This interesting combination of men recently came together here in the Windy City for a series of structured focus groups specifically designed for gay, bisexual and transgender men of color who are living with HIV. The level and degree of brutal honesty that existed within the group was so astounding and yet so sacred that I am almost reluctant to reveal here what was discussed there. However, and with the group's permission, the content of the recent discussions has concerned me to the point that I feel that some of it needs to be shared.
As an African American man living with HIV, I can totally relate to the sexual complexities that men of color living with such a stigmatized virus face on a day-to-day basis. For that reason, I challenged the members of the focus group to not only share their sexual experiences, fetishes and phobias with the rest of us, but also their views about disclosure, prevention and "re-infection."
Because my primary purpose is to get a better understanding of where past and current prevention strategies have fallen short, I admit that I operate with a dual agenda. Aside from creating a safe space for men of color living with HIV to share with and learn from one another, my dual purpose in conducting a focus group of this nature is also to study and observe the behaviors of such men. The prevalent beliefs surrounding disclosure, prevention and re-infection among this group of men was, at times, alarming.
Of the members who participated in the focus group, myself included:
The Centers for Disease Control (CDC) reports that the rate of HIV infection in the United States has stabilized at about 40,000 new infections annually since the early 1990s. However, according to "The Time is Now: The State of AIDS in Black America" (published by the Black AIDS Institute; www.blackaids.org), this rate is not reflected in the HIV infection rate for African Americans, who now account for more than half (about 54%) of new infections in this country, but only make up about 13% of the population. For this reason, the content of the discussions in our group disturbs me.
One member is in a relationship with a married man. He said he uses condoms, but if his partner doesn't want him to, that's fine with him. He won't, however, say he has HIV. This member said flat out, "I don't care."
It should be made clear that as an advocate as well as a prevention and treatment educator, my position is to avoid placing judgment upon anyone or anything at any time. My objective, rather, is to attempt to make sense of the behaviors at hand and to creatively encourage alternative behaviors. In an effort to do this, I refer constantly to the belief that stigma, be it self-stigma or otherwise, plays a huge role in the sexual behaviors of people living with HIV. The reality is that the stigma that our society places on both HIV and men who have sex with men is so deeply rooted that before such issues can be dealt with effectively, we must address and deal with the stigma.
With the overall rate of new HIV infections holding steady year after year in the United States, it is almost easy to validate the federal government's argument to cut funding from prevention programs. It is easy to assume that since we have not seen any dramatic decline in new infections that prevention education programs are not productive enough to justify their cost.
Apparently, however, with the increase in new infections that we are seeing since the proposed cuts, especially in minority populations, this assumption could be deadly. The question that we as a nation of concerned citizens must now seek to answer is, "how exactly should prevention intervention/education programs be structured to make them more effective?"
The CDC proposed and funded "Prevention with Positives" initiative is an excellent concept, in theory. Identifying and then educating people who are living with HIV has all the potential in the world to alter people's behaviors, hopefully leading to a decline in new HIV infections for the general population at large. However, it shifts the burden of behavior change solely on HIV-positive individuals, and, well let's face it, that alone is just not enough.
In a recent discussion, two of the members of the group, both under the age of 25, said that they had both always used condoms prior to learning of their HIV status. We do know that condoms are not 100% effective, primarily due to user error.
We also know that total abstinence is the only sure way to prevent HIV transmission. In our society, however, total abstinence is not a realistic approach for married couples or for those whom marriage is not an option (e.g., gay people), thus "abstinence only" programs are not 100% entirely effective either.
However, there are some prevention program models being implemented throughout the nation that are producing results. Programs such as the Mpowerment Project, www.mpowerment.org, operated by the Center for AIDS Prevention Studies at the University of California at San Francisco, is the first documented HIV prevention intervention program for young gay/bisexual men that has succeeded in reducing sexual risk behavior by 15% to 24%.
The S.I.S.T.A. (Sistas Informing Sistas on Topics About AIDS) project, also out of California, is a curriculum that was created for and by African American women, and is currently sanctioned by the Howard County Health Department as one of the most effective HIV/AIDS prevention curriculum for women of color. The key to the success of such programs, however, is arguably the holistic, non-judgmental approach that is at the core of their foundation.
What is clear then, is that prevention intervention/education programs should take on a holistic approach in order to be more effective. The physical, mental and societal influences on both HIV-positive and negative individuals regardless of age, race or sexual orientation must all be considered. Issues of racism, sexism, homophobia and, most certainly, stigma that exist in the world must be addressed. To fail to do so would mean more casualties in the ongoing war against HIV/AIDS that has already cost us millions of precious lives worldwide.