An Interview with "James" by Brian Fuss

The following is from an interview with James (not his real name) an HIV+, gay male, sex worker, pro-Dom, and former drug user.  Thank you for sharing your story, James.

James grew up in a Midwest town Pentecostal family where religion and family were constantly reinforced by their twice a week church attendance. James remarked, “All of my friends were from that church; in fact, I did not know anyone other than church members.” At the age of 16, after struggling with his sexuality “forever,” James shared with his older sister about being gay. James stated, “My sister betrayed me and told my parents and this ensued a shit storm in my life.” His parents demanded he “repent of his homosexual, evil ways and go back to loving the Lord.” However, James knew he could not deny who he was, and told his parents as much. His parents threw him out of the house until “he properly repented and served the Lord.” Alone, hungry, scared with his last $100.00, James went to LA hoping a friend would help.

“The friend was a total asshole and basically had sex with me for a few days and then told me to beat it.” Now, completely alone, in a strange city, and frustrated, James had no idea what to do. Then, a kindly man offered him a warm bed and food. “He was a nice guy…at first he said I could just hang out until I got on my feet. Then he started to flash around a lot of money. When I asked him what he did, he said he worked in the porn and sex industry. This was more money than I saw in my whole entire life.” He became James’s mentor, telling him what porn shoots to go on and what places to stay away from. “The way to make more money was to do it (sex) raw (bareback), so of course I became that type of actor. I was making a lot of money between this and my lucrative escort business. With that came the partying, more sex, and HIV.”

“HIV completely changed my life. First, it [HIV positive status] got me into recovery.” James explained he left partying and entered (drug and alcohol) recovery and has been sober for 5 years. “Being an escort brings its own stigma, but it, honestly, is something I do not have to self-disclose, unless I want to date you…there is the rub…most guys are completely intrigued by my sex work, but hesitate to get involved with me because of it. I have heard numerous times…you are a great guy but I can’t be with (date) a hooker…I ain’t no hooker!” James further explained that HIV is the second hurdle that creates a lot of stigma in his life, both professionally and personally. “I have an obligation to tell clients, if they ask, about my HIV status (James explained he is 80% safe with clients and is undetectable) if they want to fuck raw.” James stated he has been single because no one wants a “HIV positive sex worker for a boyfriend, and that just hurts.”

I asked James two question, which I believe are important and pertinent to the discussion of stigma and I offer James’s answers in their entirety.

Many profiles on gay dating sites have the terms clean and dirty to describe someone who is HIV- verses someone HIV+. What are your thoughts? “I’m not dirty! When I see that shit, I just get pissed and usually say someone. Gay men can be so pathetic when it comes to HIV status. Think about the terms…because I am HIV+ I am somehow defective and should be ignored or worse cleaned up…it reminds me of what my parents said when they threw me out of the house…maybe I am just dirty.”

What is your advice to other young men in a similar situation? “You are more than your status, the drugs you take or the work you do! Don’t let anyone take your humanity away from you!”

In conclusion, James tells a story of stigma and shame from growing up gay in a Midwestern town to being a sex worker to being in recovery to being HIV+. It is estimated that more people delay treatment or refuse to get tested out of shame and stigma, especially if they are involved in the sex industry.

_ _ _ _ _ _ _

This interview was conducted by Brian Fuss of the Harm Reduction Coalition 

Breaking Down Barriers: Addressing HIV Stigma in Health Care Settings by Betrand Audoin, Executive Director of the IAS

Bertrand Audoin is the Executive Director of the International AIDS Society (IAS) and a member of the Stigma Action Network's Steering Committee. He has been working in the HIV field for almost 20 years, and first became involved in the response to the epidemic at grass roots level in the early 1990s. For more information about Bertrand read his full IAS bio here.

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Given that the International Congress on AIDS in Asia and the Pacific (ICAAP11) – in Bangkok is soon upon us I’d like to do a follow up to the New York Times opinion piece I wrote a few months ago on the impact of homophobic laws and discrimination following the recent murders of a transgender youth and a gay man. 

