NIAID HIV

Language
Guide
February 2020
NIAID HIV Language Guide

Table of Contents
About this Guide ....................................................................................................................................... 1
Methodology ............................................................................................................................................ 2
General Considerations ............................................................................................................................ 4
5 Quick Tips............................................................................................................................................... 5
HIV Basics .................................................................................................................................................. 6
Sex, Gender & Sexuality.......................................................................................................................... 10
Substance Use......................................................................................................................................... 16
Miscellaneous Terms & Topics ............................................................................................................... 19

i
 NIAID HIV Language Guide About this Guide

About this Guide

When scientists and administrators write or speak about HIV, We condemn attempts to label us as
the words they choose have the power to passively perpetuate "victims," a term which implies
ignorance and bias. Conversely, they have the power to defeat, and we are only occasionally
respectfully and accurately represent people and ideas. This "patients," a term which implies
passivity, helplessness, and
guide was designed to help those at NIAID communicate about
dependence upon the care of
their work using empowering rather than stigmatizing
others. We are "People AIDS."
language, especially as it relates to HIV.
– The Denver Principles, 1983
Since members of ACT UP and other HIV and AIDS advocates
published the self-empowerment manifesto known as The
Denver Principles in 1983, language has been a central theme in efforts to dismantle stigma around HIV.
Many HIV advocacy groups and media outlets embrace slogans such as “language matters” and promote
primers on using empowering language, as do other organizations that advocate for other health
conditions and marginalized groups. Conversations about language choice frequently come up during
demonstrations, conferences and listening sessions.

Empowering language remains an important focus for such organizations because language perpetuates
stigma, and as studies continue to bear out, stigma helps perpetuate the HIV epidemic. While many
factors that contribute to health-related and societal stigmas are entrenched and systemic, NIAID
officials have the immediate power and opportunity to improve language and lead by example.

This guide includes language suggestions for communicating

about HIV and related topics. Below are a few examples of the
impact such language can have.

Tweeting from a 2017 National HIV Nurses Association meeting, UK-based HIV advocate
Silvia Petretti makes the point that “difficult to reach people” puts the onus of obtaining
HIV services on individuals facing adversity rather than on public health efforts.

Ugandan advocate Dric Adoni tweets about

stigmatizing language around HIV from a popular
youth HIV awareness event, the Y Plus Beauty
Pageant. This tweet from American educator and autism and HIV advocate Morénike Giwa
Onaiwu complimented person-first language used by a presenter at ACTG 2018.

1
NIAID HIV Language Guide Methodology
Methodology

This guide was created by the NIAID Office of Communications & Government Relations (OCGR) News &
Science Writing Branch (NSWB) with input from the Division of AIDS (DAIDS) Workforce Operations,
Communications, and Reporting Branch (WOCRB). This guide is a living document, subject to change as
language standards in various fields may evolve. This guide was last updated on February 19, 2020.

Before finalizing the first version, multiple representatives from NIH, other public health organizations
and community-based advocacy groups had the opportunity to review and contribute to relevant
sections of this guide to help ensure scientific accuracy, community buy-in, and cultural competence.
Reviewers included subject matter experts and communications experts from other NIH institutes and
centers, including the National Institute of Mental Health (NIMH), National Institute of Drug Abuse
(NIDA), National Institute of Alcohol Abuse and Alcoholism (NIAAA), National Institute on Minority
Health and Health Disparities (NIMHD), the NIH Office of Research on Women’s Health (ORWH) and the
NIH Sexual & Gender Minority Research Office (SGMRO). Multiple DAIDS officials, including leaders in
the Office of the Director, were also consulted.

For a non-federal perspective, WOCRB facilitated review of this document by a diverse group of
community members serving the NIH-funded HIV/AIDS Clinical Trials Networks in various community
liaison and advisory capacities. This group consisted of community advocates who are or have been
involved with Networks’ Global Community Advisory Boards, Community Partners, the Tuberculosis
Trials Consortium Community Research Advisors Group, the AIDS Clinical Trials Group Underrepresented
Populations Committee, the Women’s Health Inter-Network Scientific Committee, the Cross-Network
Transgender Working Group, and the Legacy Project Working Group and Women's HIV Research
Collaborative of the Office of HIV/AIDS Network Coordination (HANC). We extend our sincere gratitude
to all community reviewers, which included people living with HIV, people in communities
disproportionately affected by HIV, citizens of the Global South, people of color, cisgender women,
transgender people, people in the LGBTQ community, sex workers, people with substance use disorder,
older people and young people, among others.

