Prior to effective treatments and federal funding for AIDS, most healthcare workers were extremely reluctant to work with PWAs. The result was the AIDS clinics were largely staffed by lesbian and gay male providers who volunteered to work with the gay men who made up the epidemic. The patients and providers had similar demographics and life experience.

Beginning in the mid-1990s, AIDS clinics and organizations began to be staffed, instead, by “professionalized” personnel who viewed their work as a paycheck, nothing more. Long time volunteers and experienced but under-credentialed workers were replaced by workers with degrees but to no attachment to or real understanding of AIDS-affected groups. Some current AIDS providers disapprove of homosexuality for religious or other reasons. (In San Francisco, at least one administrator of an AIDS facility donated money to California Proposition 8.) The result is that people with AIDS correctly believe that their providers look down on their sexual orientation.

Attributing the problem to “mental health” simply pathologizes patients’ accurate perception that their providers disapprove of their sexual orientation, or should I say, “risk behavior?”