Why We Can't Wait: Moving Beyond (Marriage) Equality to End HIV
December 1, 2015
On December 1, World AIDS Day, people across the world will come together to stand in solidarity with people living with HIV and commemorate those who have died of HIV-related illnesses. On this day, I've taken a step back to reflect on how far we've come in the fight against HIV. In 1988 -- the inaugural World AIDS Day celebratory year - no one on the ground could have conceptualized taking just one to two pills a day for HIV treatment, a once-a-day pill to prevent HIV in the real world, or that if a person living with HIV is diagnosed early enough today and begins treatment right away, they could have an average life expectancy of 75 years. But while this day is an opportunity to honor the lives of those we lost and will never forget, it's of the utmost importance that we question and challenge our own comfort.
This year marked a monumental win for LGBT advocates with the Supreme Court ruling that the fundamental right to marry is guaranteed to same-sex couples by both the Due Process Clause and the Equal Protection Clause of the Fourteenth Amendment to the United States Constitution. Underscoring this historic win was a message of equality, and we as a community never failed to drive our selling point: "The U.S., as a progressive nation, cannot discriminate against love due to one's sexual orientation." And while I'm grateful for the Supreme Court's ruling, as it's a step closer to destigmatizing the lives of LGBT people, as a Black gay man, it's hard to celebrate equality when you know there's a narrative left out of the storybook ending. Yes, it's nice to think of same-sex couples riding off hand-in-hand into the sunset -- the romanticism of equality actualized being quite attractive -- but all is not right in our community. Our dream of equality is a dream deferred amid some pretty harsh realities.
To the Broader LGBT Community
Currently, Black gay men make up approximately 2% of the U.S. population in the U.S, but accounted for three-fourths of all estimated new HIV infections from 2008-2010. Additionally, gay men are 40 times more likely to contract HIV than the general population, which spikes dramatically to 72 times more likely among Black gay men. Young Black gay men represent the only population in the United States to experience a statistically significant increase in new HIV infections from 2006 through 2010, increasing 48% during the period. When analyzed by race, the HIV Care Continuum demonstrates that the highest disparity is among Blacks, with 79% having not achieved viral suppression, followed by Latinos at 74%. Additionally, transgender women are at high risk for HIV infection, with Black transgender women having the highest percentage of new HIV-positive test results. Unfortunately, consistent data for transgender individuals does not exist; further evidence that funding and research where it's needed the most is important if we want to take meaningful action to end HIV.
If we are to truly move the needle on HIV incidence within our country we must understand intersectionality: that Black gay men, Latino gay men, and transgender individuals experience myriad inequities -- homophobia, transphobia, racism, stigma, marginalization, homelessness, and poverty. The romanticism of achieving equality must be met with the recognition that Black, Latino, and trans lives do matter in the realm of public health through solidarity, collaboration, and responsive advocacy. We must firmly assert that the lives, bodies, and health of Black, Brown, and trans individuals have value -- just like same-sex marriage -- in our community. We must ask ourselves: what is really driving the epidemic in these populations? Contrary to popular opinion, multiple studies have shown that Black gay men are less likely to have condomless sex than White gay men, and far less likely to use drugs like poppers or crystal methamphetamine during sex, which heightens the risk of HIV infection. Now is our opportunity to stop speaking about employment, housing and other basic needs and other supportive services as if they're abstract or mere theoretical concepts, and allow our work and advocacy to reflect that they're real, they're here, and we can stop fueling systems of oppression today; but only if we're willing -- only if we really believe #BlackLivesMatter.
To Faith-Based Leaders
Recent studies have shown that men who have sex with men (MSM) who attend church are more likely to present with later presentation for HIV care and typically have lower CD4 T-lymphocyte counts -- which is the most important laboratory indicator of how well your immune system is working and the strongest predictor of HIV progression. There are individuals within your congregations, sitting in your pews, searching for love, compassion, leadership, and they deserve more than homophobic or transphobic rhetoric that serves as a barrier to their treatment and care.
In Black communities specifically, the church is often the nexus -- or at least a significant part -- of the Black experience. We need to hear more nuanced conversations concerning HIV coming from behind the pulpit. As leaders and pillars of your communities, your word is often law. Take the opportunity to wield that power interdependently: partner with a local HIV service organization to conduct testing; outsource an organization to come in and discuss the power of stigma among you and your church leadership. On the flip side: health departments and public health professionals cannot be afraid to seek out non-traditional partnerships in even less traditional spaces. Only through working together in a way like never before can we be the change agents that our message of equality strives to achieve.
To Service Providers
It's time to break away from what feels comfortable. Stop being afraid to talk about sex, understand the nuances of the LGBT experience, and become immersed in culturally responsive care: a dialogue-based approach that responds to the needs being presented by the individual in front of the provider, within the contextual understanding of social/economic/political/linguistic disparities. Providers should never get to the point where they stop learning, or think they can receive a certificate and therefore be competent in someone's culture or care. Your willingness to engage and learn -- instead of waiting to be presented with information -- is paramount in helping marginalized populations navigate the HIV healthcare delivery system. If you have questions or lack comfort in your provider/patient interactions: reach out to an organization that can offer technical assistance on engaging with key populations.
To Legislators and Policymakers
Every piece of language you write into law impacts the lives of millions of people. It is by necessity that you seek out, learn, hear, and understand how employment, housing and other basic needs and other supportive services are interconnected. We must also re-examine laws that impose excessive criminal penalties on people living with HIV who know their HIV status and who potentially expose others to HIV. We will hold you accountable for crafting laws that are reflective of recent science, and don't support or uphold stigma and discrimination, bringing awareness to the issues impacting our communities the most.
On this World AIDS Day we have the opportunity to take the HIV care and advocacy movement to sights unseen. The dream of equality is clearly within our path, but just like the pursuit of any achievement or goal we have to ask ourselves: Are we willing to get messy and uncomfortable? Are we really willing to do the work?
Terrance Moore is a health policy expert who has been living with HIV since 2001. Terrance is also the deputy executive director at the National Alliance of State & Territorial AIDS Directors (NASTAD). NASTAD strengthens state, territory and global-based public health leadership, expertise and advocacy and bring them to bear in reducing the incidence of HIV and hepatitis infections and on providing care and support to all who live with HIV and hepatitis.
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