While serving as a clinical nurse specialist at Maryland’s National Institutes of Health (NIH), Christine Grady received an unforgettable piece of advice from a patient in her care: “The most important thing that you can do is not to judge me.”
This patient contracted an AIDS-related illness during the early 1980s, a time when the Acquired Immunodeficiency Syndrome and HIV (the human immunodeficiency virus that causes AIDS) provoked intense moral censure in North America and around the world. The first known modes of transmitting HIV—through sexual activity and intravenous drug use—reinforced existing forms of discrimination including homophobia, misogyny, and anti-Black racism. This stigma exacerbated an already devastating diagnosis: a median survival time of 18 months.
Canada would experience its deadliest year of the AIDS epidemic in 1995. The following year, at Vancouver’s World AIDS Conference, effective antiretroviral treatments were announced.
In the decades since, so much and yet so little has changed. Antiretroviral therapy has enabled HIV-positive individuals—including members of our community—to live long and healthy lives. Unfortunately, this treatment, along with effective prevention strategies, testing, and supports, remains out of reach for many who need it. As Peter Piot, Sarah Russell, and Heidi Larson (2007) contend in their exploration of the “politics” of AIDS, “the epidemic is fueled by injustices.” Where social and economic barriers exist, where racial inequality and other forms of discrimination are most deeply felt, that is where the highest case counts of HIV and AIDS-related illnesses can be found locally and globally. Today, 55% of the world’s HIV infections are in eastern and southern Africa. In North America and Western Europe—home to 6% of global infections—HIV-positive cases are highest within communities already contending with discrimination, poverty, or other barriers. In Canada, reports released in 2017 and 2018 identified the overrepresentation of Black and Indigenous individuals among HIV cases, along with an overall rise in HIV diagnoses for women.
The work to eliminate stigmas, break down barriers in health care settings, and provide education across Canada continues to be engaged in and led by the very communities most impacted by the HIV epidemic. It remains essential that we all play our part to promote awareness about transmission and prevention, to make testing readily available, and to provide more equitable access, in Canada and globally, to antiretroviral therapy. There is still no cure for HIV/AIDS. There is no vaccine, and stigma around the virus persists. The World Health Organization reports that the global death toll from AIDS-related illnesses has reached more than 36 million and continues to rise.
On World AIDS Day, I encourage you to explore how to support efforts to end AIDS as a public health threat by 2030. Learn about the innovative HIV/AIDS research being conducted here at U of T, including at the Faculty of Pharmacy, Dalla Lana School of Public Health, and Temerty Faculty of Medicine. Consider ways to engage with local organizations that provide HIV/AIDS support and education.
Working together, we can lift the silence and the stigma around HIV/AIDS and help change the course of this epidemic.