By David J. Martin, PhD, ABPP (Senior Director, APA Office on AIDS)
In the aftermath of the mass shooting of LGBT people in an Orlando nightclub on June 12, 2016, there was a great deal of discussion concerning the shooter’s motives. Was it a hate crime? An act of terrorism? Members and allies of the LGBT community have come together to express their support for the victims and to denounce violence against LGBT people.
Although the solid links between the LGBT community and the HIV prevention and treatment communities resulted in a strong show of solidarity, there is another reason HIV care providers and educators should be concerned about the shooting and its aftermath: It is an instance of the stigma that can increase the risk of HIV transmission and reduce the ability of people with HIV to fight their disease.
The day after the Orlando shooting, the PBS NewsHour interviewed Mark Potok of the Southern Poverty Law Center, during which he described his study of 14 years of FBI data on hate crimes. He noted that LGBT people are twice as likely as Muslims or African Americans, four times as likely as Jews, and 14 times as likely as Latinos to be victims of hate crimes.
As Greg Herek noted in an editorial that appeared in the Boston Globe, LGBT people have known for a long time that they are “stigmatized in American society and are ongoing targets for violence, harassment, and discrimination”—sometimes described as “felt stigma” or “perceived stigma.” Beyond the physical and psychological damage to those directly victimized by anti-LGBT attacks, LGBT people are frequently reminded that they may also be potential targets of violence, creating a heightened sense of vulnerability and fear.
Violent hate crimes are just one category of the stigma and discrimination LGBT people experience:
They are at risk for family rejection—many LGBT youth who are rejected by their families run away from home and become homeless.
They are at risk for institutionalized homophobia: In many states they can be fired or not hired for being LGBT.
Until recently, intolerant attitudes toward LGBT individuals have been codified in local, state, and national law such as “Don’t Ask, Don’t Tell,” and the Defense of Marriage Act. The lawsuit brought against the Obama administration over its letter to school districts regarding transgender use of restrooms is a continuing reminder of discrimination against LGBT people.
LGBT people of color are doubly stigmatized because of the additional prejudice and discrimination associated with their race and ethnicity.
Although most LGBT community members demonstrate resilience in the face of these psychosocial factors, they do take a toll. These factors have been associated with poor mental health (increased depression, anxiety, loneliness, suicide ideation/attempt), diminished self-esteem, and drug and alcohol use/misuse.
Just as important, they can increase the risk of HIV transmission in the LGBT community. And for those living with HIV, they may diminish the body’s ability to fight HIV beyond the damage done by the virus itself:
In an early study, Steve Cole and his colleagues reported that gay men with HIV who concealed their sexual orientation demonstrated faster disease progression than gay men with HIV who did not conceal their sexuality.
In a later study, Dr. Cole and his colleagues reported that gay men with high levels of autonomic nervous system activity (ANS: a measure of stress) experienced impaired response to anti-HIV medication—their viral loads prior to starting anti-HIV medication did not drop nearly as much as those with low ANS levels.
In 2003, Ron Stall and his colleagues reported on the impact of psychosocial health problems (polydrug use, depression, childhood sexual abuse) on high-risk sexual behavior among gay men; they found that the more of these health problems gay men had, the higher their sexual risk. Similarly, in 2007, Brian Mustanski and his colleagues demonstrated the role of psychosocial health problems (binge drinking, street drug use, regular marijuana use, psychological distress, sexual assault, partner violence) in increasing high-risk sex, and in 2012, Ann O’Leary and her colleagues also reported similar findings. They suggested that the overall constellation of findings suggests that “cumulative adverse psychosocial health conditions of any sort seem to exert their negative effects on HIV risk and infection.” Dr. O’Leary and her colleagues also found that optimism and education lessened (but did not eliminate) these effects.
The Orlando mass shooting is another manifestation of the multiple psychosocial insults that still confront the LGBT community. The recent findings cited here (and others) suggest that, in addition to their impact on the mental health of the LGBT community, these insults contribute to increased risk for HIV and diminished physical health among people with HIV. For these reasons, HIV providers need to continue partnering with their LGBT allies in confronting anti-LGBT bias and discrimination.
You can visit the American Psychological Association’s Office on AIDS website for information on psychology and HIV. While there, you can also read the Resolution Opposing HIV Criminalization recently passed by the APA Council of Representatives. The Psychology and AIDS Exchange is a topical newsletter on emerging HIV-related issues.
Image source: Flickr user Ashley Van Haeften via Creative Commons