We have PrEP, condoms, and testing but I’m still at risk of HIV transmission
Written by: Kahlib Barton
I tested positive for HIV on my college campus at 19 years old. Ten years of personal affirmation, self-love, and banished regret still has not made it easier for me to accept this declaration. I spent the first quarter of my diagnosis living completely in the dark, having only told my boyfriend at the time what I was experiencing.
After living with HIV in silence for three years, I finally made the decision to open up about my diagnosis. Afraid and unsure, I took to Facebook Live to share my experience with the world all while preparing myself to be labelled an outcast by my family and friends. To my surprise, I was embraced by them despite being uneducated at the time but wanting to know more about what it means to be HIV positive. They craved understanding so they could be more supportive to me but their desire for understanding was all the support I needed. This embrace was fuel to my personal advocacy mission, pushing me to open up about my HIV status more than I ever imagined. I began attending conferences and rubbing shoulders with many people who shared my experience across demographic barriers.
I can remember one day sitting in a room full of people living with HIV, an older person raised their hand to pose a question to the group. They rose and asked a version of the following, “How is it possible for young people to test positive for HIV this day in age? Have you all not learned from our mistakes? Are you not attempting to access any preventative measures?” For a second, I began to travel back to the genesis of my experience with HIV; a time that was full of self-loathing and blame for me. I had done so much work to move away from this space but hearing these questions pushed me into deep reflection.
Comprehensive Sex Education
My experience with health education inside my public school exclusionary and homophobic.
I grew up in Marshall, Texas, a small town about two hours east of Dallas. In my hometown, we are fortunate enough to have access to health courses that incorporate sex ed (60% of Texas public school districts promote abstinence only education according to The Texas Tribune). These courses are designed to teach youth about their bodies and the importance of taking care of it. Out of this semester long course, we spent one week discussing the dangers of STDs.
The coach leading the course would click through provocative slides of human genitalia that had evidently been exposed to an STD and left untreated. Many of the students in the classroom would gawk and clamor at the images, making it difficult for interested people to learn. Much of the language from the coach around these images would all lead to abstaining from sex, while the students in the room exclaim disgust and what they would do to someone if they ever “put them in that situation”. The teacher would stand in front of the class pushing abstinence while we students were already sexually active.
Throughout the entirety of this hell week, there was no mention of what I as a queer person needed to do to stay safe. All of the language was very gendered and moved with the assumption that I would be engaging in sex to procreate. My understanding of HIV exposure was riddled with misinformation, most of which I learned from my uneducated, sexually active peers.
Comprehensive sexual education has been proven to delay sexual activity, increase condom usage, and decrease the number of sexual partners according to AIDS United. This means that my likelihood of exposure to HIV would had significantly decreased had I been given the proper information when it was necessary.
I wish I would have had access to pre-exposure prophylaxis (PrEP). Had I ever been given the opportunity to access this medication, I may not be positive today. Around the time of my diagnosis, our only option was condoms and they were not always accessible.
Of course, I could always go to a drug store and purchase condoms but in my world it was never that easy. Being from a small town means always having to be precautious about your actions. During my adolescence I recall usually being in the drug store with my mother. My mother, who knew nothing about my sexuality and definitely not about me being sexually active, would not have responded well to me throwing condoms in the basket. Those rare occurrences when I was in the drugstore without her, I was too afraid that one of the people shopping or working would report back to my mother. My hometown had no AIDS service organizations so there were no options for free contraceptives.
Today, we have biomedical and behavioral interventions that are focused on reducing risk of HIV transmission. In the US there are a little over a million people living with HIV, 15% of which do not know their status (HIV.gov). With so many advancements, we have to be more critical about our approach to the epidemic. Targeted universalism suggests that if we create a system that works for the most impacted, then everyone else’s needs will be met. People in rural areas need access to the contraceptive, prophylaxis, medication, testing, comprehensive sexual education, etc. just as much as people in urban areas do. Having these methodologies accessible in these areas will change the trajectory of the virus today but when this happens people will still be at risk of contracting HIV because it has not disappeared. What is just as important as having access is for people to understand that stigma is harmful, violent and it does not promote a healthy society. Regardless of how or when a person becomes HIV positive, what matters is them being healthy. Our obsession with the how is understandable but our energy should not be pointed to the person living with HIV, it should be pointed to the broken system that continues to push communities into the margins.