The challenges faced by the LGBTQ+ community during the HIV/AIDS crisis in the 1980s and early 1990s has once again entered the public consciousness thanks to the new Channel 4 drama, ‘It’s a Sin’. This show, produced by Russell T. Davies and Nicola Shindler and named after the Pet Shop Boys’ 1987 hit, chronicles the lives of a group of friends at the beginning of the devastating epidemic that claimed thousands of lives in England and across the world.
The show grapples with the shame felt by individuals who contracted HIV/AIDS throughout the epidemic, as well as the confusion and discrimination perpetrated by misinformation—the fear of skin-on-skin contact, the deep cleaning of crockery, and the (illegal) detainment of HIV+ patients for the fear of contamination. One scene explored this misinformation through the examination of home remedy myths, featuring the consumption of battery acid as a rumoured cure.
The wild success of this show, providing All 4 with its highest monthly streaming figure ever (6.5 million views across 5 episodes), has uncovered many hard questions about the state of HIV/AIDS and the stigma surrounding the illness in the 21st century.
Stigma – the proliferation of “negative beliefs, feelings and attitudes” towards people with HIV, as well as the “process of devaluation” of people living with HIV/AIDS – was rife in the 1980s. Little was known about the illness and as it was a predominantly sexually transmitted virus which mainly affected the LGBTQ+ community, a preconception of HIV/AIDS as ‘dirty’, and only contracted if someone was a ‘slut’ became popularised in public opinion.
One early stigma-busting event occurred in 1987, with the late Princess Diana opening a purpose-built HIV/AIDS unit at the London Middlesex Hospital, where she shook the hand of a patient. This sent shockwaves throughout the world’s media, working to thwart the myth that HIV could be spread through touch alone.
Despite this, almost 40 years since the first AIDS related death in the UK, great stigma still exists around HIV, its transmission, and the lifestyles of those who contract it. A 2019 poll by YouGov for the Terrence Higgins Trust found that a staggering 41% of people living in the UK held the misconception that anyone living with the virus can spread it, and a shocking 64% of people would feel uncomfortable having sex with a HIV+ person on effective treatment. Furthermore, the poll uncovered that 48% of Britons would feel uncomfortable kissing someone with HIV, and 38% would feel uncomfortable even dating someone who was HIV+.
It is important to note that there has never been a chance of spreading HIV through contact such as this.
With modern methods of managing HIV, like PrEP (pre-exposure prophylaxis), it is almost impossible for a patient diagnosed as HIV+ to pass on the virus. PrEP comes in the form of a tablet or injections, and reduces the risk of HIV transmission through sex by around 99%, and by around 74% by those who inject drugs. As of Thursday 1 October 2020, PrEP in England is now free on the NHS from sexual health clinics.
Alternatively, in emergency situations where an individual believes they have come into contact with HIV, PEP (post-exposure prophylaxis) can be taken within 72 hours. PEP makes infection less likely, but it does not always work.
PrEP and PEP only protect us from HIV, and are not a substitute for condoms to protect against STIs.
Antiretroviral drugs are used to treat anyone who contracts HIV. This medication stops the virus from replicating inside the body. This works to reduce their viral load (the volume of the virus in the blood) to undetectable levels—meaning that a blood test cannot detect the virus. If the viral load persists at undetectable levels for over 6 months it is not possible to transmit the virus during sex. This is referred to as undetectable=untransmissible (U=U).
Despite these highly effective treatments against the once-deadly illness, a large amount of stigma and mystery still shroud HIV/AIDS . Therefore, the question remains: what is to be done about the remaining stigma surrounding HIV/AIDS?
HIV stigma pervades many areas of life in the UK outside of public opinion. One of these areas is within public policy. Although men who have sex with men (MSM) can now give blood in the same way as everyone else (starting from summer 2021), these laws only changed recently. In 2011 – just 10 years ago – the lifetime ban on homosexual blood donation lifted, and a still discriminatory 12-month abstinence period was put in place. Although marginally better than the ban, this policy still furthered the myth of homosexual men being more prone to STIs and HIV, and made little sense due to NHS Blood’s rigorous blood testing procedures.
The National AIDS Trust (NAT) outlines several policies that could be adopted to help defeat HIV/AIDS stigma in the UK:
1. Putting an end to criminal prosecutions for the transmission or exposure of HIV (other than in cases of intentional transmission).
2. HIV education should be included as a part of a comprehensive curriculum for PSHE and SRE in schools.
3. NHS commissioning bodies should invest in stigma reduction programmes in healthcare settings.
Change starts at the top. It is imperative that the Government recognises the issues surrounding HIV stigma and begins to work in earnest to end the perpetuation of this within public policy.
Another significant stigma identified by the National AIDS Trust is self-stigma. This covers the undue shame and fear felt by some HIV+ people, as well as poor self-efficacy and knowledge of their rights. Solutions to this stigma can be fairly straightforward, including the promotion of opportunities for HIV+ individuals to challenge stigma and discrimination as a community, and the provision of programmes including skill-building activities and peer support. There is no reason to be ashamed of being HIV+. It does not denote ‘dirtiness’, it isn’t a death sentence, and it absolutely doesn’t mean HIV+ people should stop living their life how they want to.
It is important to challenge stigma wherever it is found. Although the battle against HIV/AIDS has been all but won, the stigma and shame it has left behind has in many ways been left unaltered. It is incumbent upon all of us to interact with shows like ‘It’s a Sin’, equally heart-warming and heart-wrenching in measure, to understand the past. But this must not be our view of HIV/AIDS in the 21st century, particularly with advancements in medical science meaning those diagnosed as HIV+ can live long and healthy lives without ever passing on the virus.
For more information, visit:
NHS Facts: https://www.nhs.uk/conditions/hiv-and-aids/
Official HIV Statistics: https://www.nat.org.uk/about-hiv/hiv-statistics
Testing for HIV: https://www.tht.org.uk/hiv-and-sexual-health/testing-hiv
National AIDS Trust (2016) Tackling HIV Stigma: What Works? Available at: https://www.nat.org.uk/sites/default/files/publications/Jun_16_Tackling_HIV_Stigma.pdf (Accessed: 28/01/2021).
Channel 4 (2021) Acclaimed new drama It’s a Sin drives record All 4 streaming. Available at: https://www.channel4.com/press/news/acclaimed-new-drama-its-sin-drives-record-all-4-streaming (Accessed: 10/03/2021).
BBC News (2017) How Princess Diana changed attitudes to Aids. Available at: https://www.bbc.co.uk/news/av/magazine-39490507 (Accessed: 27/01/2021).
Terrence Higgins Trust (2019) Almost half of Brits would feel uncomfortable kissing someone with HIV. Available at: https://www.tht.org.uk/news/almost-half-brits-would-feel-uncomfortable-kissing-someone-hiv (Accessed: 27/01/2021).
NHS (2018) HIV and AIDS. Available at: https://www.nhs.uk/conditions/hiv-and-aids/ (Accessed: 27/01/2021).