The issues of stigma and discrimination can also be deeply felt in health care settings too. People are more likely to use health services if they are confident that they will not face discrimination; that their use of services will not expose them to other risks, such as detention due to their criminalized status; that their confidentiality will be maintained; that they will have access to information; and that they will not be coerced into accepting services without consent. 

Many reports reveal the real existence of the discrimination that many people living with HIV/AIDS experience in health-care systems, including  differential treatment; the denial of treatment; HIV testing without consent;  breaches of confidentiality and  refusal of treatment – refusal to provide medical services to people living with HIV.

Women living with HIV/AIDS experience double discrimination in health-care settings. Reports indicate that pregnant women are routinely tested for HIV without their knowledge, much less informed consent to the procedure.

In India, spouses of all HIV-positive men are advised, and sometimes forced, to undergo HIV testing whether seeking medical care or not. HIV testing is also administered as a rule to all patients prior to surgery and in cases where a suspicion of HIV arises based on their physical appearance or belonging to a high-risk group, such as sex workers. Generally, such testing is mandatory, no consent is provided and there is no pre- or post-test counseling.

It is truly unacceptable that reports are still revealing that 29% of persons living with HIV/AIDS in India, 38% in Indonesia and over 40% in Thailand say that their HIV-positive status had been revealed to someone else without their consent.

This stigma and discrimination towards people with HIV can lead to a vicious cycle with well documented negative health implications ranging from increased depressive symptoms to engaging in risky sexual behaviour.

We’ve long known that there are three main causes of HIV-related stigma in health facilities: a lack of awareness among health workers of what stigma looks like and why it is damaging; fear of casual contact stemming from incomplete knowledge about HIV transmission; and the association of HIV with improper or immoral behaviour.

At the IAS we strongly believe that HIV professionals, whatever their level and field of engagement and action, can play a pivotal role in breaking down barriers and contributing to achieving universal access through a human rights framework. They are a key entry point for promoting and implementing change and preventing situations of abuse and dysfunction in a wide range of settings

The IAS has a two pronged approach to its work with HIV professionals:  ensuring that health care providers and HIV professionals are aware of their own human rights AND enabling HIV professionals to realize rights based approaches and attitudes in all work they undertake both in and outside of provide health care settings.

The IAS also aims to equip HIV professionals with the skills and tools necessary to ensure patients’ rights to informed consent, confidentiality, treatment and non-discrimination and  to also build their ‘legal literacy’ by improving their knowledge of human rights and the national and local laws relevant to HIV.

I am convinced that building both the knowledge and capacity of HIV professionals will empower them to become agents of change and enable them to provide the highest available standard of care to people living with, affected by and at higher risk of becoming infected with HIV.

I look forward to my colleagues at the Stigma Action Network reporting back on their own workshop at ICAAP 11 as well as their impressions of the more generalized discussions around the issue at the conference.

International Day of the Girl

International Day of the Girl encourages us to draw our attention to the inequalities facing young girls across the world. We are called to take a critical look at whether or not girls are given the same opportunities as boys in terms of access to education, financial stability, and sexual empowerment. Here at the Stigma Action Network, we are most concerned with how girls are affected by the HIV epidemic. After examining the data related to this topic, we ultimately found that:

• In sub-Saharan Africa, young women aged 15 to 24 are up to 8 times more likely than young men to be living with HIV.[1]
• Worldwide, young women account for 66% of young people living with HIV.[2]
•  Women living with HIV are more likely to experience violence as result of their status, than men living with HIV.[3]
• Prevalence of first forced sex among adolescent girls is as high as 48% in some countries, which further maintains the HIV epidemic.[4]

While these facts are indeed surprising, the factors that perpetuate them are even more alarming. Three of these most significant factors are outlined below.