A variety of source materials were consulted in the writing of this language guide. Notably, the Centers
for Disease Control and Prevention’s HIV Stigma Language Guide and “Why Language Matters: Facing
HIV Stigma in Our Own Words” by Vickie Lynn, Ph.D., MSW, MPH, and other members of the Well
Project have been a tremendously valuable resources on stigmatizing language around HIV. Materials
included in the University of California San Francisco HIVE Online #LanguageMatters campaign also
informed this “HIV Basics” chapter of this guide and beyond.

Additionally, guidance documents and learning modules compiled by the DAIDS Cross-Network
Transgender Working Group informed language standards around sex and gender in this guide’s “Sex,
Gender & Sexuality” chapter. Specifically, “Guidance on the Use of Gender-Inclusive HIV Research
Practices” and its Appendix, “Use of Non-Stigmatizing, Gender Inclusive Language,” outlined language
preferences reiterated in this document. The Working Group drew on insights of community
representatives of trans experience. The 2019-2023 Trans-NIH Strategic Plan for Women’s Health
Research, compiled by ORWH, also informed this chapter.

2
NIAID HIV Language Guide
Language guidance for the “Substance Use” was informed by a 2017 Office of National Drug Control
Policy memorandum entitled, “Changing Federal Terminology Regarding Substance Use and Substance
Use Disorders,” as well as by training resources compiled by the Substance Abuse and Mental Health
Services Administration and its partners.

Limitations
The language preferences described in this guide apply primarily to English speakers in the United
States. Language preferences may vary in a global context. Translation can also change the connotation
of certain phrases.

While great care was taken to incorporate many perspectives from the community, individual language
preferences vary. Similarly, while OCGR and WOCRB will continually review this document for accuracy
and relevance, preferred language is subject to change.

3
NIAID HIV Language Guide General Considerations
General Considerations
Context
Choosing appropriate language always depends on the context in which the language appears.
Generally, this guide applies to language appropriate for official government communication. While
these principles may be applied broadly to scientific talks, funding opportunity announcements (FOAs),
requests for proposals (RFPs), media interviews and public calls for clinical research participation, other
contexts may call for specific language that does not fit neatly into the following guidelines.

Images
Written and spoken word are only one facet of communication. Images and body language also convey
messages, tone and—unfortunately—stigma. Be mindful of how an image you use may affect its
audience. In the context of HIV, most advocates prefer images that highlight people living vibrantly with
HIV to those that may show graphic depictions of AIDS symptoms. Similarly, substance use disorder
advocates caution against using images of alcohol, syringes or pills in relation to substance use, as these
may trigger someone in recovery.

The Platinum Rule

Many learn as children that the best way to respect others is to follow the Golden Rule: “Treat others as
you wish to be treated.” Many advocates in the HIV community promote the Platinum Rule: “Treat
others as they wish to be treated.” This guide aims to help scientists and administrators use fair,
accurate and respectful language, but preferences can change and vary across groups and individuals.
They can also evolve overtime.

Remain receptive to feedback from those who are most affected by stigmatizing language and prioritize
expertise from their lived experiences. When possible, proactively seek input from marginalized voices.
Recognize that there may not be a universal “right” answer for how to discuss a certain topic and that
finding the most appropriate language may mean rephrasing or reframing a message instead of just
replacing terms. While some may find this to be a frustrating challenge, investing in respectful
communication can strengthen the relationship between government officials and the public they are
trying to reach.

Questions?
If you are an NIH employee, the NIAID Office of Communications & Government Relations is available to
assist with your communications needs and can consult on the appropriate use of language. Contact
them at [email protected].

4
NIAID HIV Language Guide 5 Quick Tips
5 Quick Tips

Try this… Instead of this… Because…

HIV HIV infection “Infection” carries the stigma

HIV disease of being contagious, a threat,
unclean. HIV advocates
people living with HIV HIV-infected people frequently highlight the
damaging consequences of this
word choice. When referring to
people, person-first language
emphasizes humanity. “Living
with” is an affirmation of life
many advocates prefer.
“People with HIV” is also
acceptable.

HIV HIV/AIDS AIDS evokes suffering and

death and should be used only
when describing specifically
AIDS. HIV is inclusive of both
HIV and AIDS when the
reference is not specific, as in
“the HIV epidemic.”

affected high-risk People and communities are

community/population or people/population/group not inherently risky. The
high-incidence population preferred terms acknowledge
societal challenges and
accurately reflect disease
dynamics.

condomless sex or unprotected sex The preferred terms are more

sex without the use of unsafe sex specific, accurate and remove
prevention tools judgement. Condomless sex
may still involve protection in
the form of U=U or PrEP.

perinatal transmission mother-to-child transmission The preferred terms do not

vertical transmission place blame on women.

