University of Central Florida STARS HIM 1990-2015 2015 Homophobia and HIV Transmission: A Six-Country Comparative Analysis Tiernan Middleton University of Central Florida Part of the Medicine and Health Sciences Commons Find similar works at: https://stars.library.ucf.edu/honorstheses1990-2015 University of Central Florida Libraries http://library.ucf.edu This Open Access is brought to you for free and open access by STARS. It has been accepted for inclusion in HIM 1990-2015 by an authorized administrator of STARS. For more information, please contact [email protected]. Recommended Citation Middleton, Tiernan, "Homophobia and HIV Transmission: A Six-Country Comparative Analysis" (2015). HIM 1990-2015. 1726. https://stars.library.ucf.edu/honorstheses1990-2015/1726 HOMOPHOBIA AND HIV TRANSMISSION: A SIX-COUNTRY COMPARATIVE ANALYSIS by TIERNAN C. MIDDLETON A thesis submitted in partial fulfillment of the requirements for the Honors in the Major Program in Biomedical Sciences in the College of Medicine and in the Burnett Honors College at the University of Central Florida Orlando, Florida Spring Term 2015 Thesis Chairs: Dr. Joanna Mishtal, Dr. Kenneth Teter Abstract This interdisciplinary study combines epidemiological data with anthropological theory to investigate the relationship between HIV transmission rates and systemic homophobia. Previous research has illustrated the link between high levels of structural violence and structural stigma to increased risk of diseases such as the link between African-Americans and heart disease. This study investigates the relationship between systemic homophobia and HIV transmission rates. Through operationalizing homophobia into seven distinct factors, I evaluated systemic homophobia in six countries, assigning a score 1-10 to each factor using secondary source aggregation. I compared composite scores, as well as scores in each operationalized factor to HIV transmission rates in those countries. The results of this study indicate a correlation between systemic homophobia and increased HIV transmission, particularly in respect to the factors Marriage Equality, LGBT Laws, Religiosity, LGBT Visibility, and Hate Crimes. Though various sociocultural factors play a role in HIV transmission, this study indicates that homophobia plays an integral role in HIV transmission. This project has pertinent applications in epidemiology, anthropology and public health illustrating the integral role of sociocultural and systemic factors that increase structural violence and risk for a disease. ii Dedication To Dr. Bill Safranek, thank you for picking up a project outside of your range of expertise and allowing me to pursue a project I loved. Your presence in my committee has been missed but your impact never forgotten. To Dr. Joanna Mishtal, you are a professor, a mentor, and a friend and I am thankful for your dedication to not only this project, but also to my development anthropologically, personally, and professionally. Your support has guided me far past this project and motivated me to pursue goals and research that are both meaningful and interesting to me. To Christian Saucedo, thank you for always being the first pair of eyes, for your continuous feedback in an area you have no expertise or interest in, and for always supporting my dreams and goals, no matter how farfetched. To Mom and Dad, thank you for your unending love and support to pursue my dreams wholeheartedly. To LGBT people around the world, may this research and research like it bring increased freedom, equality, and protections such that we may one day be safer, healthier, and more equal members of society. iii Acknowledgements Thank you to my committee for four semesters’ worth of support. Thank you for reading, editing, theorizing, and working with me to create an interdisciplinary project that I love. Thank you to Dr. Joanna Mishtal and Dr. Kenneth Teter for taking over the project after Dr. Safranek’s passing. Thank you to Dr. Alexander Cole for your feedback and interest in this project.Thank you to Dr. Bruce Wilson for joining the committee at the last minute and providing your pivotal expertise so essential to the project. Thank you to Dr. Shana Harris for the countless resources provided to Dr. Mishtal and me throughout the year. Finally, thank you to Anne Dolmovich, Christian Saucedo, Rena Perez, Ashley Powell, Cassie Rall, and Camila Cymring for providing edits. iv Table of Contents Abstract ........................................................................................................................................... ii Dedication ...................................................................................................................................... iii Acknowledgements ........................................................................................................................ iv Table of Contents ............................................................................................................................ v List of Figures ................................................................................................................................ xi List of Tables ............................................................................................................................... xiii List of Acronyms ......................................................................................................................... xiv INTRODUCTION .......................................................................................................................... 1 BACKGROUND AND LITERATURE REVIEW ........................................................................ 1 Theoretical Framework ............................................................................................................... 7 Structural Violence and Health ............................................................................................... 8 Conceptualizations of “Risk” in the Context of Health ........................................................ 11 Structural Stigma and Health ................................................................................................ 14 This Project’s Approach ........................................................................................................... 18 PURPOSE, RESEARCH QUESTION, AND HYPOTHESIS ..................................................... 20 Purpose ...................................................................................................................................... 22 METHODOLOGY ....................................................................................................................... 23 Definition of Terms................................................................................................................... 23 v Defining HIV Epidemiology for this Study .......................................................................... 23 Operationalizing Homophobia: Seven Factor Analysis ........................................................ 25 Selection of Countries for Comparative Analysis ................................................................ 33 CANADA ..................................................................................................................................... 36 Introduction ............................................................................................................................... 36 Level of Marriage Equality ....................................................................................................... 38 Laws Regarding LGBT Populations ......................................................................................... 40 Adoption and Child Rearing ................................................................................................. 40 Anti-Discrimination Laws .................................................................................................... 41 Privacy and Identity .............................................................................................................. 42 Rate of Hate Crimes .................................................................................................................. 43 Medical Understanding ............................................................................................................. 45 Sex Education ........................................................................................................................... 48 Religious Influence on Policy ................................................................................................... 50 LGBT Visibility and Media Representation ............................................................................. 51 Infection Rates .......................................................................................................................... 53 Conclusion ................................................................................................................................ 55 SPAIN ........................................................................................................................................... 56 Introduction ............................................................................................................................... 56 Level of Marriage Equality ....................................................................................................... 59 Laws Regarding LGBT Populations ........................................................................................