Titty Confessions: Silent Killers: The Deadly Dance of Stigma and Ignorance
July 21st marks Zero HIV Stigma Day. It deeply saddens me to reflect on the unfortunate cuts to HIV research, the criminalization of those living with the illness, and the fact that the top three communities impacted by HIV—Black individuals, men who have sex with men (MSX), cisgender women, and transgender people—are often overlooked.
I long for conversations about HIV to be normalized, free from shame, judgment, or stigma. In my view, these are key factors that allow HIV to run rampant in our communities. We engage in many discussions, not just about HIV but about disclosure on various topics, yet we fail to create a safe space for such discussions. Disclosing your transgender identity can put you at risk, even from someone who looks and sounds just like you. When we add another “taboo” or a barrier to the mix, it complicates matters further. People shy away from discussing these issues because it challenges the reality they work hard to maintain—a sense of normalcy. I pray for a day when we can have honest conversations about something as normal as sex and how to protect ourselves. Until that point, we must stop asking for disclosure when we aren't taking the necessary precautions for our safety, such as using PrEP, Doxy PEP, condoms, and engaging in open conversations about safer sex.
August 20th is Southern HIV/AIDS Awareness Day. I was reminded of this while talking to my magazine editor, and I felt a wave of emotion, recalling how the South has historically handled this subject. Living in Georgia, I saw how relaxed attitudes towards HIV were, despite the CDC headquarters being in Atlanta. In this month's episode of Titty Confessions, we will call out how the state of Georgia fails its residents. However, as I embark on this healing journey, I’ll also invite you to reflect, as defensiveness often blocks us from learning. According to HIV.org:
Approximately 1.2 million people in the U.S. have HIV. About 13% of them are unaware of their status and need testing.
HIV continues to disproportionately impact certain populations, particularly racial and ethnic minorities, such as gay men and men who have sex with variable (MSX). Historically, the term MSM has also included transgender women and non-binary individuals, which does not accurately categorize the data we need. To be respectful, I refer to this group as MSX.
In 2022, an estimated 31,800 people acquired HIV in the U.S.
In 2022, 37,981 people aged 13 and older received an HIV diagnosis in the U.S. and its territories.
HIV diagnoses are not evenly distributed across states and regions, with the highest rates of new diagnoses occurring in the South at 49%.
Why is this information important? According to census.org, 54% of Black people live in the South. I recently spoke with my little brother about the Great Migration and how, to this day, the government continues to fail our Southern families. There are fewer opportunities for our unhoused population, and transitioning individuals often face a rougher path without a support system. While there are many health disparities I’ll discuss later, at least y’all have good food down there—that's something!
Our first concern is with healthcare providers, including hospitals, clinics, and individual practitioners. I remember living in Midtown Atlanta a few years ago when I went to Emory Hospital for blood work and an STI panel. Emory is affiliated with Emory University School of Medicine, which claims to "train top healthcare professionals and conduct cutting-edge research." My first issue arose when the gender marker on my ID didn’t match the one on my insurance card. Depending on your insurance, they may not cover hormone therapy if it contradicts your sex assigned at birth. Although this may have changed, it was an issue I faced a few years ago. My visit went well until the doctor inquired about my last menstrual cycle and whether I could be pregnant. I deflected, knowing that this didn’t apply to me as a trans femme person. However, when she saw my insurance card, she seemed to malfunction. At that point, she misgendered me, asked about my dead name, and commented on how I “really fooled her.” I was so frustrated that I simply grabbed my things and left.
On a separate visit, I met with a doctor for the same STI panel and asked him about PrEP. He claimed he had never heard of it and asked me what it was. Instead of explaining, I reminded him that Emory is a teaching hospital. He responded that since I was a Black woman, he thought I was discussing something else, as PrEP is "for men" and I wouldn't need it. After I finished educating him, I informed him that I consult closely with the CDC and that given the high rates of HIV in the Black community—including Black cisgender women—he should have considered me a suitable candidate for PrEP. At that point, this white doctor face went red and revealed his implicit biases by saying, "It's because I didn’t think you could afford it," while looking me up and down. Admittedly, I was dressed discreetly in sweatpants, Birkenstocks, a sports bra, and a hoodie, but gatekeeping life-saving medication based on biases is unacceptable. After that encounter, I vowed never to enter another medical facility in Georgia again.
Next, I have concerns about community-based organizations. In the early 2000s, their efforts were abysmal. Living through that time motivated me to pursue the work I do today, as I witnessed firsthand how the system mistreated marginalized communities. I remember sitting with friends and family in doctors' offices in Columbus, Georgia, walking in full of hope, only to be told that there was nothing anyone could do except monitor our status. I recall a nurse saying there was nothing they could do until someone reached AIDS status with a CD4 cell count of 213 or less. Back then, people were not known for their bedside manner, and strength-based language was not widely understood. Going to a medical professional for care after being sexually assaulted and hearing them say, "You were lucky to get a low strain," is unacceptable. I hope practices have since adopted a patient-centered approach, emphasizing compassion and empathy. Thankfully, I eventually met a supervisor—a lovely Black woman—who ensured I received the best treatment available at the time.
Lastly, I must address faith-based organizations and churches. Unfortunately, these institutions form the backbone of a significant percentage of Black families, often clinging to outdated and dangerous ideologies about how one should live. I remember hearing clergy refer to church members as if they were animals, suggesting that it was divine justice if a gay man contracted an STI. Given their influence in the Black community, they could leverage their power to address the reality of premarital sex. Even without delving into issues of gender and sexuality, comprehensive sex education is often replaced with scare tactics and fear-mongering.
How can we hope to overcome the stigma surrounding HIV when so many refuse to acknowledge its impact on the Black community, reminiscent of the crack epidemic in the 1980s?