Tag: U=U

Fear Is Rising. HIV Stigma Is Rising With It


The data says fear-based stigma is growing fastest. At the same time, our laws and policy debates continue to signal danger in ways that may reinforce that fear.

From 2021 to 2024, the share of U.S. adults holding at least one stigmatizing belief about people living with HIV rose from 31.5% to 43.0%. Fear-based stigma increased faster than blame-based stigma.

When outdated HIV criminal laws stay on the books, they send a message that science can’t erase: people living with HIV are still dangerous. I see the consequences of that message every day.

Law teaches the public who to fear.

Executive summary

The Williams Institute[1] found that HIV stigma among U.S. adults rose sharply from 2021 to 2024, with fear-based stigma rising meaningfully faster than blame-based stigma.[2] This matters because fear is the kind of stigma that gets written into policy, and recent institutional signals, including stalled legal reform and visible federal retreat from HIV commitments, may be feeding the fear rather than calming it.[2]

What the new data says

A February 2026 brief from the Williams Institute delivers a finding that should stop us cold: HIV stigma in the United States is increasing, not declining.[2]

From 2021 to 2024, the share of U.S. adults holding at least one stigmatizing belief about people living with HIV rose from 31.5% to 43.0%.[2] In 2024, about one-quarter of adults expressed blame-based stigma (26%), and nearly one-third expressed fear-based stigma (31%).[1]

But the increase is not evenly distributed.

The report describes two main forms of HIV stigma:

  • Fear-based stigma is discomfort or avoidance rooted in exaggerated or inaccurate beliefs about how HIV is transmitted.[2]
  • Blame-based stigma is belief that people with HIV are “immoral” or “blameworthy” and therefore “deserve” what happened to them.[2]

Both contradict modern science, including the basic reality that when a person living with HIV takes treatment as prescribed and gets and stays virally suppressed (undetectable), they do not transmit HIV to sexual partners.[3]

And one form of stigma is rising much faster than the other.

From 2021 to 2024, “blame-based stigma only” rose slightly (10.9% to 12.1%); “fear-based stigma only” rose more (12.8% to 16.8%). The share of adults endorsing both fear-based and blame-based stigma nearly doubled (7.8% to 14.1%).[2]

That pattern matters because blame is a moral judgment, but fear is a risk judgment.

Fear is the kind of belief that convinces the public they need “protection” from people living with HIV.

When stigma becomes law

The report says explicitly what too many public conversations avoid: fear-based stigma and blame-based stigma “run counter to scientific evidence” and still shape social and political conditions, including HIV criminalization and other structural discrimination.[2]

This is not theoretical. The Williams Institute notes that 32 states have laws that criminalize people living with HIV and 28 states impose enhanced criminal penalties tied to HIV status.[1] Indiana is in both of those numbers. The brief describes how many HIV criminal laws do not reflect current science about transmission risk and can criminalize conduct that poses negligible or no risk, such as spitting or biting.[2]

Here is the loop I cannot unsee anymore:

Stigma → shapes public attitudes → which shape law → which reinforce stigma.

A feedback loop.

Fear rarely grows in isolation. It grows in environments where institutions continue to signal danger.

The message laws send

There’s a piece of this that is hard to explain unless you live close to it. Laws do not just punish behavior. They tell stories about who is “risky,” who is “unsafe,” and who deserves special suspicion.

When HIV criminal laws stay on the books for decades after the science has changed, people living with HIV feel that. Even if enforcement is sporadic, the symbolism is constant.

And the message those laws send is hard to ignore:

You are still the monsters people were taught to fear in the 1980s.

I see this firsthand in our work with HIV Modernization Movement-Indiana.

For 10 years, we have worked to modernize HIV criminal laws in Indiana.[1] In that time we have achieved two significant legislative wins in 2020 and 2021, and one smaller penalty fix just this year in 2026.

But meaningful legal reform continues to stall in Indiana.

Our legislation has spent years bouncing between two chambers at the statehouse. Each session, it moves forward, then quietly gets redirected. From the outside, that looks like routine legislative gridlock. From the perspective of people living with HIV, it reads as a repeated institutional judgment: you are still dangerous enough that the law must keep treating you differently.

If you want to understand why fear-based stigma can rise even as treatment improves, start there.

Law teaches the public who to fear.

That is how fear-based stigma survives progress. Not because people have never heard “HIV is manageable,” but because their institutions keep teaching them “HIV is danger.”

