We are living in a golden age of HIV prevention options and optimism. However, not all communities affected by HIV have enjoyed a decline in new cases. Among black gay, bisexual and other men who have sex with men (MSM) -- especially young men -- HIV rates are increasing. In early 2016 the U.S. Centers for Disease Control and Prevention (CDC) released a new assessment of lifetime HIV risk showing that one in two black gay men will acquire HIV in their lifetime.
The CDC's Jonathan Mermin, M.D., was widely quoted as saying that these numbers are "not a foregone conclusion ... [but] a call to action." However, this is by no means the first time statistics on black MSM's disproportionate HIV rates have come to light.
"Undoing hundreds of years of structural disenfranchisement can't be solved with pills or ads to 'get tested,'" said Johnnie Kornegay, one of several black gay men working in and/or living with HIV who critiqued CDC's report, in the Georgia Voice. Considering that black gay men tend to use condoms more, have fewer sex partners on average and get tested more often than other gay men, simply scaling up behavior change interventions and cookie-cutter prevention options clearly will not work in this community, and never has.
So what will work? What do community-based experts believe must be done to curb a galloping epidemic in an already marginalized community?
- Ask young black MSM.
- Think more broadly about what prevention means. Have you ever seen a picture of James Baldwin, Essex Hemphill or Bill T. Jones in the waiting room of an HIV service provider? Integrating art and culture into HIV prevention and care -- including decorating waiting rooms with images of inspiring black gay men to affirm patients' identities; partnering with intersectional organizations to provide young men a range of growth and educational opportunities; and paying attention to young men's physical, emotional and social wellness (such as stress levels, sense of purpose and other health factors, alongside HIV status) are just a few approaches to better support black MSM facing HIV, according to the Counter Narrative Project, an Atlanta-based organization that seeks to build power among U.S. black gay men.
- Address the totality of black MSM' lives, not just HIV. "If I'm at a table where the only thing we're gonna talk about is HIV, but we're not gonna talk about unemployment, housing, education and the criminal justice system, that's not gonna work," said longtime activist Ron Simmons in a recent cross-generational conversation between black gay leaders living with HIV. Simmons pointed out that the main source of attention and resources for issues facing black MSM is around HIV, but the structural inequities that fuel its spread, not the virus, are the main problem. "You can be HIV negative, but you can be unemployed," he noted. "You can be HIV negative, but you may have to sell your body to survive."
- Learn to address anti-black racism and other -isms in HIV services. Then do it. The fact that race matters when it comes to HIV has been an ongoing conversation among advocates most impacted by racism and HIV that has not translated into large-scale policy or organizational change.
The CDC even cites "homophobia and transphobia [and] racism" as key underpinnings of the ongoing HIV epidemic in the South -- the hardest-hit region in the U.S. and home to a high percentage of black people living with HIV. Yet, the CDC offers no solutions that directly address systems of oppression.
Even if it means stepping outside of comfort zones, if health systems and HIV service bodies truly want to see HIV rates fall among black MSM, they must stop operating as if systemic oppression is something that oppressed people made up and start exploring best practices for weeding out stigma and addressing the effects of anti-blackness and other forms of inequity.
- Talk about HIV prevention methods where black people will be listening. "We need to begin a national conversation around PrEP [pre-exposure prophylaxis]," said longtime activist and writer Kenyon Farrow in an Advocate feature in early 2016. PrEP has been heralded as a game-changer in HIV prevention. However, until recently, PrEP awareness efforts have been largely geared toward white gay men. Campaigns seeking to affirm black sexuality and inform black folks about PrEP have begun to spring up in major cities, but more must be done. "We need someone from CDC to go on all the black talk-radio shows -- like Tom Joyner or Rickey Smiley -- where millions are listening," Farrow stressed. "The fact that they haven't done this is a failure of vision and leadership."
- Expand Medicaid. Black people living with HIV are less likely than whites or Latinos to get consistent medical care. In the era of the Affordable Care Act, many states' failure to expand Medicaid has contributed to black gay men's challenges in accessing care and prevention services. The Counter Narrative Project pointed out this disparity in its response to Michael Johnson's sentencing under draconian HIV criminalization laws:
It is ironic that the state of Missouri would convict Michael Johnson of criminal transmission out of a claim of concern for "the public". If Missouri has such concern about the health and wellbeing of its residents, why won't the Missouri state legislature even expand Medicaid -- a very easy way to ensure nearly all people with and at risk for HIV could have access to health care? ... Johnson will be in prison, and the accusers who are currently HIV negative will likely remain highly vulnerable to HIV infection. That's the state's fault -- not Michael Johnson['s].
- Stop blaming black gay men for their vulnerability to HIV. "As though 'bad behaviors' has ever been a good enough explanation for a health catastrophe or as though good behavior has ever solved one," as scholar Adam Geary, who writes about how anti-black racism has shaped the HIV response, put it.
- Recognize and support black gay men's safe spaces. From bars and clubs to dance halls to the houses of the long-standing ballroom community, black MSM men -- black LGBTQ folks as a whole -- have sought and secured connection and survival throughout the HIV epidemic and beyond. These spaces can play important roles in HIV prevention, but must be honored and respected, not exploited. "I can only hope that more agencies realize that behind the numbers and results are people," George M. Johnson wrote about integrating HIV testing into ballroom culture in the District of Columbia -- "people who deserved to be treated as more than a means to another funding source."
Olivia Ford is a contributing editor for TheBody.com and TheBodyPRO.com.
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