• Girls’ Lack of Empowerment: According to global statistics, girls are significantly poorer, less educated, and as a result less financially and socially empowered than their male counterparts. This power imbalance reduces young women’s choices as they negotiate their sexual health and relationships, often giving them little choice in determining if and when to have sex, and in cases of consensual sex, whether that sex is safe. Furthermore, poverty prevents underprivileged girls from receiving adequate health care and education, and as such resources are essential in fighting the HIV epidemic, breaches in these areas may lead to HIV infection.

• Biology: The risk of becoming infected during unprotected sex is two to four times greater for women than for men, and for young girls, the risk can be even higher.[5] This biological disparity gives further evidence as to the importance of educating girls about their sexual health and rights, specifically as they relate to HIV.

• Culture: And lastly, cultural mores may encourage men to have many sexual partners.[6] This is particularly problematic surrounding the issue of child marriage, as such customs can facilitate the spread of HIV to girls in high-risk areas. And given that one-third of the world’s girls are married before they reach the age of 18, such practices can have quite widespread and devastating effects.[7]

As you can see, there are a multitude of socio-economic and biological factors that put girls at a higher risk of HIV. But what is the solution to this problem? And how can we curb these inequalities and give girls the power to take control of their sexual health?

Carol Bellamy, Executive Director of UNICEF offers up her thoughts:

“Education is crucial to success against the pandemic. 

In fact, UNICEF remains convinced that until an effective remedy is found,

 education is one of the most effective tools for curbing HIV/AIDS”

Luckily, the following organizations are contributing to the fight against HIV by educating girls about the importance of and how to protect themselves by engaging in safe sex! Here are a few #StigmaWarriors who are doing great work with girls on HIV education:

Girls Learn International, Inc

Girls Learn International, Inc. takes a unique approach to girls’ education by partnering American schools with schools in foreign countries where girls do not enjoy the same educational opportunities as boys. This organization functions as an after school program that offers service oriented learning to young girls. Participants in the US chapters learn of the challenges facing girls in their partner schools including child marriage, trafficking, poverty, sexual health, and educational disparities. Money that is raised domestically goes towards purchasing textbooks, teachers' salaries, meals, and transportation in partner schools. Girls Learn International, Inc. has 47 partnerships in the following countries where HIV rates are notably high: Afghanistan, Bangladesh, Cambodia, Ghana, India, Kenya, Nepal, Pakistan, Tanzania, Uganda, and Vietnam. Learn more about this organization and how you can help support the education of girls across the world. 

Maasai Girls Education Fund

On the Top 10 list of countries most affected by HIV/AIDS, Kenya comes in at #4. Girls living in poverty have less control over their sexual health, both because of lack of education and because of sexual abuse. "A large, national survey of secondary school girls in Kenya found that 40 per cent of those reporting sexual activity indicated that their first sexual experience was forced or that they were 'cheated into having sex.'"[8] The Maasai are nomadic pastoralists originating from the lower Nile valley with a strong traditional culture that often prevents females from receiving an adequate education. Only 48% of Maasai girls in Kenya enroll in school, and only 5% of those who enroll reach the secondary school level.[9] Such educational disparity can further facilitate the spread of HIV, as girls who remain uneducated are not only unable to make sexually sound decisions, but are also unable decisions that may secure a promising future. The Maasai Girls Education Fund works to combat this, however, by providing a safe environment where girls can receive a quality education. Donations to the Maasai Girls Education Fund go towards buying uniforms, books, and helping to pay tuition. What makes this organization stand out are their community workshops that attempt to reverse cultural beliefs and norms that discourage young girls from enrolling in and committing to school. And as enrollment in school is the best HIV prevention method available to girls (as noted by the World Bank), this organization’s work can surely make a difference.