5
NIAID HIV Language Guide HIV Basics
HIV Basics

Try this… Instead of this… Because…

HIV HIV/AIDS AIDS evokes suffering and

death and should be used only
when specifically describing
AIDS. HIV is inclusive of both
HIV and AIDS when the
reference is not specific, as in
“the HIV epidemic.”

HIV HIV infection “Infection” carries the stigma

HIV disease of being contagious, a threat,
unclean. HIV advocates
HIV transmissions new HIV infections frequently highlight the
new HIV diagnoses damaging consequences of this
word choice.
transmit infect
acquired became infected

prevents HIV prevents HIV infection

prevents transmission of HIV
prevents acquisition of HIV

people living with HIV HIV-infected people Person-first language

HIV positives emphasizes humanity. “Living
HIVers with” is an affirmation of life
HIV carriers many advocates prefer.
people infected with HIV “People with HIV” is also
acceptable. “HIV-positive
people without HIV HIV-uninfected people people” is generally not
preferred but still used by
some community members.
“Poz” also is sometimes used
by community members.

died from complications died of AIDS The preferred terms avoid the
related to HIV or died of an incorrect assumption that AIDS
AIDS-related illness is uniformly fatal and clarify
that opportunistic infections
are the acute cause of death.

6
NIAID HIV Language Guide HIV Basics
Try this… Instead of this… Because…

HIV response HIV elimination To some in the community,

HIV eradication these terms have a
paternalistic and militaristic
connotation and imply people
living with HIV must disappear
to achieve an end to the
epidemic.

people living with HIV HIV cases People should not be described
as “case,” as this term
new HIV diagnoses new HIV cases deemphasizes humanity and
people newly diagnosed with implies burden.
HIV
research participant research subject “Subject” is dehumanizing. Not
volunteer patient all participants are patients.

client patient When describing a person

using the healthcare system,
“client” is considered
empowering.

engage a population target a population These preferred terms

emphasize community-
priority population/group target(ed) population/group oriented, participatory
key population/group approaches to ending an
epidemic, instead of
paternalistic, top-down
approaches.

perinatal transmission mother-to-child transmission The preferred terms do not

vertical transmission place blame on women.

infant exposed to HIV HIV-exposed infant Person-first language

emphasizes humanity.

sero-different sero-discordant “Discordant” implies a couple is

unsuitable for each other.
“Magnetic” and “mixed status”
are also terms used to describe
couples comprised of one
person with HIV and one
without HIV.

7
NIAID HIV Language Guide HIV Basics
Try this… Instead of this… Because…

affected high-risk People and communities are

community/population or people/population/group not inherently risky. The
high-incidence population preferred terms acknowledge
societal challenges and
accurately reflect disease
dynamics.

person behaviorally at-risk person People do not have inherent

vulnerable to HIV person who engages in risk risk. Certain communities—
behaviors including sexual and gender
person who puts themselves at minorities, as well as people of
risk color—are often labeled as the
“people who engage in risk
behaviors,” while populations
with lower community viral
load may engage in a similar or
higher frequency of the same
behaviors but remain less likely
to acquire HIV because of the
community viral load. Where
possible, specify the activity
and provide appropriate
context.

likelihood, chance risk The preferred terms help

reduce passivity applied to
populations.

hardly reached or hard to reach The preferred terms put the

unsuccessfully engaged populations/individuals onus on the health sector
populations/individuals rather than an individual.

condomless sex or unprotected sex The preferred terms are more

sex without the use of unsafe sex specific, accurate and remove
prevention tools judgement. Condomless sex
may still involve protection in
sex with the use of condoms protected sex the form of U=U or PrEP.
and/or other prevention tools safe sex

has multiple sexual partners promiscuous Avoid “promiscuity” and its

derivatives, as it is an
unnecessary value judgement.

8
NIAID HIV Language Guide HIV Basics
Try this… Instead of this… Because…

treatment non-completion treatment default “Default” is a negative term

that implies a value judgement
about the person who did not
complete treatment.

adherence compliance “Compliance” implies passive

behavior/following
instructions, while “adherence”
acknowledges a person’s active
engagement in care.

internal condom female condom Some transgender men and

nonbinary people may use
internal condoms vaginally,
and people of all genders can
use internal condoms for anal
sex.

external condom male condom Some transgender women and

condom nonbinary people may use
external condoms for
intercourse; people of all
genders may cut external
condoms to create dental
dams.

