Combating Homophobia in AIDS Education

JAMES M. CROTEAU and SUSANNE MORGAN

Homophobia is a central theme in response to the AIDS epidemic. In this article we review literature explicating the connection between homophobia and AIDS and then call for the integration of antihomophobia elements into AIDS education. We discuss negative messages in portrayals of gay and bisexual men and in discussions of safer sexual practices, as well as materials and educational strategies that explicitly contradict such homophobic messages. We then discuss the emerging trend to exclude lesbian women and gay men in education and programs, suggest guidelines for countering such exclusion, and give examples of creative approaches to inclusion.

After a generation of growing social tolerance for homosexuality, the epidemic has generated new fear and heightened old hostilities. Just as syphilis created a disease-oriented xenophobia in the early twentieth century, AIDS has generated a new homophobia. (Brandt, 1988, pp. 367-368)

Hof

omophobia is not only the "persistent and irrational fear of homosexuality" but also a prejudice that leads to people (Hancock, 1986, p. 1). Such homophobia has been a central theme in responses to the AIDS epidemic. Shilts's (1987) and Bayer's (1985) chronicles of the AIDS epidemic made clear the profound effect of homophobia on the politics of AIDS, particularly in the lack of institutional response in the early years. Homophobia has also had a profound personal effect on the lives of gay people dealing with HIV-related concerns, including the denial or harassment of gay lovers and friends concerning hospital visiting privileges, funeral arrangements, and inheritances; the added emotional burdens when disease necessitates "coming out"; and the homophobic assumptions made daily by service providers.

The "new homophobia," however, has reached well beyond its direct effect on gay people with AIDS and their loved ones. Many authors have discussed harassment and violence toward lesbian women and gay men that is connected to AIDS-related fears or prejudices (i.e., Batchelor, 1984; Bayer, 1985; Herek, 1986; Shilts, 1987). Bayer (1985) cited statements of religious leaders and other public figures who employ AIDS as a justification for homophobic views. Batchelor (1984) cited formal "hate campaigns" against gays and lesbians that claim the AIDS epidemic as reasonable "evidence" for their attack. Joseph et al. (1984) studied AIDS in the gay community and found "the fear of potential hostility, whether physical and personal or legal and community-wide, was frequently experienced" (p. 1301), and, indeed, surveys indicate high rates of verbal and physical harassment (National Gay and Lesbian Task Force [NGLTF], 1987, p. 9).

Whether homophobia has actually increased as a result of AIDS is a complicated question. Two-thirds of local lesbian and

gay organizations who report incidents of violence "believed that the fear and hatred associated with AIDS has fostered anti-gay violence in their communities" (NGLTF, 1987, p. 8). Schneider (1987), however, examined public opinion polls and concluded that "the polls show a slight deterioration in attitudes toward homosexuals [sic] but no evidence of mounting anti-gay hysteria" (p. 6). Furthermore, Grieger and Ponterotto (1988) found that overall a sample of college students did not have negative views toward homosexuality and did not report a worsening of their attitudes toward lesbian and gay people as a result of AIDS. It is important that, even though overall public attitudes may remain fairly constant, there could be increases in overt harassment and violence. As one NLGTF staff person speculated, perhaps AIDS is giving those who already have an antigay prejudice an excuse to express that prejudice more openly (Schneider, 1987).

No matter what the interpretation of these findings, research indicates a clear and strong relationship between homophobia and negative attitudes about AIDS (Goodwin & Roscoe, 1988; Grieger & Ponterotto, 1988; and O'Donnell, O'Donnell, Pleck, Snarey, & Rose, 1987). These studies found a strong relationship between fear of or negative attitudes toward homosexuality and fear of and/or negative attitudes toward those with AIDS. Grieger and Ponterotto also found that closeness with a gay person not only predicted positive attitudes toward homosexuality, as has been found previously (Hancock, 1986; Herek, 1984), but also that closeness to a gay person predicted positive attitudes toward persons with AIDS. Indeed, the AIDS epidemic does seem "inextricably bound in the minds of the American people" with people who are gay (Grieger & Ponterroto, 1988, p. 415).

Counselors and other human service professionals are in the forefront of many AIDS education efforts and some are also involved in antihomophobia education. The clear interweaving of homophobia and AIDS calls for the conscious integration of antihomophobia education into AIDS education.

This article is a concrete and practical guide to such integration. Our article does not examine the strong political and social obstacles that may exist to the integration of antihomophobia education, especially in AIDS education for young people (Martin, 1988). Instead, we focus on the selection, design, and implementation of educational programs and materials on AIDS.

We believe homophobia exists in AIDS education both through the communication of negative messages about lesbian women and gay men and through the exclusion of lesbian. women and gay men and their concerns. The structure of the article reflects these two areas. We first illustrate the blatant and subtle homophobic messages that exist in AIDS education materials and programs. Second, we provide some examples

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that contradict these homophobic messages and suggest guidelines for such contradictions. Third, we illustrate ways that gay and lesbian people are often rendered invisible in AIDS education. Finally, we provide illustrated guidelines on combating homophobia through the inclusion of lesbian and gay people in AIDS education.