Commit 2 Change

Young women are the victims of heavy abuse in India as well, in part because they are viewed as the less desirable of the two genders: over 25,000 of adolescent girls are malnourished and suffer from illness and medical neglect [10]. Commit 2 Change is dedicated to supporting female orphans in India by providing them with secondary education, with a particular emphasis on sexual health and HIV/AIDS prevention. Millions of children across the world have become orphaned after losing their parents to HIV/AIDS. Orphaned children are more likely to become impoverished and less likely to be enrolled in school as a result. A study done by UNICEF reveals that "the irony is that orphans are frequently deprived of quality education, which is the very thing they need to help protect themselves from HIV" [11]. India ranks #3 on the Top 10 countries most affected by HIV/AIDS.

The SAN congratulates the above-mentioned organizations (and others around the world!) who are doing great work to educate girls about safe sex and to prevent the spread of HIV among this particularly vulnerable population. However, The Girls Insights report conducted by the International Center for Research on Women found that "girls said they still lack even the most basic knowledge, autonomy and other assets critical for their health and empowerment." This demonstrates that even more must be done if we are to stop the spread of HIV and related stigma!

We hope that more organizations accept the challenge of incorporating sexual education, including education around HIV, into curriculum for young girls and adolescents. Programs must also be developed in a way that empowers girls to use this education to make sound decisions about their own sexual health. Together, with this sort of integrated approach, we can help girls gain control over their lives and futures, and help make a future without HIV a reality.

(Visit UNICEF for more details.)

National Gay Men's HIV/AIDS Awareness Day: A Guest Blog by Daniel Bauer

Special Thanks to Daniel Bauer for sharing his work with the Stigma Action Network, 

in celebration of National Gay Men's HIV/AIDS Awareness Day.

To view the original blog entry, click here.

As a very out and proud gay man and 10 year warrior living with HIV/AIDS, I stand tall in an effort to bring a greater awareness to this year's National Gay Men's HIV/AIDS Awareness Day on September 27, 2012.


This morning I was searching the internet to see how this year's awareness day is shaping up; and to find elements of hope that would not only inspire me but also lend a voice to a call to action. In my search, I came across the following powerful statement by Frank J. Oldham Jr., President and CEO of the National Association of People with AIDS. I believe he sums up what I is a very necessary call to action as a gay man - a call to action I feel I must embrace and put into motion. In his words, I share this with you:


"We have a responsibility. To the quarter-million brothers and lovers we have buried. To the allies who have supported our fight for treatment access and civil rights. To ourselves.

We have a responsibility – to know our own status. Every gay man who is active with multiple partners (or thinks his partner may be) needs to get tested every three months.

We have a responsibility – to know how to protect ourselves and others. We’re excited about the potential of treatment-as-prevention and PrEP, but we all still need to keep our condoms handy.

We have a responsibility – to be as open as we can be about being HIV-positive. Sometimes disclosure isn’t safe, and safety comes first – but our brothers need to know they know people just like them who are living with the virus. And any new partner needs to know our status before the clothes come off.

We have a responsibility – to demand access to healthcare for ourselves and for all Americans. It’s not just a human right, it’s common sense. It costs the public sector more to ignore epidemic than to deal with it, and we need our elected officials to know we know that.

We have a responsibility – to demand to be treated as “normal.” We are normal. We should insist on marriage because it’s our right, and because it forces our neighbors to reconsider the homophobia that gave the HIV epidemic its opportunity to explode in the gay community and move on from there.

We have a responsibility – to love. Last year on National Gay Men's HIV/AIDS Awareness Day, we gave a Positive Leadership Award, NAPWA's highest honor, to Alvin Collins and John Sullivan. Alvin had been one of the unlucky few who, despite the best modern treatment for HIV, don't do well. John stuck to Alvin through thick and thin – and Alvin stuck to John. Alvin died this Spring. We have a responsibility to honor that love.

We have a responsibility. We changed the world in the eighties, insisting on treatment and research when Washington didn’t want to hear us. Today we have the medical and behavioral prevention tools we need to make new HIV infections a thing of the past. We insisted then. We can do it again."