[people with undetectable viral extremely unlikely to transmit Describe the principal of
load] do not transmit HIV HIV treatment as prevention, or
nearly impossible to transmit “Undetectable equals
HIV Untransmittable” clearly and
consistently. Using qualifiers
no risk almost no risk that suggest U=U is only
zero risk greatly reduces risk somewhat effective is
close to zero risk inaccurate and is seen by some
in the community as a result of
[viral suppression] prevents helps prevent HIV paternalistic mistrust of people
HIV living with HIV. Unnecessary
qualifiers also stigmatize by
eliminates onward sexual makes it hard to sexually perpetuating the
transmission transmit HIV overestimation of transmission
HIV risk.

9
NIAID HIV Language Guide Sex, Gender & Sexuality
Sex, Gender & Sexuality

Try this… Instead of this… Because…

sexual orientation sexual preference “Preference” suggests that non-

heterosexuality is a choice, a
concept often used to
discriminate against the LGBTQ
community. “Preference” also
suggests a selection from two or
more choices, excluding
bisexual people and pansexual
people, among others.

assigned male/female at birth born male/female The preferred terms affirm

gender identity.
sex assigned at birth biological sex
sex at birth

transgender man used to be a woman

born a woman
female-to-male (FTM)

transgender woman used to be a man

born a man
male-to-female (MTF)

transgender transgendered “Transgendered” is a dated

trans term that suggests a point in
time when a person “became”
transgender people/person transgenders/a transgender transgender, which diverges
people/a person who is from the lived experiences of
transgender most transgender people.
people/person of trans Similarly, “transgenders” is
experience dated and does not emphasize
humanity.

10
NIAID HIV Language Guide Sex, Gender & Sexuality
Try this… Instead of this… Because…

trans man transman “Trans” is an adjective that

helps describe someone's
trans woman transwoman gender identity, and it should
be treated like other adjectives.
Merging the adjective and the
noun risks suggesting that a
trans man or woman is more (or
less) than just a man or just a
woman, which goes against how
many trans people identify
themselves.

gender affirmation transgendering “Gender affirmation” and

gender confirmation sex change “transition” define the
transition the surgery interpersonal, interactive
transitioning pre-operative/post-operative process whereby a person
receives social recognition and
support for their gender
identity and expression. This
process can but does not
necessarily involve medical
intervention, which can include
hormone therapy and one or
more surgeries to affirm one’s
gender. “Pre-/post-operative”
may still be used in medical
literature but should not be
applied to a specific person
without their consent.

person with a difference in sex hermaphrodite Differences in sex development

development (DSD) (DSD) is an inclusive umbrella
intersex person term that refers to congenital
person who is intersex atypical variations in the
development of chromosomal,
gonadal, or anatomical sex.
Many but not all people with
DSD identify as intersex. When
using the term intersex, also use
and define DSD. Classical
understandings of the term
“hermaphrodite” are usually

11
NIAID HIV Language Guide Sex, Gender & Sexuality
Try this… Instead of this… Because…

limited to individuals with both

traditionally male and female
anatomical features,
particularly genitalia. This term
also is considered offensive
because of its mythical origin
and historically derogatory use.

people of childbearing women of childbearing People of all genders and sexes

potential potential may have childbearing
potential.

people with reproductive men with reproductive People of all gender may have
potential potential reproductive potential.

people men and women Using “men and women” as a

proxy for “everyone” excludes
individuals of all genders both genders/either gender transgender people, nonbinary
or be specific—cisgender men people and other sexual and
and cisgender women gender minorities.

Other Sex, Gender & Sexuality Vocabulary

sex biological category based on reproductive,
anatomical and genetic characteristics, generally
defined as male, female and intersex

gender a composite of socially constructed roles,

behaviors, activities and/or attributes that a
given society considers appropriate for members
of a given sex

12
NIAID HIV Language Guide Sex, Gender & Sexuality
queer people who identify as queer may think of their
sexual orientation and/or gender identity as
characterized by non-binary constructs of sexual
orientation, gender and/or sex

(The term is considered more fluid and inclusive

than traditional categories for sexual orientation
and gender identity, and some even use the term
to describe their political beliefs. Once
considered a pejorative term, queer has been
reclaimed by some LGBT people to describe
themselves; however, it is not a universally
accepted term even within the LGBT community.)

