As we enter the season of Black Gay Pride, we examine the response to the HIV epidemic among Black gay and bisexual men in Philadelphia, where the HIV infection rate is five times the national average and one-and-a-half times the rate of New York City's, the traditional epicenter of the AIDS epidemic.
As Philadelphia implements strategies to reduce AIDS and HIV infections -- including an outreach program in faith communities last November and a controversial condom campaign targeting teens launched earlier this year -- recent city data show substantial increases in HIV/AIDS diagnoses among men who have sex with men (MSM).
In its latest HIV/AIDS epidemiological report, Philadelphia's AIDS Activities Coordinating Office reported that new cases of HIV infections among gay and bisexual men have risen dramatically over the past three years, with 280 new cases reported in 2007, 309 new cases in 2008 and 350 new cases in 2009 -- a 29 percent total increase.
Data regarding new cases among Black MSM, specifically, were not available because the city only recently began tracking that group as a distinct population, says David Acosta, prevention coordinator for the Philadelphia Health Department. But Black MSM are clearly affected, he says, since African Americans make up nearly half of the city's population.
Of the 911 total HIV infections reported in Philadelphia in 2009, 38 percent occurred among MSM -- more than among heterosexuals (31 percent), injection drug users (29 percent) and those who contracted the virus trough heterosexual contact but didn't identify any risk factor (25 percent).
Nationwide, MSM may not be receiving prevention messages, according to recent data from a 21-city study published by the Centers for Disease Control and Prevention (CDC). The study found 28 percent of Black MSM nationwide infected with the virus -- the highest rate of any demographic group. Of those, 59 percent were unaware of their infection. Young men of color were the least likely to know.
Philadelphia ranks high among cities in which many gay and bisexual men lack knowledge of their HIV-positive status, according to a September 2010 Morbidity and Mortality Weekly Report.
Of the 440 Philadelphia men tested in 2008 who identified as MSM, 48 (11 percent) tested positive for the virus -- significantly lower than the 19 percent rate for men of all races and ethnicities in the CDC study, but much higher than the HIV rates of most sub-Saharan African nations. A whopping 34 of those who tested positive, or 71 percent, said that they were unaware they had contracted the virus -- a substantially higher percentage than even the 59 percent of Black MSM who were unaware of their HIV-positive status in the CDC study.
With 73 percent of its Black MSM population unaware, only Baltimore ranked higher than Philadelphia among cities in which gay and bisexual men learned through testing that they had the virus.
"The city's AIDS priority changes whenever we get new data," says Acosta of the city's health department. "Hispanic men may be the priority one year, African American women may be the priority in another year. Our numbers are showing MSM as a population at risk. We're doing what we can to reach that population," he says.
Such outreach requires additional strategies, such as communicating culturally specific prevention messages and messages that go beyond the effeminate gay stereotype, which many African American MSM reject, Acosta explains.
The city funds two programs targeted to Black MSM. One program, "Many Men, Many Voices," run by the city's Mazzoni Center, uses three-day retreats as a formal intervention to teach African American men 21 and younger about risky sexual behaviors and how to change them.
Another program, Brothers United Philadelphia, run by the SafeGuards Project & the LGBT Health Resource Center, models itself after the CDC's community-level intervention program called D-UP (Defend Yourself). It uses peer-intervention volunteers trained in healthy sexual practices who move throughout the Black MSM community creating new and healthier social norms.
"African American MSM under 18 are part of a generation who grew up without prevention messages that were targeted toward them. Today we can do more to reach young people, such as social media and the Internet," says Brian Green, SafeGuards' director. "Success in reaching the younger population is critical if we hope to turn things around."
The Colours Organization, Inc., one of the oldest Black gay and lesbian organizations in Pennsylvania, also targets African American MSM through testing, counseling and outreach. But Robert K. Burns, Colours' executive director, warns that reaching Black MSM requires strategic relationships and an acceptance that often only African American AIDS organizations can provide.
Still, leaders in the African American community, such as clergy, politicians and business leaders, have to make AIDS prevention a priority in order for such messages to make an impact, Green says.
Winslow Mason Jr., M.S., is an organizational development specialist and journalist who has done outreach and education in Philadelphia's Black gay community.