So on this day - I will embrace these words and calls to action above! I hope you too will join and follow me!

I am Daniel and I am living pozitively! Thank you for following my blog!

World Contraception Day 2013: 12 Awesome Posters that Promote Condom Use and HIV Prevention

One hundred years ago (and, in fact, well before that), if you wished to be intimate with some significant other, you’d only have had a handful of contraceptive options. And of those options, no method could, without a doubt, protect against HIV or STIs. But you now live in an era where access to modern contraceptive methods (particularly barrier methods like male and female condoms) are made effectively and are more accessible, a pretty amazing accomplishment when you consider how far we've come in this department.

Hence, each year, we commemorate this awesome feat with World Contraception Day, in hopes to raise awareness of the contraceptive methods available, as well as to celebrate decades of responsible and thoughtful decision-making. As an organization, committed to reducing the prevalence of HIV through eliminating the stigma surrounding it, we celebrate World Contraception Day as a day to celebrate taking control of your health and preventing the spread of HIV through male and female condom use!

On that note-- we’ve compiled twelve noteworthy health posters from the last few decades that promote condom use and preventing the spread of HIV! Be sure to look out for your favorite.

1. Lifesaver. Condoms Can Protect You.

While this poster is rather simple, its message of condom use as a life-saving tool is incredibly accurate. Sometimes you don’t need all of the bells and whistles to pull off an effective condom awareness ad; a few words of encouragement will do.

2. Protect Your Valuables

You wouldn’t let your dog out without a leash, right? That’s the underlying message behind this condom awareness ad: keep your equipment safe! (And, for goodness sake, please don’t actually put your house pets in condoms.)

3. Whatever you call it use it, or call it a night!

To some people it’s a Sling; to others it’s a Thing! What’s it to you?

4. Condoms Can Protect Any Person, No Matter What Color They Are

HIV doesn’t discriminate, and neither do condoms! In fact, you could probably find the condom of your dreams right now, in your closest convenience store.

5. Do the Safe Thing

This cheerful ad gets us every time. Choosing to use contraception is not only important for you, but for your loved ones as well! You wouldn’t want to expose your significant other to HIV, and you would hope that your significant other was just as thoughtful, right?

6. Stop AIDS

While this HIV awareness poster promotes a very straightforward message, it’s undoubtedly effective. Making the link between contraceptive use and HIV reduction is about as clear as it gets.

7. Be Good in Bed

There really is nothing more benevolent than using a condom every time. It's a great way to do your part, much like volunteering to feed the homeless or not cheating on your taxes.

8. Sailors, 1988

This HIV awareness ad presents a pretty clear message, and it targets a specific group that might be at heightened risk for HIV and other STDs. What more could you want from a condom ad? 

9. The Best Cover-Up Since Watergate

Although Nixon probably wouldn't agree with this HIV awareness advertisement, we sure do! Deciding not to cover up with a condom is almost as scandalous as the Watergate cover-up (okay, it's probably a bit more scandalous).

10. Good Boys Always Wear Their Rubbers

Think about it. You wouldn't dare step outside without your raincoat and your little rain boots; you could easily catch something. Engaging in unsafe sexual activity is basically the same thing.

11. Who is HIV Positive?

Awareness ads like these tend to be attention grabbers, and rightfully so! Habitual use of a condom really is to best way to protect yourself against HIV and other STDs!

12. Moroccan Awareness Poster

You don’t need to understand the text in this ad in order to understand the importance of regular condom use, because that’s one message that clearly transcends location and culture. This is one of thousand of awesome promotion advertisements created for display in countries around the world.

So there you have it. Which one was your favorite? And what did you learn? If nothing else, we hope you grasped that HIV and other STDs don’t discriminate between groups of people, making us all at risk of contracting them. Luckily, a condom can significantly reduce such incidents! Stay safe and use a condom!

Happy World Contraception Day!