Unclean: The Removal of HIV Stigma and Discrimination

The Removal of HIV Stigma and Discrimination | by Burt Humburg

I had a conversation with some Facebook friends on the topic of why it was wrong to describe an HIV negative status as “Clean.” The thesis was that using “Clean” to refer to HIV status was offensive because, by extension, it implied that HIV positive people are “unclean” or “dirty” and thereby promoted the stigmatization of HIV positive people.

In that thread, one person provided a personal, poignant example. While at a bar and in front of a crowd, someone intending to offend him referred to my friend as “Dirty,” mortifying him. In a different conversation, someone who didn’t know my friend was positive asked, “You’re interested in that guy? Isn’t he dirty?”

I could provide my own examples of when I’ve (inadvertently) been offensive in describing my status. I used to describe it in online profiles as “DDF” (drug and disease free). When it was pointed out to me that this puts HIV status on the same level as drug use, I changed the language of my profile and haven’t used the abbreviation since. Similarly, when someone pointed out how describing HIV negative status as “Clean” implies HIV positive status is dirty, I changed the language of my profile and haven’t used it since.

In that Facebook thread, I made it clear that I was in foursquare support of the removal of HIV stigma and discrimination. But I was skeptical of the idea that we should make removing the hurtful sense of the word clean from our language a goal unto itself.

There are several reasons I think this. First, it seems too specific to focus just on the word “Clean.” There are other words out there that could be used in a hurtful context that somehow miss being targeted. What about the word “Healthy?” As in, “I’m not HIV positive. I’m healthy.” Why not get rid of it also in our effort to support our HIV positive brothers and sisters? What about the other words that can potentially be used hurtfully? I think the reason we aren’t targeting these other words is because the words themselves aren’t the problem. Words don’t create stigma. Words mark stigma. Absent stigma, words cannot be stigmatizing. In ancient times, the word “Christian” used to be stigmatizing, used by jeering Romans to describe an upstart, proselytizing religious group. Nowadays, followers of Jesus actually identify with the term precisely because it is no longer stigmatizing.

Second, considering the word “Clean” to be a universally inappropriate way of expressing a disease free status seems to be a rather modern evolution in our language. I’m guessing that ever since the germ theory of disease explained why people got sick, people were using “Clean” or “Clear” to describe absence of that state. “My son’s chicken pox has cleared up.” “I’ve got a clean bill of health.” Monty Python’s lyric, “At least we both were lying when we said that we were clear [of STIs].”

So if “Clean” was such an anodyne way to describe disease-free status previously, why is it now considered so hurtful? My guess is that it is because of the stigma associated with being HIV positive. In the 70s, STIs were acquired and treated. While I wasn’t conscious of the sexual zeitgeist then, I have never heard of anyone who minded someone describing his or her status of being syphilis negative as “Clean.” The difference is, right now, unlike syphilis, HIV is incurable (although, I hasten to add, it is treatable and preventable). In the future, when HIV becomes curable, I suspect there will be much less stigma about being HIV positive and, If I’m right, once again, like the 70s, no one will care about “Clean” as a status descriptor.

Notice how in the first two reasons, it is the stigma of HIV that makes “Clean” so hurtful, which brings us to the third reason we shouldn’t make the removal of a single hurtful context of a single word our specific goal: it misses the point. What happens if we succeed in removing the word “Clean” as a descriptor of HIV status but leave unchanged the stigma associated with being HIV positive? Hateful people could still stigmatize HIV positive people; they just wouldn’t use the word “Clean” to do it.

The fourth and final reason we shouldn’t focus on ending the hurtful use of “Clean” as a goal unto itself is that I think it is a distraction, one that can have harmful consequences. In that Facebook thread, I drew a lot of fire and may have even lost friends because I shared these views. Note that this was despite the fact that I made it clear in that thread that I was an advocate for HIV positive people and that I worked against HIV stigmatization and discrimination. It might be argued that if we can’t get rid of at least this bad language, then we haven’t made any progress. Then again, at least from my own experience on that Facebook thread, it can alienate people who would otherwise be allies.

I could draw an analogy to driving a combine. Drivers who focus on matching the last row and look only a few feet in front of the wheel tracing that last row find that their courses careen left and right. Instead, if those drivers look at the horizon, they’ll have parallel rows and the particular path for the wheels will take care of itself. I think as we move closer to our goal of destigmatizing HIV, we’ll see less and less HIV statuses described as “Clean” for the same reason.

So what should be the appropriate response to improper use of “Clean?” Ideally, we would educate transgressors about what they are inadvertently implying without getting too worked up. After all, if our goal is the removal of stigma for being HIV positive, it’s hypocritical to turn right around and stigmatize those people ourselves. I will admit I don’t always see these transgressions as opportunities to educate. More often than not, I see someone’s profile on Scruff with a status description of “Clean,” use it to draw an inference about how ignorant that person is generally, and move on to a more promising profile.

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