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HIV Prevention, Young Gay Men of Color and the Fourth Wave of HIV Activism

November 15, 2013

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Jeremiah Johnson

Jeremiah Johnson

HIV, the virus that causes AIDS, is a virus without an agenda -- anyone can contract it, and we are all on what medical professionals call the "continuum of risk." Unless you're talking about abstinence or masturbation, almost every sexual act falls somewhere on the risk continuum; and belonging to some social, ethnic and economic groups puts people at higher risk for HIV. At the nexus of many contributing factors (economic disempowerment, homophobia, racism, stigma, inadequate school systems and criminalization) are young gay men of color, a group considered by many in the HIV community to be facing "AIDS 2.0" -- a second epidemic.

As we enter the fourth decade in a world that includes HIV, and as our tools to fight HIV in those who are infected become more fine-tuned, many organizations and advocacy groups are turning their attention to what some are calling the "fourth wave" of HIV activism: widespread prevention advocacy.

Attendees at this year's Gay Pride March in New York City saw the AIDS Coalition to Unleash Power (ACT UP) declare an "HIV emergency" in the city. ACT UP cited projections based on statistics from the U.S. Centers for Disease Control and Prevention (CDC) estimating that more than half of young gay men and transgender women may be HIV positive by age 50 if trends persist. Members aboard a float shouted "1 in 2, could be you!" to onlookers. The Treatment Action Group (TAG) -- which began years ago as a working group in ACT UP, and is one of the most recognizable names in advocacy for people living with HIV -- has even turned its attention to prevention, realizing its essential role in ending HIV globally. Jeremiah Johnson is TAG's inaugural HIV prevention research and policy coordinator, ushering in a new era of focus for the organization. Johnson, less than a quarter of a year into his new role, is aware of the challenges that lie ahead in advocating for those who are negative. "It's going to be a very different beast, because there is a different set of community stakeholders in the U.S. that needs to be brought together to talk about this problem," he said.


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A Community Response to Prevention Funding Cuts

Unfortunately, as advocacy agendas shift toward prevention, government dollars are not being similarly invested in those most likely to become HIV positive. At a community discussion held in New York City around how best to support young gay men of color in the face of shrinking prevention dollars, a mélange of experts and community members attempted to read the prevention funding tea leaves, which were colored by federal budget slashes affecting organizations nationwide.

One member of Outstanding Beautiful Brothers (OBB), a prevention initiative aimed at young gay men of color and run through Gay Men's Health Crisis (GMHC), seized the microphone during the question-and-answer session and lamented, "OBB has helped us get to a place in life where we thought we would never be." On the funding cuts, he continued, "We come from turning tricks and being homeless and doing so many other things. Now we're here and now we have to stop. Why? I don't understand why we have to go back to where we came from. I thought we were moving forward. It seems to me like we're moving backwards."

"That is an enormous disparity that tells us something about where this epidemic is lodged and speaks to us that this epidemic is more than just about a biological event." -- Dr. Perry Halkitis

Dr. Perry Halkitis of New York University's Center for Health, Identity, Behavior and Prevention Studies was one of the experts at the community discussion. Dr. Halkitis described a study he had performed through the center that followed a cohort of young gay and bisexual men. In the cohort, the rate at which participants became HIV positive (or the "seroconversion rate") was 6.2 percent overall; however, when broken down by race, the rates wildly differed. While white men seroconverted at a rate of 0.5 percent, Latinos did so at a rate of 7 percent, only slightly above average. Young black men became HIV positive at a rate of 21.3 percent. Said Halkitis, "That is an enormous disparity that tells us something about where this epidemic is lodged and speaks to us that this epidemic is more than just about a biological event."

One social problem young gay men of color may face is homelessness, and not having a home is a risk factor for HIV. Carl Siciliano, executive director of the Ali Forney Center, which provides services to homeless LGBT youth (who comprise a whopping 40 percent of homeless youth nationwide), underscored the importance of housing as prevention. While asserting that housing can help reduce sex work, substance use and other factors associated with a high risk for HIV infection, he noted that "New York City provides 250 youth shelter beds. ... [T]here are more than 10 times as many youth who can't access shelter than there are beds," and that LGBT youth were even more disenfranchised by the shelter system due to stigma and homophobia.

Shariff Gibbons, a participant of Outstanding Beautiful Brothers, said at the meeting, "If you are a gay man of color, it's almost like you don't exist."

Dr. Blayne Cutler of the New York City Department of Health and Mental Hygiene said, despite the city's best prevention efforts, "Do I expect that things might get even worse? I have to say that I absolutely do. But that has never stopped us in New York City before, and it's not going to stop us now." TAG's Johnson also understands the massive undertaking that is health advocacy for young gay men. When Johnson sat down with me, he pointed to the need for government policies that are in line with what is necessary for HIV-negative individuals to stay negative. At the forefront of good sexual health, he said, is overall wellness; and the Affordable Care Act is a step toward making sure more people take care of their bodies.

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