Monday, February 8, 2016

Hate is Not a Public Health Value

Among the smorgasbord of rubbish proffered by Bryan Fischer at last week's Value Voters Summit was his hope of hopes that the next president of the United States "will treat homosexuality not as a political cause at all, but as a threat to public health."

Hate is Not a Public Health Value


Among the smorgasbord of rubbish proffered by Bryan Fischer at last week’s Value Voters Summit was his hope of hopes that the next president of the United States “will treat homosexuality not as a political cause at all, but as a threat to public health.”

Fischer is the director of issues analysis for the American Family Association, identified as a “hate group” by the Southern Poverty Law Center for its anti-gay agenda. He believes that “homosexual behavior represents the same threat to human health that injection drug use does,” and wants a “president who understands that neither homosexual behavior nor injection drug use represent lifestyles that any responsible government ought to normalize, legitimize, legalize, protect, sanction, or subsidize.”

Never mind Fischer’s misrepresentation of the public health challenges of injection drug use (to be addressed in a future post); he gives voice to long debunked beliefs that homosexuality is a public health menace.

Fischer’s claim of a homosexual threat to public health relates to rates of HIV/AIDS among gay men, and the decimation that the virus caused in gay communities in the 1980s and 1990s. It has long been standard rhetorical nonsense to lay the blame for the HIV/AIDS pandemic squarely on gay men. But remember that HIV/AIDS is not what the hatemongers of the 1980s liked to call the “gay plague” — it is transmitted by both unprotected gay and straight sex, as well as by blood transfusions and from mother to child during birth and breastfeeding.

Indeed, the “UNAIDS Report of the Global AIDS Epidemic 2010” tells a much different story. As of 2009, there were approximately 33.3 million people living with HIV around the world. Of those, 15.9 million are women and 2.5 million are children. Every year, 2.6 million people are infected and 1.8 million die. The epidemic is ravaging Sub-Saharan Africa, where 22.5 million people are infected and 5% of the adult population is living with HIV/AIDS. Worldwide, transmission of the disease is through both hetero- and homosexual sex, as well as from mother to child. Poverty status, race, and gender all are significant risk factors for contracting HIV. According to the Centers for Disease Control, between 2006 and 2009 there were 171,840 new cases of HIV diagnosed in the United States. African Americans accounted for 50% of these new diagnoses, whites for 30%, and Latinos for 20%. In 2009, 30% of new cases in the U.S. were heterosexually transmitted – and in Philadelphia, based on slightly older data, 55% were.

If this weren’t such an awful tragedy -- and if comments like Fischer’s didn’t have such a long history of damaging the public’s health and furthering the political cause of homophobia – then Fischer would be just another bigot worth ignoring. But as a speaker at the Value Voters Summit, he shared a stage with almost every Republican presidential candidate, only one of whom, Mitt Romney, dared to repudiate him, albeit weakly and without mentioning Fischer by name.

Dating back to the 1980s, anti-gay bigotry all too often guided public health policy around what was a frightening and fast-growing epidemic. Because AIDS was mistakenly thought by many to be a gay man’s disease (it was first called G.R.I.D. — Gay Related Immune Deficiency), federal public health efforts, including education programs and the promotion of condoms, were stymied by the Reagan White House. The President himself would not address AIDS until 1987.

Making matters worse, homophobic public health practices predated the emergence of HIV. It wasn’t until 1973 that the American Psychiatric Association stopped equating homosexuality with mental illness. The quackery of “curing” gay men and women of their sexuality through the guise of “treatment” continues even today. Philadelphia’s activists have for decades been fighting against anti-gay bigotry, and have been leaders in HIV/AIDS activism.

Blaming groups to be carriers of disease was not new to public health in the 1980s. At the turn of the 20th century, for example, immigrants from eastern and southern Europe were associated with a variety of infectious diseases. African Americans were falsely accused of harboring and spreading tuberculosis and syphilis. And Asian immigrants in California were mistakenly believed to be attracting bubonic plague.

The historian Allan Brandt believes this stigma reflects a tension between social fear and social tolerance that generates “new fears and heighten[s] old anxieties.” Just as earlier diseases once provoked xenophobia and racism, the response to HIV/AIDS reflects an enduring homophobia. In a time when homophobic policies are being successfully challenged (the spread of marriage rights for gay and lesbian Americans and the repeal of “Don’t Ask Don’t Tell”), we are also seeing bigoted public health policies and pronouncements.

If we’ve learned anything from HIV/AIDS and other infectious diseases, it’s that the underlying microbe or virus isn’t the only danger. Human ignorance and hatred can be just as hazardous to the public’s health. Hate is not a public health value.

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What is public health — and why does it matter?

Through prevention, education, and intervention, public health practitioners - epidemiologists, health policy experts, municipal workers, environmental health scientists - work to keep us healthy.

It’s not always easy. Michael Yudell, Jonathan Purtle, and other contributors tell you why.

Michael Yudell, PhD, MPH Associate Professor, Dornsife School of Public Health, Drexel University
Jonathan Purtle, DrPH, MSc Assistant Professor, Drexel University School of Public Health
Janet Golden, PhD Professor of history, Rutgers University-Camden
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