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In 2017 the age-adjusted percentage of adults in America with Diabetes was 8.5%.  If we add up rates of schizophrenia (1.1%), bipolar (2.6%), major depression (6.9%), anxiety disorders (18.1%), and substance use disorders (8%), we total 36.7% of the US population. That’s over four times the prevalence of diabetes. 


Diabetes is a disease primarily driven by choice – obesity and inactivity.  Yet diabetes is a socially acceptable condition.  Conversely, mental health is primarily caused by underlying brain structures and morphology. The same can be said for aspects of addiction behaviors. Why are these distinctions and statistics important? Because while diabetes is an accepted part of American society, mental health and substance use remains misunderstood and stigmatized.


Perception is fact in the eye of the beholder.  How do we change perceptions?  It’s simple: through facts.  If we look to the past, there is a direct correlation between the historical perception of AIDS in the 1980’s and 90’s and the current perception of mental health and substance use disorders.  AIDS started as a moral pariah yet now is widely accepted as simply a virus that can affect anyone regardless of perceived morality.  What changed in the public eye?  More importantly, how and why did it change?  



As of 2016, 675,000 people have died of AIDS in the US since it was first diagnosed.  That equates to an average of 19,853 deaths per year. Drug and alcohol-related deaths over that same time equate to an average of 54,632 per year – over 270% higher than the AIDS rate.  And this does not account for the recent exponential increase in annual opioid-related deaths experienced over the last few years.


The National Alliance on Mental Illness (NAMI) states that one in five Americans suffer from some form of mental illness.  The 2016 Surgeon General’s Report on Addiction in America stated that one in seven Americans would develop a substance use disorder at some time during their lives.  For those affected by substance use disorders, over half of them suffer from a co-occurring mental illness. The numbers demonstrate that these conditions are a normal aspect of society.  We are all around you.  If five people get in an elevator, at least one of them is suffering.  Think about it.  



AIDS was commonly called gay related immunodeficiency disease (GRID) or a gay cancer in the infancy of the American epidemic.  The perception that AIDS was a gay disease persisted throughout the early 1980’s and beyond.  AIDS was “God’s punishment to gays” in the minds of many Americans.  It was viewed as a moral failure, in much the same way as mental health and substance use disorders are viewed today.  


Ryan White helped force the conversation in 1985.  A middle-schooler with hemophilia who was infected with HIV through a blood transfusion challenged society’s narrative of a moral failure.  One individual’s public stand against fear and ignorance made the difference and sparked a national discourse that ultimately turned the tide of public perception.  He put a face on the issue.  He humanized it.


Naturally, throughout this timeline, the government lagged in all aspects.  Legislation enacted by Congress in 1993 banned the travel to the US by anyone found with HIV.  15 years later, in 2008, President Bush issued an Executive Order finally allowing HIV-positive people to enter the U.S.  The CDC removed its restrictions in 2010.  It took 38 years from 1982 when the medical definition of AIDS was coined for the U.S. government to acknowledge the fear and stigma associated with the disease was unfounded and allow free and open travel. 


Nothing will happen until we take the masks off and talk about it.  We can tiptoe around the issue and have some feel-good moments during Mental Health Awareness month (every May), but a green ribbon is not a face.  Awareness is a concept – while a face is a person and that person is real. A person is a loved one, a friend, a coworker, an acquaintance, and more.  What shifted the tide in HIV perception was the human confrontation of people who came out and said, “I have it.” That’s the hardest thing to do – are you ready to do it?  You are normal, and you are not alone.

Be Unonymous.

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