Other possible drivers of rising fear

The Williams Institute brief documents the increase in stigma, but it is not designed to answer the “why now” question.[2]

I tried to think of some other reasons that come to mind from my advocacy work and interactions, in addition to the above analysis on the impact of outdated HIV criminal laws. Several other trends could explain fear-based stigma in particular.

One is the post-pandemic collapse in trust. When people distrust science and public health, they do not update their beliefs, even when the underlying facts change.

Another is plain HIV illiteracy. The science is clear, but the public’s mental framing is often stuck decades behind. Federal health agencies and providers still have to state, clearly and repeatedly, that people with HIV who are undetectable do not transmit HIV through sex. This is known as U=U, or Untransmittable is Undectable.[3]

A third driver is visibility that can unintentionally backfire. When HIV criminalization becomes more publicly discussed, the issue returns to the surface of public consciousness.

Government Signals and Public Risk Perception

The Williams Institute data stops in 2024. But the signals the current administration is sending now may shape what happens next.

When governments signal retreat from the HIV response, the public does not interpret that as progress. They interpret it as warning.

The White House issued an executive order in January 2025 directing a 90-day pause in U.S. foreign development assistance, pending review, with Office of Management and Budget enforcement through apportionment authority.[4]

Within the global HIV response, the policy debate has been especially loud around PEPFAR.[5] KFF reports that the administration’s FY 2026 budget request included $2.9 billion for bilateral PEPFAR activities, described as a $1.9 billion reduction.[6]

Even if some cuts are proposed rather than fully enacted, the social impact of the signal can be immediate: debate about shrinking HIV investment tells the public “this problem is getting less attention,” not “this problem is solved.”

Add symbolic erasure to that, and fear has fertile ground.

In late 2025, reporting indicated the U.S. government declined to mark World AIDS Day in the way it had historically.[7]

In February 2026, The Center for HIV Law and Policy’s Project Justice Partners workgroup published a statement framed around “defying erasure,” explicitly tying today’s HIV justice work to resisting silence and criminalization.[8]

Here is the backfire mechanism: When policymakers publicly debate cutting HIV funding or mute HIV awareness, they make HIV visible again. But visible as something the government is stepping away from. If the public already sees people living with HIV as risky, that retreat signal can be interpreted as: “They are going to be more dangerous now.”

The visibility, paradoxically, can amplify fear.

Policy decisions do more than allocate resources. They communicate priorities. When governments visibly debate cutting HIV funding, retreat from prevention commitments, or reduce public recognition of HIV awareness efforts, the public receives a signal about how seriously the threat is perceived.

For people whose understanding of HIV is already outdated, those signals can reinforce the belief that HIV remains a danger rather than a manageable condition.

Why this matters

Stigma is not a feelings problem. It is a public health problem.

The Williams Institute brief summarizes how stigma is linked to worse outcomes for people living with HIV, including poorer mental health, reduced engagement in care, and lower quality of life.[2]

Public health agencies also emphasize that HIV stigma discourages testing and accessing services.[9]

So when fear-based stigma rises, it is not just cruel. It is epidemic-fueling.

The challenge ahead

If fear-based stigma is rising, then the continued presence of HIV-specific criminal laws deserves scrutiny. Laws exist to address real harms and protect public safety. But they also send signals about how society understands risk.

When statutes continue to treat people living with HIV as uniquely dangerous decades after the science has changed, those signals can reinforce public fear rather than reflect current medical reality.

Over time, the gap between law and science can unintentionally sustain the stigma public health efforts are trying to reduce.

Next steps for advocacy messaging and strategy

Start treating fear-based stigma as a measurable communications failure, not a vague cultural problem:

  • Lead with U=U in plain language and repeat it relentlessly, because fear thrives on ambiguity.[10]
  • Pair that with a “law lags science” narrative that frames stalled reform itself as ongoing structural stigma.[2]
  • Pre-bunk the retreat-signal effect by naming how proposed cuts and muted awareness days can be interpreted as rising danger.[6]
  • Force accountability inside the legislature by making the bottleneck visible and concrete.

When law lags science long enough, the law itself begins to shape the fear it was originally meant to address.

The science has changed.
The people have changed.

Now the law (and the story it tells) must change too.

Keep Tellin’ The Story,
Professor Peacock

What are your thoughts on the reasons for this shift? Drop your ideas in the comments.

Note: The opinions expressed here are my own and do not reflect the views of HIV Modernization Movement–Indiana, the Williams Institute, or any other organization mentioned, unless quoted or attributed directly. This piece reflects my personal reflections and analysis. I used AI tools to help edit and organize my notes and online journaling into a more coherent, blog-friendly format.

