Prejudice Comes in All Varieties!

For many of us, the term "prejudice" translates into racism and then into the range of negative, stereotyped assumptions about others based on no more than externally observable features such as skin color or eye shape. We further translate this into discrimination and the full negative history of treating those whom we observe to be racially different.

This negative trail of thought leading to negative, hurtful, and even fatal actions is well captured in the recent book Medical Apartheid: The Dark History of Medical Experimentation on Black Americans From Colonial Times to the Present by Harriet Washington,¹ which documents medical abuses of African Americans from the colonial period to the present day. From time to time, her editing also reflects the reality that every one of us carries some level of racism: preconceptions about ourselves or others based on personal experience, family history, or scholarly perspective.

As a side note, rather than seeking to entirely eliminate these racially (or ethnically) established perspectives on the world, a reasonable goal would be to admit their presence and seek dialogue that ensures equitable incorporation of persons and perspectives in any program, organization, or entity of interest. But that is an issue for another time.

The starting point for this consideration of prejudice comes from the twisted way in which automatic negative judgments about some people or conditions, coupled with automatic positive attitudes toward other people, can backfire. According to current statistics reported in the Atlanta Journal-Constitution, 20 to 30 Georgia newborns annually enter life infected with HIV, despite the documented success of treating maternal HIV infection during pregnancy and delivery.² This high rate (for the United States) of transmission apparently follows the decision by Georgia maternity care providers that there is no need to offer HIV testing to all pregnant women, because of perceptions that some, perhaps as many as 25%, are not at risk for this disease.

There are other possible explanations for the low test rate: a higher proportion of Georgia women refuse the test when it is offered than do women in other states, or too many Georgia women are receiving less than optimal prenatal care in settings that are too busy to offer and explain prenatal HIV testing. In the first case, it is possible that the refusals may be associated with the way the test is offered, such as "I have to offer you the HIV test during your pregnancy, but you don't really need it, do you?" In the latter, there are probably other risk situations going undetected and untreated as well.

Identifying Prejudice
The assumption I make, however, is that at least some of the failure to test is based on caregivers' negative prejudice that only "bad" women or "ignorant teens" would have HIV infection and the positive prejudice that the woman currently in the examining room does not fit either of those categories and is therefore "safe."

Yet another statistic suggests that this reasoning should be reconsidered: in careful examination of recent statistics about unwanted pregnancies leading to abortion, the groups at highest risk are adults, not the assumed-to-be-careless teens.³ If a range of adult women, many of them married, have been unable to avoid an unwanted pregnancy, how are we to judge that these women are free of the risk of HIV infection?

Early in the HIV epidemic, many people expended incalculable energy trying to make this awful disease applicable only to some number of "them" who were presumed to be different, deniable, probably oversexed or overdrugged, and definitely not like "us," the safe and secure. As a means of confronting this prejudice, posters and coffee mugs appeared with a list of variations on the sequence "AIDS affects gay men; AIDS affects gay men and drug users; AIDS affects gay men, drug users, and prostitutes; AIDS affects gay men, drug users, prostitutes, and Africans," which continued seemingly endlessly until the entry "AIDS affects everyone."

We are generally much better at identifying the prejudices, stereotypes, biases, and discriminations of others toward ourselves, those we hold dear, or those who are more like us. We often wear impenetrable blinders to the ways in which we communicate with or act toward others––ways that are based in prejudice, stereotype, and bias and that result in discrimination against the vulnerable.

Discrimination has another twist: we speak of the discriminating diner, the discriminating music critic, the discriminating art collector––the person who pays attention to what is in front of him or her and finds the best qualities. Some of this discrimination can have negative results: those meals, songs, or paintings that do not measure up are discarded.

However, a person determined to discriminate positively in favor of every human being encountered can have a powerful impact on a community. A prejudice that every person is worth a thoughtful assessment of potential risks, including HIV infection, without regard to superficial differences that might affect the findings, should be incorporated into our HIV and AIDS programs at every step.

References:

References1. Washington HA. Medical Apartheid: The Dark History of Medical Experimentation on Black Americans From Colonial Times to the Present. New York: Doubleday; 2006.
2. Perdue signs HIV pregnancy screening act. Atlanta Journal-Constitution. May 18, 2007:Metro section.
3. Strauss LT, Gamble SB, Parker WY, et al; Centers for Disease Control and Prevention. Abortion surveillance––United States, 2003. MMWR Surveill Summ. 2006;55(SS11):1-32.