bisexual having the potential to be emotionally,

romantically and/or sexually attracted to people
of the same and different gender—not
necessarily at the same time, in the same way or
to the same degree

pansexual not limited in sexual attraction with regard to

sex, gender identity or gender expression

cisgender person person who identifies with the gender that was
assigned to them at birth; sometimes
abbreviated as cis

gender identity an individual’s sense of being male, female,

intersex, genderqueer, gender nonconforming,
etc.; not necessarily visible to others

gender expression how one chooses to convey one’s gender identity

through behavior, clothing and other external
characteristics

nonbinary person person who identifies outside of a gender binary

by seeing themselves as neither male nor female

genderqueer person person who does not identify as a man or woman

or subscribe to conventional gender distinctions

gender non-conforming person person whose gender expression is not consistent

with the societal or cultural norms expected of
that gender

13
NIAID HIV Language Guide Sex, Gender & Sexuality
gender fluid person person whose gender identity shifts between
different genders (or no gender) or across the
spectrum

agender person person who does not identify with any gender;
agender people may wish to have no gender
expression at all, which many find difficult to
achieve in our gendered society

bigender person person who identifies as two genders

pangender person person who identifies as all genders

trans* an umbrella term that refers to many identities

[sometimes] transgender within the gender identity spectrum

misgender to refer to someone, especially a transgender

person, using a word or address that does not
correctly reflect their gender identity

Pronouns
Though exceptions exist, as a rule, use pronouns that correspond to a person’s gender identity. Because
gender identity is an internal characteristic that should not be assumed, it is best practice to ask for a
person’s pronouns. In addition to the binary English pronouns “she/her” and “he/his,” some people may
use non-binary pronouns, including the pronouns “they/their” used as singular terms, among others.
When using the singular “they,” still conjugate the verb as a plural, as in, “they are gender nonbinary.”

It is considered by some to be extremely offensive and even violent to misgender someone by using
inappropriate pronouns. When writing about a hypothetical person, like an anonymous participant in a
study enrolling people of all genders, use the singular “they” rather than “he or she” to be inclusive.

Identity & Specificity

In certain contexts, it may be appropriate to use language that explicitly references sexual behaviors
instead of referencing sexual orientations and gender identities. For example, a study may evaluate the
ability of an experimental modality to prevent HIV transmission during anal intercourse between people
assigned male at birth who identify as men. While many enrolled in this study are likely to identify as gay
or bisexual, there may be others who do not identify this way but nonetheless have anal intercourse
with other cisgender men. In other words, medical specificity to describe behavior should be accounted
for outside of individuals’ identity around sexual orientation. In this case, an accurate description of the
enrolled participants is “cisgender men who have sex with men.”

In other contexts, it may be appropriate to highlight sexual orientation. Using this language can honor
the contributions of these communities or connect with people on an identity level. For example, one

14
NIAID HIV Language Guide Sex, Gender & Sexuality
might say, “The first cases of AIDS were reported in young gay men,” or “The advocacy group aims to
increase PrEP use among gay and bisexual men of color.” All science takes place in a cultural context,
which must be considered when we prepare written materials for the general public.

Relationships
Avoid language that assumes the nature of a given relationship. For example, be mindful that not all
sexual partners are romantically involved, which may be implied by terms like “couples.” Similarly, do
not assume sexual partners are monogamous or value monogamy. Use the terminology preferred by the
individuals described when possible, or simply use the neutral term “sexual partner(s).”

Pregnancy & Family

Do not assume a given family dynamic or relationship between parent and child. Be mindful that
children are raised by biological mothers and/or fathers, as well as by adoptive parents and other
caregivers. Often, language around pregnancy, childrearing and family can reinforce gender-stereotyped
roles, particularly for women. Avoid language that implies childcare or ensuring a child’s health is the
sole responsibility of mothers. Similarly, avoid language that portrays pregnant or breastfeeding people
as mere vessels supporting a child.

15
NIAID HIV Language Guide Substance Use
Substance Use

Try this… Instead of this… Because…

new syringes (and works) clean syringes “Clean” and

unused syringes (and works) “dirty/contaminated” evoke
sterile syringes (and works) unnecessary value judgements,
as well as specific visual
used syringes (and works) dirty syringes assumptions that may not be
contaminated syringes accurate. The preferred terms
are clearer and more accurate.
“Needles” may also be used
when engaging a community
that is more likely to use that
terminology.
person who injects drugs injection drug user (IDU) Person-first language
person who uses drugs drug user/abuser emphasizes humanity.
person with substance use drug addict
disorder drug-addicted

person with alcohol use alcoholic

disorder

substance use disorder drug addiction This preferred term aligns with
drug dependence the medical community’s and
drug habit federal government’s initiatives
drug abuse to raise awareness that
compulsive substance use is a
alcohol use disorder alcoholism complex brain disorder rather
alcohol abuse than a moral failing or
alcohol dependence personality flaw.
“Abuse” is a negative term that
invites a value judgement.
Addiction is not a diagnostic
term although it is an
acceptable synonym for
moderate or severe substance
use disorder. Dependence, on
the other hand, is not
synonymous with substance use
disorder; see “Dependence vs.
Addiction,” below.