 

Sources

[1] Williams Institute — HIV Stigma Is Pervasive and Increasing Among U.S. Adults
https://williamsinstitute.law.ucla.edu/publications/hiv-stigma-us/

[2] Williams Institute — HIV Stigma Is Pervasive and Increasing Among U.S. Adults (Feb 2026 Brief)
https://williamsinstitute.law.ucla.edu/wp-content/uploads/HIV-Stigma-Feb-2026.pdf

[3] CDC — HIV Treatment as Prevention
https://www.cdc.gov/hivpartners/php/hiv-treatment/index.html

[4] The White House — Reevaluating and Realigning United States Foreign Aid
https://www.whitehouse.gov/presidential-actions/2025/01/reevaluating-and-realigning-united-states-foreign-aid/

[5] Council on Foreign Relations — PEPFAR Has Saved Tens of Millions of Lives. Why Is It at Risk?
https://www.cfr.org/articles/pepfar-has-saved-tens-millions-lives-why-it-risk

[6] KFF — The Trump Administration’s Foreign Aid Review: Status of PEPFAR
https://www.kff.org/global-health-policy/the-trump-administrations-foreign-aid-review-status-of-pepfar/

[7] PBS NewsHour — Trump declines to mark World AIDS Day
https://www.pbs.org/newshour/show/trump-declines-to-mark-world-aids-day-as-funding-cuts-threaten-hiv-prevention-efforts

[8] Center for HIV Law and Policy — Defy Erasure, Defend Resistance, Disrupt Criminalization
https://www.hivlawandpolicy.org/news/defy-erasure-defend-resistance-disrupt-criminalization-positive-justice-project-partners-group

[9] CDC — Stigma and HIV
https://www.cdc.gov/hiv/health-equity/index.html

[10] CDC — Undetectable = Untransmittable
https://www.cdc.gov/global-hiv-tb/php/our-approach/undetectable-untransmittable.html

U=U, Ten Years Later: What the Science Settled and the World Still Hasn’t


I learned about U=U in 2019.

Not in 2016 when the message officially launched. Not at the beginning. I learned about it three years later, when the science was already clear and the evidence overwhelming. And what struck me immediately wasn’t the data. It was the disconnect.

Doctors had the science.
The world hadn’t caught up.

People living with HIV are still being treated as dangerous. Still criminalized. Still framed as a problem to manage rather than people to respect. The science says something radical and simple. Undetectable equals untransmittable. Zero risk. Full stop. But culture, law, and everyday beliefs are still operating on fear.

That gap changed me.

Later that year, I launched #CelebrateUU, not as an education campaign, but as a visibility project. I didn’t want to explain U=U. I wanted people to see it. Real people. Real faces. Real intimacy. Because stigma doesn’t dissolve through statistics alone. It dissolves when humanity becomes undeniable.

Over the years, I’ve watched U=U do incredible things.

When people receive clear, confident U=U information, it changes how they see themselves. It restores sexual confidence. It reframes treatment from obligation to empowerment. It opens the door to honesty, joy, and possibility. In clinical settings where providers speak clearly and without hedging, trust grows. Fear recedes. People breathe again.

But ten years in, it’s also clear where U=U hasn’t gone far enough.

U=U didn’t fail. But its impact has been uneven because belief spread slower than evidence.

Too many providers still hedge.
Too many public messages flatten U=U into a slogan.
Too many rural and marginalized communities are left behind.
Too many laws still treat people with HIV as a risk, not as people living with a managed condition.

And in the middle of this, a real and complicated concern has emerged. The fear that U=U creates a viral divide.

That concern deserves honesty, not avoidance.

A person’s value is not determined by viral load. Full stop. When someone can’t reach viral suppression, that is very often a failure of systems, not individuals. Housing instability. Mental health. Poverty. Trauma. Access gaps. Stigma itself. These are not personal shortcomings. They are structural barriers.

And the vast majority of people who are not virally suppressed still care deeply about preventing transmission. They take precautions. They disclose. They navigate risk thoughtfully and responsibly, often with far less support than they deserve.

But here’s the hard truth we can’t avoid.

Fear of creating a viral divide cannot be used to weaken or hide settled science.

The answer to inequity is not diluting the truth. It’s fixing the systems that keep people from benefiting from it. When we hedge U=U out of discomfort, we don’t protect people. We reinforce stigma. Worse, we create space for bad policy.

