What Is the Cost of Homophobia and Other Systemic Biases?

Contributing Editor
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Is it possible to put a global price tag on bigotry? A tool called the Homophobic Climate Index purports to approximate the global economic cost of homophobia -- and that cost, in terms of nations' coffers of dollars and cents, is significant. We also know that attempts to erase or shame communities affected by HIV can reach as high up as the United Nations, with profound consequences.

But what are the costs of homophobia, transphobia and other systems of injustice in the eyes of frontline HIV care providers, researchers and advocates? At AIDS 2016 in Durban, South Africa, we gathered perspectives from a global group of HIV professionals.

Credit: nito100 for iStock via Thinkstock.

Keletso Makofane, M.P.H.

Global Forum on MSM and HIV, South Africa

There's an answer that has to do with rands [dollars] and cents. Maybe it's important work in this moment where dollars and cents and efficiencies are what we think we should be saying to our governments.

I think the cost of homophobia, though, is a human cost. ... Ultimately, the cost is distraction. In a lot of places in Africa, maybe around the world, [gay people are] a scapegoat. ... A scapegoat is any group of people who can be maligned and used to draw attention away from something else.

So the cost of homophobia is also a cost that we all bear as citizens; it's a cost of not understanding what is really happening: that there are groups of people who benefit immensely from the setup of our economic and political systems and keep us busy fighting with each other while they loot.

[The economic answer is] a double-edged sword, because we are saying that we accept a way of thinking about lives that puts lives in service of money and talks about money primarily and lives secondarily. ... We are also saying that there are people's lives for whom oppression doesn't cost us anything, or from whom we benefit when we oppress them, and so it's fine to oppress them. That is an argument that sets us back more than it advances our cause.

Credit: Olivia G. Ford.

Tonia Poteat, Ph.D.

Johns Hopkins Bloomberg School of Public Health, United States

I am a public health researcher who focuses on understanding and addressing health disparities. Stigma and discrimination against sexual and gender minorities causes unnecessary suffering, disease and death across the world.

It also costs us our humanity. We lose the ability to appreciate the beauty of sexual and gender diversity. It shuts down the immense capacity of the human heart to truly see and value each other in all the ways we are the same and different, and we miss connecting with each other in meaningful ways. The cost of homophobia and transphobia is enormous.

Photo courtesy of the JHU Center for Public Health and Human Rights.

Julien Kerboghossian

Y+ Network (Global Network of Young People Living With HIV), Lebanon

Homophobia has several direct and indirect costs. It has costs for the government, costs for the families and costs for the person who is actually facing the homophobia. For example, if a person is gay and facing homophobia at school or at university, he may drop out of that university just to try to hide and not be exposed to that type of homophobia, which can cause bad consequences for his future.

If he is facing homophobia at health care centers, he will tend not to go and get the services he needs, and maybe he would get HIV or other STIs [sexually transmitted infections] which would cost our governments a lot of money to pay for his treatment and health care.

Credit: Olivia G. Ford.

Erica Woodland, LCSW

The cost of homophobia and transphobia for people of color is quite literally the body through murder and assault, as well as the blatant neglect by institutions and communities who have promised to care for us as LGBTQ people. Long-term lack of access to housing, education, health care and employment paired with violence from the state itself consumes our flesh. This is not a metaphor. Our right to life is at stake and embedded in this very question.

Due to the crisis that transphobia and homophobia have caused in our communities, we often do not even have the space to understand or heal the spiritual cost. ... For many people of color, the white-dominated LGBTQ community will never be a safe haven as we are forced to choke back the ever-present legacy of white supremacy, genocide and race-based violence.

Credit: Yev Zakhrakin.

Kwaku Adomako

African and Black Diaspora Gay Network, Canada

The cost of homophobia, for me, is the loss of personhood. I think the Orlando shootings were a real eye opener about the depths of internalized homophobia and what it can manifest. That's violence that we perpetrate on ourselves. The cost is personhood: who we think we are.

Credit: Olivia G. Ford.

Sannisha Dale, Ph.D.

Massachusetts General Hospital, United States

The cost of homophobia is high and far-reaching at the individual, interpersonal, community and structural levels. ... There are stressors placed on interpersonal relationships (be it with partners, friends, family) that have to tackle and navigate homophobia in addition to the regular challenges in relationships.

Some communities are casting monolithic portrayals of its members -- be it on the basis of narrowly defined sexual orientation, sexuality, religion, culture, gender roles, masculinity norms -- and losing the opportunity to openly embrace the richness of their LGBTQ members.

Structurally, we are denying our economy, health care system, education system, etc. and future generations an opportunity to benefit from humanity and love at its full capacity.

Credit: Selfie by Sannisha Dale.

Jaime Luna

GNP+ (Global Network of People Living With HIV), Panama

Homophobia can stop opportunity for the LGBTQ population. The results can be very terrible and can also lead to death. It's not just the money cost; it's about the human rights cost.

Credit: Olivia G. Ford.

Robert Garofalo, M.D., M.P.H.