16
NIAID HIV Language Guide Substance Use
Try this… Instead of this… Because…

born in withdrawal born addicted Despite any dependence that

born dependent on [drug] may be present, infants are not
capable of the compulsive
infant with neonatal substance use despite negative
abstinence syndrome addicted infant consequences that defines
addiction.

not currently using substances clean Labeling the use of drugs as

negative [for a toxicology “dirty” and the absence of drug
screen] use as “clean” invites a value
judgement that stigmatizes
currently using substances dirty people who use drugs and does
positive [for a toxicology not accurately reflect the
screen] complexities of substance use
disorder and recovery.

medication for opioid use opioid replacement “Replacement” and

disorder (MOUD) methadone maintenance “substitution” imply
drug substitution medications merely “substitute”
one drug or “one addiction” for
medication-assisted treatment another, fueling a stigmatizing
(MAT) [when referring to or misconception that prevents
inclusive of medications used to people from accessing
treat alcohol use disorder] treatment. MAT should not be
used when referring to
treatment for opioid use
disorder, since “assisted”
implies medications are
secondary to other forms of
treatment, which is no longer
considered to be the case.

treatment center rehab “Rehab” and “detox center”

detox center carry cultural stigmas and
misconceptions.

person in recovery former addict/alcoholic These person-first terms honor

recovered addict/alcoholic the belief of many clinicians and
reformed addict/alcoholic people with substance use
disorder that recovery is an
ongoing and variable process.
Some individuals may claim a
term like “addict,” but such

17
NIAID HIV Language Guide Substance Use
Try this… Instead of this… Because…

terms should not be applied

without that person’s consent.

Dependence vs. Addiction

“Dependence” and “addiction” are related but frequently confused terms. Addiction is defined as a
pattern of compulsive substance use—marked by a change in behavior caused by biochemical changes
in the brain—despite negative consequences related to that substance use. Addiction is not a diagnostic
term but is considered synonymous with moderate to severe substance use disorder. Dependence,
however, is characterized by the physical potential for withdrawal symptoms. Importantly, it is possible
for someone to be dependent on a substance used for medical purposes without experiencing
addiction. It is best to explicitly define these terms or else avoid them.

Drug Misuse
While the term “drug abuse” is generally frowned upon, there is disagreement about the utility of “drug
misuse.” Many people find the term helpful when discussing substances that have medical as well as
illicit uses, such as prescription opioids. Others claim this terminology suggests fault on the part of
people with substance use disorders and creates a stigma that they may deserve consequences of such
“misuse.”

Regardless, it is important to not use “misuse” and “substance use disorder” interchangeably, as not all
people who use substances recreationally experience substance use disorder or require treatment to
stop using substances. For example, a single occasion of binge drinking is considered alcohol misuse but
may not reflect alcohol use disorder in a given individual.

18
NIAID HIV Language Guide Miscellaneous Terms & Topics
Miscellaneous Terms & Topics

The following terms and topics were recommended for inclusion in this guide because they have
previously arisen in communication related to HIV research. The inclusion of a population or group in
this section does not necessarily indicate that this population or group has a high incidence of or is
behaviorally vulnerable to HIV.

Try this… Instead of this… Because…

sex worker prostitute “Sex work” implies ownership

over a person’s own career
choice, while “prostitution” and
sex work prostitution its derivatives carry engrained
transactional sex commercial sex work cultural stigmas. Specifying “sex
sale of sexual services work” as commercial is
redundant and otherizes.

sex trafficking sexual slavery In the context of forced or

forced prostitution coerced transactional sex by
minors, the preferred terms
sex trafficking of minors child prostitution emphasize role of exploiters
because children cannot
consent to sex work. Some
community members prefer the
term “youth sex work” to
describe transactional sex by
minors they feel is not coerced
or forced. However, this is
controversial.

survivor of sexual assault rape victim “Survivor” is more empowering

than “victim,” which evokes
defeat and helplessness. When
referring to a specific person,
always use a term they approve.

intimate partner violence domestic violence The preferred terms are more
specific to two separate ideas:
gender-based violence violence between intimate
partners and violence
specifically based on gendered
power imbalances. They also