This matters because stigma doesn’t just live in attitudes. It lives in law.

U=U exposes how outdated HIV criminalization laws are, but science alone doesn’t repeal bad laws. When institutions hedge on U=U, they reinforce the idea that people with HIV are inherently dangerous, and that shows up in courtrooms, sentencing, and statutes.

In recent years, my work has shifted toward implementation. Grounded in U=U University, which clearly defines the science, I’ve focused on the question that ten years of U=U now demands: What happens after awareness?

Knowing the science is not the same as practicing it. When providers hesitate, when systems stay silent, stigma survives. And patients pay the price.

If a provider can’t explain U=U clearly, confidently, and consistently, then the promise of U=U remains theoretical for the people who need it most.

Ten years later, U=U has proven what’s medically possible. The virus can be rendered untransmittable. Fear no longer belongs in the science.

The work now is alignment.

Aligning healthcare with evidence.
Aligning law with reality.
Aligning public messaging with dignity.

Until our systems behave as if they believe what the science already tells us, U=U remains true, but its promise isn’t fully realized.

And that’s where the next decade begins.

I Don’t Need a Specialist Anymore — And That’s a Good Thing


When I was first diagnosed with HIV in 2012, the idea of seeing anyone other than an infectious disease specialist would have felt reckless, even dangerous. This was before PrEP, before U=U. Specialists were the gatekeepers – the people who knew the ever-changing science, the ones who gave me the sense of being in the safest possible hands. For a long time, they were the difference between life and death.

So when I learned today at my routine HIV lab follow-up that the Damien Center is shifting away from relying on infectious disease doctors, and instead training primary care physicians to handle HIV, my first reaction wasn’t celebration. It was shock. Fear. Even a little sadness. A part of me wanted to feel special, to believe that my care required the highest tier of expertise, that my condition set me apart in a way that demanded more than “just” primary care.

But sitting with that discomfort, I realized something important: this change is a milestone.

It’s not about being less cared for. It’s about HIV care becoming ordinary in the best possible sense. What was once an emergency requiring specialists is now a chronic condition that can be managed alongside everything else. Just like diabetes, high blood pressure, or asthma. And just as most people with diabetes don’t see an endocrinologist every month, most people living with HIV don’t need an infectious disease doctor at their side for every check-up. We need skilled, compassionate primary care providers who are equipped with the right training. That’s exactly what this new model is delivering.

The truth is, the biggest factors in HIV health today aren’t whether you have access to a specialist; they’re whether you can access care at all, whether your doctor treats you with dignity, whether you have support for housing, food, mental health, and transportation. Medicine has advanced so much that the day-to-day fight isn’t with the virus itself – it’s with the systems that surround care. And if we’re honest, it’s with stigma itself. Stigma kills.

When I was first diagnosed, I was in the hospital. A case of misdiagnosed stage-2 syphilis landing me in the ER. Thankfully, my visit to the ER is the reason I was diagnosed so soon after being exposed to the HIV virus. My infectious disease doctor told me they caught my HIV very early – he only saw a handful of cases each year like mine. I was lucky to be in his hands.

Around the time I was diagnosed in 2012, newer medications were available, and the medical advice began to shift towards starting treatment right away. Why? Because the side effects of the latest antiretroviral treatments (ARTs) were much milder, making it smarter to begin medication quickly to lower the viral load. This was all before the idea of U=U was introduced.

So, I’m very thankful for my infectious disease specialist, because he caught me “on the forefront of change.” Looking back, that was huge step forward.

Now, 13 years later, the fact that I don’t “need” one anymore isn’t a downgrade — it’s proof of progress. It means that medications work so reliably, and outcomes are so good, that HIV can finally be seen for what it is: not a death sentence, but a manageable chronic condition.

Of course, specialists still exist for rare or complicated cases – and that’s important. But the default has shifted. HIV no longer requires a small elite circle of experts. Instead, it belongs in the hands of everyday doctors, woven into the fabric of routine healthcare.

That’s not loss. That’s victory.

So yes, there was some grief in letting go of the idea that I needed a specialist. But in the end, this shift means something profound:

I am not defined by HIV. My care is not extraordinary because of this virus.

This disease is not terminal. It’s ordinary.

And that’s extraordinary.

Keep tellin’ the story,

Professor Peacock

Note: These are my thoughts and my story. I used AI to make helpful edits to my ramblings and online journaling, including some organization to be more blog-friendly.