Ann & Robert H. Lurie Children's Hospital of Chicago, United States

I would add to those things HIV-related stigma, not just transphobia and homophobia. The cost has been a generation, or generations, of people who have found themselves disenfranchised from one another and disenfranchised in many ways from their families and communities of origin. In that isolation and in that marginalization has grown a broad range of health disparities that we now know affect these populations. And that's not limited to HIV. It's violence. It's substance abuse. It's homelessness. I think the cost of bigotry is almost uncategorizable.

Credit: Jeff Berry.

Silke Klumb

Deutsche AIDS-Hilfe, Germany

In Germany, we are a very liberal country. But there's no equal marriage for gay and lesbians. So, adoption rights are different, and the status of it's a bit different. I think the biggest problem is that, looking from the society, you have gay mayors; you have even gay ministers sometimes. But the individual coming out for each person is still a big step, and people still live in families and in social situations where they fear being discriminated against. They fear it because they see that their families discriminate against gay and lesbians.

So, the individual step is still a big step. As long as they don't have good role models and cannot be sure and safe in coming out, we will have to fight homophobia.

Credit: Naomi G. Harris, M.P.H.

Finn McMurray

Elizabeth Taylor AIDS Foundation, United States

The cost of homophobia is huge. It, as well as so many other discriminations and negative and ugly attitudes towards people, is really bringing us down and bringing us backwards -- not only in coming together and uniting as people, but in eradicating this disease and saving lives.

I think we're seeing a lot of tension right now in the world. And I think unity and coming together and realizing that we all need to work together and we all need to respect each other -- we all need to care for each other -- is one of the most important things. And I think relaying that message is a huge part of our work.

Credit: Naomi G. Harris, M.P.H.

Lars Klitgaard


I think it's really different from country to country. In Denmark, because we have -- there will always be idiots, but I don't experience much homophobia in Denmark. And I don't think the homophobia is much related to HIV, to be honest. But obviously gays sometimes have a -- statistically they have another way of having sex, and that's more risky. From Denmark, it's really popular for gays to go to Berlin, for instance, where they do drugs and have gang bangs and stuff like that. And, of course, that's more risky than what a straight person does[.]

I definitely think in some countries -- because I talk with lots of people, and some, they say they don't want to go to the clinics because if they have HIV, they will be stamped as being gay. Then they would rather not go. Of course, that has a huge impact.

Credit: Naomi G. Harris, M.P.H.

Joel Goldman

Elizabeth Taylor AIDS Foundation, United States

The cost of homophobia is, you know, is stigma. And if people don't have the freedom to come out about who they are because they feel like they're going to be judged or stigmatized, it's -- I guess I will bring it back to HIV and AIDS. I know a heterosexual man who's on a TV show and he's now out, from Big Brother. He told me before he came out publicly on another show, which was Couples Therapy; we had a talk about the costs of coming out.

He said the reason that he didn't get on treatment right away is, he even felt stigmatized as a heterosexual man, walking into any kind of a clinic that would give him medication. Because he lived in a small town, I think, in Florida, at the time. He was just worried even about going into the local drug store to pick up his AIDS meds because of what he felt would be perceived -- and he's not homophobic at all, but he thought [he] perceived stigma towards him. But I think it's true with anything.

I think if we could get rid of the phobias in the world, and people could live to be who they are, no one would be afraid to walk in to get tested, to pick up their medications.

Credit: Naomi G. Harris, M.P.H.

Jessica Salzwedel

AVAC, United States

The biggest cost is that people aren't accessing services that are available -- and that services are being limited. I think seeing people who are here at AIDS 2016, who are just hearing about PrEP [pre-exposure prophylaxis] for the first time, both in the U.S. or in other countries -- it's so hard because this information is around, and it's available. So having people be limited in services and treatment because they're afraid of their own personal safety is a horrible thing, and it's such a shame. That's what I see as the way it impacts.

Credit: Naomi G. Harris, M.P.H.

Jane Ng'ang'a


Definitely, when we look at homophobia, it causes more new infections. Why? Because we have not reached out to the gay, the transgender. Because of that homophobia, because of that stigma, we don't reach out to these people with education. Yet, it's just like hiding our heads in the sand like the ostrich. This is happening. These are our brothers. These are our husbands. These are our sisters. So everyone who is involved in homosexuality, they belong. They need to have a sense of belonging.

I tend to believe that when somebody is discriminated [against], sometimes they want to hit back. So, I think this person will not even protect [themselves]; after all, they have nothing to lose. Because people have already discriminated against them. So, I tend to think that if it would be more inclusive, it would be easier to reduce even the risk of HIV infection in this population, as well as in the larger community.

Credit: Naomi G. Harris, M.P.H.

Gcina Ngcoya and Ndalo Ngcoya

South Africa

Ndalo: It has a really big impact because a lot of people get [criminally] charged; they get mistreated; they get abused by people who suffer from homophobia. But people are slowly adapting to it and are not homophobic anymore.

Gcina: It's crazy because [homosexuality] is thought of as a disease or thought of as a disability. You'll hear people be like, "Oh, my gosh, she's got it!"

"Got what? What do you mean?" Like it's a sickness or something. So, a lot of people can't express their sexuality because of the fear of judgment. That's like saying someone who is black can't do something, or can't say something, or can't live because they're black. You're depriving someone of their life. That's crazy.

Credit: Naomi G. Harris, M.P.H.