By Tamara E. Holmes

      A lot of headway has been made in the fight against the HIV/AIDS epidemic. Yet gender based bias and its relationship to race and class can negatively affect the care that people receive. A Brown Bag Lunch Webinar hosted by the Black AIDS Institute in January 2018 shed light on the influence of some of these factors and provided strategies for combating them.

There are a number of ways that gender identity can impact HIV prevention and care. For one, gender based bias can create an environment where the HIV epidemic can thrive. “If we let biases get in the way of our work, there can be pockets of populations and communities that never hear the information that we have,” said Marie-Fatima Hyacinthe, a mobilization coordinator for the Black AIDS Institute and leader of the webinar.

In some cases, those who don’t fit into the traditional gen-der identities of male and female can be subject to further discrimination. In other cases, HIV/AIDS prevention and treatment strategies can ignore the experiences and needs of transgender individuals. For example, a lack of data about the transgender community leads to a lack of resources to help those individuals fight the HIV/AIDS epidemic.

Gender can also play a role in the care that people living with HIV/AIDS (PLWHA) receive. For example, implicit biases or stereotypes related to gender can erode the trust between a patient and provider. Misconceptions about gender identity can also cause providers to provide inaccurate information and care to patients.

The Intersection of Race and Class

Gender doesn’t exist in a vacuum. Intersectionality refers to the experience of being affected by more than one social classification, such as race or gender, at the same time. In other words, one’s experience can be impacted by one’s gender as well as by other classifications, such as race and socioeconomic class, at the same time.

In order for HIV prevention and treatment strategies to work, people who advocate for PLWHA must be aware of this intersectionality and listen to and honor the unique experiences that patients bring to the table. “HIV is an intersectional issue, so our programs have to be intersectional,” Hyacinthe said.  The webinar provided four strategies for creating intersectional programs:

Strategy 1: Practice cultural humility. “Cultural humility is about creating relationships with communities and clients that allow them to lead in their own care and in their own advocacy,” said Hyacinthe. That means letting people tell you what is important to them and what they need in order to feel respected and valued. When organizations practice cultural humility, they create a welcoming environment for each individual who comes through their doors.

Strategy 2: Empower clients and communities with information.

     Often, gatekeepers of information will make assumptions about what a person needs or doesn’t need to know. For example, a clinic may assume that a woman in a long-term heterosexual relationship doesn’t need information about pre-exposure prophylaxis (PrEP) and therefore may not tell her something she needs to know. In order to effectively provide the education that communities need, advocates must share all information with those in the communities rather than let assumptions and biases determine which data they provide.

Strategy 3: Acknowledge and address mistrust. Because of historical abuses and present injustices, some people in marginalized communities have lost trust in medical institutions. This particularly shows up frequently among Black Americans. “We have to recognize that the communities that we work with might be facing these issues, and we have to really take stock of our own processes and make sure we are not exacerbating those issues,” Hyacinthe said.

Strategy 4: Stand in solidarity with communities we advocate for. When we work with marginalized communities, we must use our institutional privilege to advocate for them to make sure that their voices are heard and they are included in prevention and treatment strategies.

Oppressions of all types can impede progress in ending the HIV/AIDS epidemic. Intersectional programs value all experiences and meet people where they are.

     Tamara E. Holmes is a Washington, D.C.-based journalist who writes about health, wealth and personal growth.



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