August 31, 2011
This week Phill Wilson cedes his editorial to fellow Presidential Advisory Council on HIV/AIDS (PACHA) member Douglas Brooks, senior vice president for community, health and public policy for the Justice Resource Institute.
The theme of this year's National HIV Prevention Conference (NHPC) could not be more timely: "The Urgency of Now: Reduce Incidence. Improve Access. Promote Equity" is a clarion call to action in the wake of the new Centers for Disease Control and Prevention (CDC) HIV surveillance report, released on Aug. 3, 2011.
Data in the report show that while the overall number of new HIV infections in the United States has remained fairly stable from 2006 to 2009, there continues to be an increase in new infections among Black gay men. Most alarming was the 48 percent increase in new HIV infections among young (ages 13-29) Black men who have sex with men (MSM) from 2006 to 2009, with a statistically significant estimated annual increase of 12.2 percent.
Simultaneously, the National Black Gay Men's Advocacy Coalition highlighted two other disturbing reports released in the same week: The CDC reported in the Annals of Internal Medicine that rates of primary and secondary syphilis disproportionately increased in recent years among Black and Hispanic young MSM, and a new study commissioned by Janssen Therapeutics and the National Medical Association (NMA) found that social stigmatization is still the largest barrier keeping African American frontline physicians from testing their patients for HIV.
What, then, could be more fiercely urgent for a convening of HIV-prevention professionals than to address the tragedy of adolescents and young adults contracting HIV at alarming rates; whose greatest risk seems to be loving, desiring and sexually connecting with one another in their own communities; and whose communities are ill-equipped to respond to the emergency?
The data here are also clear. Through his research, Gregorio Millett, senior policy adviser at the Office of National AIDS Policy, has demonstrated that these men do not engage in riskier behaviors, do not have a greater number of sexual partners and often do have health insurance.
This is not new; we've been here before, in various ways. For example, six years ago this summer, we were all shocked to learn that a CDC-funded study of MSM conducted in five U.S. cities between June 2004 and April 2005 showed that 46 percent of Black MSM tested were HIV positive, and 64 percent of those men were unaware of their status.
The theme of the NHPC is inextricably linked to the National HIV/AIDS Strategy (pdf) for the United States (NHAS). We cannot truly claim fidelity to the NHAS vision if we do not actualize an America where new HIV infections among Black gay men are rare and, when they do occur, each man "will have unfettered access to high quality, life-extending care, free from stigma and discrimination," as the strategy describes.
The United States has to become a place where Black gay men are enveloped in a system of medical, mental-health and spiritual care as well as nurturing, not a place where they personify a tragic, seemingly intractable, health disparity. As an Institute for Gay Men's Health statement argued six years ago: "If Black, gay men mattered, HIV-prevention interventions would be democratically developed and framed in the language of love, intimacy, connection and sex. HIV prevention would honor the knowledge and wisdom Black gay men bring to bear in creating solutions that make sense to their day-to-day realities. We would embrace this knowledge as credible evidence."
Our country needs an HIV portfolio that considers every possible culturally competent option for Black gay men: behavioral interventions (including trauma resolution), biomedical interventions, spiritual interventions and any other supports that can transform the untenable situation in which we find ourselves.
This should not be read as a call to forget other populations. In fact, this is a plea for inclusion, not exclusion. It is a plea for an HIV portfolio rooted in social justice. Drawing from the social work profession's values of honoring the "dignity and worth of the individual," it is a call for treating Black gay men caringly and with respect, promoting socially responsible self-determination, and enhancing the capacity and opportunity for Black gay men to change and to address their own needs.
Such action will fortify those whose work is to employ their very best open-minded thinking to advance this vision. It will also usher in a brave new world in which empowered Black gay men are supported by the Black and gay communities from which they hail, and the government of their country, so that they can walk with the bold confidence that comes with knowing that they are seen, valued and cherished and that they matter.
Douglas M. Brooks, M.S.W., is senior vice president for community, health and public policy for the Justice Resource Institute and a member of the Presidential Advisory Council on HIV/AIDS (PACHA).