19
NIAID HIV Language Guide Miscellaneous Terms & Topics
Try this… Instead of this… Because…

each include relevant violence

outside of a shared home.

person who has experienced abuse victim Use more empowering or

violence neutral terms than “victim,”
which evokes defeat and
survivor of violence helplessness. When referring to
a specific person, always use a
term they approve.

person to be evaluated for tuberculosis suspect “Suspect” evokes suspicion and

tuberculosis personal fault.
person at risk of TB disease
tuberculosis prevention and tuberculosis control “Control” evokes paternalism.
care

prevention of TB transmission

people/participants with TB or hepatitis coinfected “Coinfect” and its derivatives

concomitant hepatitis or people/participants carry the same stigma as
concomitant TB “infect.”

people with tuberculosis/TB TB cases People should not be described

as “case,” as this term
new TB diagnoses new TB cases deemphasizes humanity and
people newly diagnosed with implies burden.
TB
older adults the aged “Adults” affirms agency and
people over [age X] elders personhood, as does person-
(the) elderly first language. Stigmatizing
seniors/senior citizens terms such as “elders” can
evoke frailty. When possible,
use a specific age.

care partners caregivers When describing people

family and friends [in caretakers engaged in an older adult’s
appropriate contexts] care, use care partner to
emphasize collaboration and
the adult’s autonomy.

20
NIAID HIV Language Guide Miscellaneous Terms & Topics
Try this… Instead of this… Because…

person who has been felon Person-first language

arrested/convicted of a felony convict emphasizes humanity. Also,
offender some of these terms have
specific legal definitions that
person who is incarcerated inmate may be confused.
person in prison prisoner
the incarcerated

people who are overweight overweight people Use specific, neutral, person-
people with [BMI or other obese people first language when describing
metabolic score] of X the obese weight and fat distribution.
people with obesity Because obesity and overweight
are diagnoses, it is acceptable
to use “people with obesity”
and its derivatives.

people with disabilities handicapped Community preference for

disabled people (preference handi-capable person-first or identity-first
varies) differently-abled (“disabled people”) varies, but
the disabled most agree euphemistic
language further otherizes
people with disabilities.

abled able-bodied “Abled” to refer to all people

non-disabled normal without disabilities is preferable
does not have a disability healthy, in contrast to people to “able-bodied” in order to be
enabled with disabilities inclusive of cognitive disabilities
and other disabilities not
considered primarily physical.
“Enabled” acknowledges the
role of systems that privilege
certain ability levels above
others.

assistive device/technology corrective device/technology Assistive technologies and

accommodation services should be portrayed as
helping and accommodating a
wheelchair user wheelchair-bound person rather than making
person who uses a wheelchair confined to a wheelchair them “correct” or emphasizing
limitation.

person with [specific mental mentally ill person Person-first language

disorder] insane person emphasizes humanity and
the mentally ill dispels the misconception that

21
NIAID HIV Language Guide Miscellaneous Terms & Topics
Try this… Instead of this… Because…

mental disorders are

E.g. person with bipolar [specific person] is bipolar untreatable. Also, insanity is a
disorder legal—not medical—definition.

died by suicide committed suicide “Committed” evokes

associations with the legal or
moral issues of “committing” a
crime or sin, whereas suicide is
often the consequence of an
unaddressed illness.

Racial, Ethnic & Cultural Identities

Generally, NIH uses race and ethnicity terminology aligning with the 1997 Office of Management and
Budget (OMB) standards on race and ethnicity. According to the OMB, these terms “generally reflect a
social definition of race recognized in this country and not an attempt to define race biologically,
anthropologically, or genetically.”

In addition, it is recognized that the categories of the race item include racial and national origin or
sociocultural groups. People may choose to report more than one race to indicate their racial mixture,
such as “American Indian” and “White.” People who identify their origin as Hispanic, Latino, or Spanish
may be of any race.

The table below offers language considerations for describing racial, ethnic and cultural identities
identified by the OMB. With few exceptions, terms used to describe a people’s race or ethnicity should
be capitalized.

Group/Population Definition Language Considerations

White OMB: having origins in any Avoid language that frames being
of the original peoples of White as a default, normal or
Non-Hispanic White
Europe, the Middle East, or “raceless” identity. Non-Hispanic
North Africa White is sometimes used to clarify
that the described group does not
include White Hispanic people.

Black or African American OMB: having origins in any African American is acceptable in
of the Black racial groups of certain contexts but excludes
Africa other members of the African
diaspora. “African American” is
not considered more respectful
than “Black.”