NEGATIVE MESSAGES: BLATANT AND SUBTLE

Some materials are quite clearly homophobic and dangerous in fueling blatant bigotry and hatred. Paul Cameron, a psychologist long known for his homophobic viewpoints, has been a part of writing many pamphlets and newsletters about AIDS (i.e., Family Research Institute, '1987a, 1987b). His proposals are often drastic and ineffective; for example, recommending the facial tattooing of HIV-infected persons as a "social quarantine" (Family Research Institute, 1987b). The most common target for such severe legal and social restrictions are lesbian women and gay men, because he bases many of his proposals on the assumption that "homosexuality, not AIDS, is the world's #1 public health problem" (Family Research Institute, 1987a, p. 3). However bigoted and hate-producing these materials may be, they are easily identified as homophobic and thus are easily eliminated from AIDS education programs.

Other materials are less blatant in homophobic content, however, and are more likely to be used by community or college AIDS programs. One such example is the video titled AIDS-A Decision for Life (Health Visions, Inc., 1987). The film portrays a heterosexual female college student who contracts an HIV infection through sexual intercourse with a man who has sexual partners of both sexes. This film reinforces homophobia in several ways. By the end of the film, the image of the bisexual man is completely negative: cold, unconcerned, and uncaring. The negative image is further reinforced because the film portrays no concern or care for his plight with HIV infection or his issues with sexual orientation. He is seen as an "other," deserving of little attention and no caring. Overall, the film portrays the "threat" to heterosexual college students as being the bisexual (or gay) men who have sex with women.

This film is particularly important to our current discussion for several reasons. First, it is realistic, compelling, and well produced. It meets the strong need for resources to confront heterosexual college students' feelings of invulnerability to AIDS and HIV infection (Hirschorn, 1987). Not surprisingly, many of our colleagues and other professionals across the country failed to recognize the homophobic content of the film. Second, any portrayal or even mention of lesbian or gay people will take on added significance because for many this may be one of their only conscious exposures to this social group. The completely negative picture of the gay or bisexual man, coupled with the lack of attention to his plight, can lead to homophobic attitudes.

Finally, a destructive theme that frequently emerges in thought about AIDS is apparent in the film. The portrayal of the gay or bisexual student as the unsympathetic other does more than simply reinforce negative stereotypes. It reinforces the common notion that people fit into two categories in relation to AIDS. One group is the "us," the "normal," or the "general population." These people are innocent, threatened not by their own risk behaviors but by people in the other category. The other category includes those who are guilty and are to be

Homophobia in AIDS blamed for AIDS. They are perceived not as undergoing human suffering and in need of attention but as the source of threat to the general population.

In 1985, then Secretary of Health and Human Services Margaret Heckler epitomized this destructive "other-us" dichotomy. She said: "We must conquer AIDS before it affects the heterosexual population and the general population... before it becomes an overwhelming problem" (Shilts, 1987, p. 554). She showed both high regard for the us or the general population and a clear callousness toward the other: gay people who already faceed an overwhelming problem with AIDS.

The epidemiology of AIDS is such that it has most heavily affected already socially marginalized groups: gay and bisexual men, intravenous drug users, the economically poor, and Black and Hispanic people. Such an epidemiology easily gives rise to perceiving those affected by AIDS as the other. Whenever any single element in the theme of "innocent victim and threatening other" is involved, homophobia (as well as racism, classism, and several social prejudices) is inherently supported.

Discussion of sexuality, so integral to AIDS prevention, can reinforce homophobia in several ways. One way is illustrated by a pamphlet recently developed for use at a Roman Catholic university (Saint Louis University, 1988). It attempts to be affirmative about sexuality in general, to give information about a full range of choices involving safer sex, and to encourage compassion without prejudice toward those with AIDS. But the pamphlet quotes the Bishop's pastoral letter on AIDS saying, "abstinence outside of marriage and fidelity within marriage as well as the avoidance of intravenous drug abuse are the only morally correct and medically sure ways to prevent the spread of AIDS." Materials describing sexuality within marriage as the best or only appropriate sexual relationship inherently criticize or abandon those people who are lesbian, gay, or bisexual. One possible outcome of such abandonment is that "the gay adolescent who has no desire or possibility for heterosexual activity may simply give up or indulge in unnecessarily dangerous behavior" or "the adolescent may be encouraged to marry when this is socially or psychologically inappropriate" (Martin, 1988, p. 380).

Another illustration of homophobia in information about sexuality and risk reduction is Understanding AIDS (U.S. Department of Health and Human Services [USDHHS], 1988, a booklet mailed to households in the United States in June 1988), which charts risk-reduction behaviors (see Table 1). There are many problems with these designations. Although D'Eramo (1988) believed they are "sexophobic, homophobic, unscientific, and confusing all at the same time" (p. 24), we will focus on homophobic aspects. First, the full range of options for reducing sexual risk is not given. Behaviors that can reduce risk, such as using a condom for anal, oral, or vaginal sex, are not listed in a "safer" or "less risky" category. Though anal sex might be the riskiest behavior, there are options to reduce its level of risk, such as using a condom and withdrawing the condom-encased penis before ejaculation. Singling out anal sex, often associated with gay sexuality, may reinforce negative ideas about gay sex.

The booklet's failure to give the full range of risk-reduction options may be particularly harmful to gay men. In fact, in what may be "the most rapid and profound response to a health threat which has ever been documented" (p. 408), Becker and Joseph (1988) found that gay men are choosing to reduce their risk by exercising many of the options not fully discussed in Understanding AIDS. Becker and Joseph state their belief that AIDS education efforts need to recognize the way behavior

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