HIV prevention and care in the afterlife of the HIV/AIDS crisis

Introduction Queer and trans individuals face stark inequities in HIV prevention and care. Existing theories and models explain how individual- and interpersonal-level stressors shape health among queer and trans populations, but less theoretical attention has been paid to how histories of structural violence continue to shape contemporary HIV-related inequities.Theory Drawing on Saidiya Hartman’s conceptualization of the “afterlife of slavery,” we conceptualize contemporary HIV-related inequities among queer and trans populations within an “afterlife of the HIV/AIDS crisis.” This framework considers how normative logics surrounding gender and sexuality that structured responses to the HIV/AIDS crisis persist within contemporary institutions, policies, and practices.Method We conducted an interdisciplinary critical narrative review examining historical and contemporary scholarship on the HIV/AIDS crisis and the health of queer and trans populations. We synthesized literature across disciplines to identify recurring conceptual frameworks and cross-disciplinary themes through which historical responses to HIV/AIDS continue to shape contemporary conditions.Results Three dominant themes emerged: (1) pathologization contributed to the stigmatization of queerness and transness; (2) rhetoric employed by the media, political actors, and the scientific community demoralized and dehumanized queer and trans people; and (3) the codification of homophobia and transphobia in laws and policies contributed to the criminalization of queerness and transness. Across these themes, historical responses to the HIV/AIDS crisis established and reinforced structural conditions that continue to shape HIV prevention and care.Discussion Contemporary HIV inequities among queer and trans populations cannot be fully understood without attention to the historical processes through which they were produced and sustained. Situating present-day HIV prevention and care through the framework of the afterlife of the HIV/AIDS crisis highlights the persistence of structural violence and provides a framework for identifying and addressing its contemporary manifestations.