22
NIAID HIV Language Guide Miscellaneous Terms & Topics
American Indian or Alaskan OMB: having origins in any When referring to a specific
Native of the original peoples of person or group of people, best
North or South America practice is to use a specific tribal
(including Central America) identity whenever possible. When
and who maintains tribal referring to the diverse group of
affiliation or community people with indigenous ancestry
attachment in the United States as a whole,
the term “American Indian” is
usually preferred over “Native
American,” which is seen by some
as euphemistic. Never use
pejorative terms, which include
“Eskimo” instead of Alaska Native.

Native Hawaiian or Other Pacific OMB: having origins in any

Islander of the original peoples of
Hawaii, Guam, Samoa, or
other Pacific Islands
Asian OMB: having origins in any East Asian may be used to
of the original peoples of the describe people with origins in
Far East, Southeast Asia, or China, Korea, Japan, Taiwan or
the Indian subcontinent Mongolia. South Asian may be
including, for example, used to describe people with
Cambodia, China, India, origins in Afghanistan, Pakistan,
Japan, Korea, Malaysia, India, Bangladesh, Nepal, Bhutan,
Pakistan, the Philippine Sri Lanka or Maldives. Southeast
Islands, Thailand, and Asian may be used to describe
Vietnam people with origins in areas south
of China but east of India
(Thailand, Vietnam, Malaysia,
Singapore, the Philippines, Laos,
Indonesia, Brunei, Burma
(Myanmar), Cambodia and Timor-
Leste).

23
NIAID HIV Language Guide Miscellaneous Terms & Topics
Latino/a or Latinx being from or descending According to the OMB, "People
from people who are from who identify their origin as
Latin America, including Hispanic, Latino, or Spanish may
Cuba, Mexico, Puerto Rico, be of any race.”
South America or Central
Most people with origins in Brazil
America
are considered Latino but not
Hispanic because most Brazilians
Hispanic descended from Spanish-
speak Portuguese. Similary,
speaking populations
Spanish people may be considered
Hispanic but not Latino.

Some people identify as “Spanish”

as a synonym for Hispanic, but
others do not prefer the term
because it implies origins in Spain.

person of color (POC) a person who is not White or Many prefer this term to “racial
of European origin minorities” and consider it
inclusive of all non-White races,
while individuals with some non-
White identities may not relate to
the term. Still others consider it
euphemistic or irrelevant. Do not
use “people of color” when
referring to one specific nonwhite
racial group; use a term specific to
that group.

racialized communities group being assigned or In the United States and Canada,
categorized in a racial this term is sometimes preferred
hierarchy to “racial minorities” because it
encompasses non-White groups
that may make up a majority of
individuals in a given geographical
area. The term also defines race as
an ascribed identity,
acknowledging an individual’s
identity may differ from another
person’s perception, which may
be useful to distinguish from self-
reported race and ethnicity
information.

24
NIAID HIV Language Guide Miscellaneous Terms & Topics
biracial having parents or ancestors Some consider using “mixed”
multiracial of different racial alone to be stigmatizing, while
of mixed race backgrounds others claim the term positively.
“Mixed race” is used frequently in
academia and elsewhere, though
some again highlight it as having
stigmatizing potential.

Indigenous peoples having origins in the original These terms may be useful to
First peoples or earliest known describe Indigenous people in a
First Nations inhabitants of an area, in global context.
Aboriginal peoples contrast to groups that have
Native peoples settled, occupied or
colonized the area more
recently in human history

Person-First vs. Identity-First Language

People with disabilities are not a monolith, and this diverse community holds different views about
whether person-first (person with disabilities) or identity-first (disabled person) language is appropriate
in most contexts. Generally, most people prefer person-first language that emphasizes humanity,
highlights autonomy, and promotes the idea that most people’s disabilities are just one facet of their life
and identity. This is particularly true for people with an acquired, chronic illness (i.e. person with
diabetes instead of diabetic).

However, some disabled people explain that their disability is an intrinsic part of their identity and
should not be appended after “person.” For example, many autistic people prefer identity-first language
because they view autism as a way of thinking and living rather than a disorder. This is sometimes called
the “social model” of disability, as opposed to the “medical model.” This concept is also related to
disability pride movements. For example, because deafness is associated with a unique education
system, language and subculture, most people in this population prefer to be called “Deaf.”

As a rule, if you are writing or speaking about people with disabilities or health conditions with which
you are unfamiliar, look up the preferred terms for that population and rely on resources put together
by those immediately affected.

25