HIV and the LGBT Community
Recent HIV/AIDS-related blog posts can be read here.
While HIV affects Americans from all walks of life, the epidemic continues to disproportionately impact gay and bisexual men, transgender women, youth ages 13-24 and communities of color, particularly in the southern United States. While tremendous medical advances have helped HIV-positive individuals live longer, healthier lives, there remains no cure and tens of thousands of new infections occur every year. Insufficient funding for HIV programs, as well as prevention methods that are not scientifically sound and persistent stigma and discrimination continue to make it difficult to fight the epidemic and provide the best possible care to those living with HIV.
HIV continues to disproportionately impact segments of the LGBT community
According to the CDC, there are over one million Americans currently living with HIV and approximately 50,000 new infections every year. Almost two-thirds of those new infections are among gay and bisexual men. Among groups identified at higher risk for infection, only among gay and bisexual men is the rate of new infections increasing – and the highest rate of new infections within that group is among black men ages 13-24. While data on the transgender community remains scarce, recent studies have shown extremely high rates among transgender women, who are nearly 34 times more likely to have HIV than other women.
Prevention, treatment and research programs are underfunded and often hampered by ideological restrictions
Until recently, prevention efforts in the United States have not been focused on or funded in the communities hit hardest by the epidemic. While Congress has provided some increases in federal funding for prevention, treatment and research in recent years, decades of neglect and economic barriers mean that the needs still outstrip available resources. For example, many state AIDS Drug Assistance Programs (ADAPs), which help provide HIV medications to underinsured and uninsured individuals, have been forced to implement waiting lists and scale back the drugs that they provide. These federal programs are also hampered by policy decisions grounded in ideology rather than science – such as providing more than $1 billion for failed abstinence-only sex education, while barring any federal funds for scientifically-proven prevention through syringe exchange programs.
Discrimination puts LGBT people at risk for infection and burdens those living with HIV
In most states in our country (as well as at the federal level), there are little or no protections against discrimination in employment, housing, and other areas based on sexual orientation and gender identity. For minorities within the LGBT community, racial and other forms of bias compound an already challenging situation. The potential consequences – job loss, lack of access to healthcare, homelessness – can push individuals into risky behaviors that greatly increase their HIV risk and severely limit their ability to obtain adequate care once infected. Furthermore, despite societal progress in understanding HIV, people living with the virus still regularly encounter stigma, stereotyping and discrimination at work, at school, in healthcare settings, and elsewhere.
For example, more than thirty states have laws in place that have been used to prosecute people living with HIV. While originally intended to promote disclosure of one’s HIV status, these laws have failed to keep up with the medical science around HIV treatment and prevention. Many statutes include references to behaviors that cannot transmit the virus, such as spitting or biting. And even in states without HIV-specific statutes, people living with HIV can be prosecuted under general criminal laws. Ultimately, policies that “criminalize” HIV and people who have it run counter to public health, discourage HIV testing, and perpetuate stigma against people living with HIV.
What has the Obama administration done to address the epidemic within the LGBT community?
- The White House released a first-ever National HIV/AIDS Strategy, explicitly including gay and bisexual men and transgender people in its plan to reduce infections, increase access to care, and reduce disparities. In 2013, the White House launched the HIV Continuum of Care Initiative, described as "the next step in the HIV/AIDS strategy."
- The President signed the Affordable Care Act (ACA) into law. Among other things, the ACA eliminates pre-existing condition limitations that have prevented many HIV-positive individuals from accessing private insurance. It also expands Medicaid, which allows low-income individuals earlier access to treatment for HIV.
- According to the Kaiser Family Foundation, 16 states have decided not to expand their Medicaid programs, creating significant barriers to affordable care for people living with HIV in these states.
- As of January 2015, those states include Alabama, Alaska, Florida, Georgia, Idaho, Indiana, Kansas, Louisiana, Maine, Mississippi, Missouri, Montana, Nebraska, North Carolina, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Wisconsin, and Wyoming
- The Department of Health and Human Services (HHS) rescinded regulations barring people with HIV from entering the U.S. for travel or immigration. As a result, the International AIDS Conference was held (in 2012) in the U.S. for the first time in over 20 years.
How is HRC working to end the epidemic?
- HRC continues to push Congress to provide the strongest possible federal response to the epidemic through fully funded prevention, treatment and research programs. HRC advocates for policies that are based on science – not ideology – and opposes public funding of abstinence-only education and bans on federal dollars for syringe exchange programs.
- HRC lobbies Congress to provide funding for science-based, comprehensive sex education, which provides all youth the tools they need to live healthy lives and reduces new HIV infections.
- HRC educates the LGBT community and our allies on the current realities of HIV prevention, treatment and care, as well as the effects of stigma on the very communities that are most in need. In October 2014, HRC endorsed the use of Truvada for Pre-Exposure Prophylaxis (PrEP) and called for increased PrEP education, implementation, and accessibility.
- HRC is pushing HHS to undertake the research necessary to revise current blood donation policy so low-risk gay and bisexual can men donate if they want to. HRC is also working with HHS to ensure that the Affordable Care Act is implemented in the most inclusive way possible for LGBT people, including those living with HIV.
- HRC Foundation is working to increase knowledge of HIV prevention, treatment, and care among LGBT people, particularly in the South, through a major grant from the Elton John AIDS Foundation.
 For readability, the term “gay or bisexual men” is used to also include other men who have sex with men (MSM) who may not themselves identify as gay or bisexual.
 Centers for Disease Control and Prevention (CDC), "HIV among Gay, Bisexual and Other Men Who Have Sex with Men (MSM)," (2010).