That’s not how people want to be seen when it comes to HIV. In the epidemic, the word “risk” is associated with the notion of “doing something wrong.”
So using the words “at risk” becomes risky in itself. It runs the risk of turning people off, and away from prevention messages. People may not avail themselves of condoms or PrEP (the HIV prevention pill) if they don’t identify with risk. If they don’t identify with HIV risk, they don’t identify with HIV prevention.
While “risk” tends to blame behavior (as in “taking risks”), “vulnerability” may more accurately express the reality. There are many things that can make people vulnerable to HIV, including their environment—not necessarily their behavior.
“I find that people struggle with labels, no matter what the label is,” says Gabriela Zapata-Alma, Program Director for Substance Use Treatment at Thresholds, a mental health organization in Chicago for people with low incomes. “Especially because different labels mean different things to different people.”
“It’s about stigma,” she says. “Whatever word we use as a label is stigmatizing and then people reject the stigma.”
“I like to frame things in the positive whenever possible,” she says. “For example, ‘What are you doing to protect your sexual health?’ Then we can discuss the gaps. I’ll ask questions. ‘Have you heard of PrEP?’ ‘What are your thoughts on PrEP?’ ”
Risk and vulnerability may be very similar, but “might you be vulnerable?” may be taking a softer approach that makes people more comfortable. Even then, a label’s a label. Zapata-Alma remembers when a client became angry after she said to him, “It sounds like you’re feeling vulnerable.” He yelled, “I’m not vulnerable!”
One way or another, however, HIV prevention messages need to be made.