIDS stigma until we exorcise prejudice and discrimination from the institutions of our culture. We must attack not only institutional antipathy and discrimination against people with AIDS, but also against gay people, African Americans, Latinos, women, the poor, and all of the other groups who are targeted by AIDS stigma.
We all look forward to the time when HIV is eradicated and World AIDS Day is simply an historical commemoration of a long-ago epidemic. But we can’t wait until then to eliminate AIDS-related stigma.
Today, on World AIDS Day 2006, we must renew our resolve to marshal our energies, our resources, and our political will to fight the stigma and discrimination associated with AIDS and the groups it most affects. We must resolve that it will soon be unnecessary for AIDS prevention campaigns to deal with stigma. We must resolve to make the epidemic of AIDS stigma just a distant memory, a phenomenon whose vanquishing offers lessons for how to respond to future epidemics with wisdom and compassion.
September 25, 2006
As a footnote to my September 22 posting on the CDC’s proposal for routine HIV testing, here are some interesting findings from an experiment I embedded in my 1999 national survey on public opinion about HIV/AIDS.
The survey included a question about reporting HIV test results to government authorities. Poll respondents were randomly assigned to be asked one of three versions of the question. One version described the CDC’s preferred policy of compiling the names of people who test positive; the other two versions described anonymous reporting procedures.
While the public supported anonymous reporting to the government by about a 2-to-1 margin, they opposed name-based reporting 3-to-1. Regardless of which version of the question they were asked, more than one third of all respondents reported that concerns about AIDS stigma would affect their own decision to be tested for HIV in the future.
One characteristic of those who endorsed name-based reporting was especially interesting. Compared to other respondents, they expressed significantly more hostile feelings toward people with AIDS, gay men, lesbians, and injecting drug users. Thus, support for name-based reporting was strongly linked with AIDS-related stigma, so much so that the former appeared to be a proxy for the latter.
Thus, two key patterns emerged: (1) AIDS stigma plays a role in shaping attitudes about HIV-testing policies, and (2) many people’s concern about such stigma affects their own willingness to be tested.
These findings have implications that are relevant today as the CDC moves to implement its new guidelines for universal HIV testing. They underscore the importance of working actively to allay public concerns about stigma and suspicions about HIV testing and reporting policies.
To be effective, testing programs should not only include stringent confidentiality safeguards but should also make the public aware of those safeguards and of public health professionals’ ongoing commitment to eradicating AIDS stigma and discrimination. This commitment could be demonstrated through highly visible anti-stigma campaigns at the national, state, and local levels.
The study described here was published in the journal Health Psychology in 2003. More details about the study are available on my website.
September 22, 2006
The Centers for Disease Control and Prevention (CDC) has formally called for a dramatic expansion in HIV testing, such that medical patients between 13 and 64 will be routinely tested unless they opt out. Separate written consent won’t be required and pre-test prevention counseling (which ensures that the patient understands how HIV is transmitted and prevented) will be dropped.
Knowing one’s HIV status is a good thing, provided the patient can effectively use the information. HIV-infected people need to be able to obtain ongoing treatment (including, but not limited to medications), and need to be able to take steps to protect their sexual partners from infection. Those who test negative need to understand that they can still get infected, e.g., if they engage in unprotected sex or share needles.
An important question to ask about the new CDC guidelines is whether they’ll meet these needs. By eliminating written consent and pre-test counseling, it’s all too easy to imagine that patients in busy emergency rooms will be tested without really agreeing to it and without being adequately prepared for the results.
Here are some other important facts about the social realities of HIV.
- HIV and AIDS are still stigmatized in the United States. In a 1999 national survey, I found that one-fourth of the US public believed that people with AIDS have gotten what they deserve. 30% would feel uncomfortable having their children attend school with another child who has AIDS, and 22% would feel uncomfortable around an office coworker with AIDS. The proportion saying they felt afraid of people with AIDS was one in five.
- That same 1999 survey revealed that misinformation about HIV transmission actually increased during the 1990s. 41% erroneously believed they could get AIDS from using public toilets. 50% believed they could get AIDS from being coughed on by a person with AIDS. About half believed they could get AIDS by sharing a drinking glass, and one third believed that AIDS can be contracted by donating blood. This sort of misinformation leads all too easily to avoidance and ostracism of people with HIV.
- More recently, a 2006 Kaiser Family Foundation national survey found that only 63% of Americans knew that HIV can’t be spread through kissing, and only 77% knew it can’t be spread by sharing a drinking glass.
- The 2006 KFF survey also found that 1 in 5 Americans would be personally uncomfortable having a coworker with HIV/AIDS, and 30% of parents would be uncomfortable if their child had a teacher with HIV. 45% of Americans believe there is “a lot” of prejudice and discrimination against people living with HIV/AIDS, and another 36% believe there is “some.” Only 11% believe that people with HIV/AIDS face “only a little” prejudice or none at all.
- The KFF poll found that AIDS is still perceived as a gay disease, with Americans more likely to associate it with gay/bisexual men than any other group. My own research has shown that this perception translates into the use of AIDS stigma as a vehicle for expressing prejudice against sexual minorities.
- Although the CDC wants to make HIV testing completely routine, the consequences of a positive HIV test are quite different from those of other routine tests. As Robert Allen, director of HIV policy for Kaiser’s Permanente Group, observed in a San Francisco Chronicle interview, “No one is ever fired from their job for having high cholesterol. Nobody got divorced from a cholesterol test.”
- Money to pay for expanded testing and its consequences doesn’t appear to be forthcoming. The same week the CDC issued its new guidelines, the US House of Representatives moved to shift millions of dollars in Ryan White funds away from California, New York, and New Jersey to other states. All of the states need money for AIDS treatment and the logical solution is to increase overall AIDS funding. However, given the huge federal budget deficit, the cost of the war in Iraq, and the President’s zeal for tax cuts, it is difficult to imagine that Congress will allocate more AIDS funding in the coming fiscal year.
Is the CDC’s plan a good one? In principle, it probably is. But it appears to give insufficient attention to the importance of informed consent, pre-test counseling, and the reality that AIDS remains a stigmatized disease.