Dissecting the "Rocket Science" Behind Rising HIV Infection Rates Among Black MSM in Chicago
A Practical Perspective
Recently, the Chicago Department of Public Health conducted a study of gay and bisexual men, including those who opt out of identifying with such labels (commonly referred to in the public health sector as men who have sex with men, or MSM). Discussion about the findings of this study alone could fill the pages of this magazine; the data is just that rich. In my opinion, however, the take-home message could be summed up in just one sentence: what white gay men did to stem the rising tide of virus within their communities from the early 1980s until now has worked.
The interesting thing to me, though, is that the data does not suggest that what they've done has a whole lot to do with changing behaviors, which is the primary focus of much of the work being done around HIV prevention. Reports of "risky sexual behavior" and substance use associated with sex were relatively the same across all racial groups, with the white men in the study actually reporting slightly more risky sexual behavior.
Still, although HIV has traditionally been (and oftentimes still is) perceived as a "gay, white man's disease," the study revealed an HIV prevalence rate of 11% among the white men surveyed. While that is excessively high in comparison to the overall prevalence rate among Chicago men in general (which is 1.2%), it pales in comparison to the prevalence rate among the African American men in the study, which totaled a staggering 30%.
What has transpired over the years to bring about this dramatic shift in the demographics of the epidemic in Chicago, however, remains a mystery. While a variety of theories to explain it have been put forth, no one is able to attribute this disparity in prevalence rates between black and white MSM to any one particular factor. The data from this study, however, provides us with some interesting clues that should not be ignored.
We cannot allow others, even those who look like us and share our cultural heritage, to convince us that our lives are not worth living ... or saving.For example, all of the black and white men surveyed who said that they were HIV-positive also reported having seen a doctor for the virus since they were diagnosed. However, while 79% of the white men said that they were currently taking antiretroviral (ARV) medications, only 43% of the black men said the same. It is no secret that ARVs reduce the amount of virus in the blood and semen of men who take them as prescribed. Aside from improved quality of life for such men, the other most important benefit from being on meds is the reduced likelihood of transmitting the virus to sexual partners. Could the lack of engagement in antiretroviral therapy be the primary contributor to the out of control rate of rising infection among black MSM?!
Well ... duh!
Should we need further support of this hypothesis, we could look at the data on the Latino men in this study. Keeping in mind that reports of risky sexual behaviors were virtually the same among men from all racial/ethnic groups, why is it that the HIV prevalence rate among the Latino men in the study is almost exactly the same as that of the white men, at 12%? Could it have anything to do with the fact that even though only 86% of the HIV-positive Latino men had seen a doctor for HIV, 83% of them said that they were currently taking antiretroviral medications?! Well ... DOUBLE DUH!
A reduction in community viral load equals a reduction in new infections within the community that achieves it. This isn't rocket science, by any means. In fact, it's common sense.
The $500 million question then, is what's keeping black MSM from engaging in ARV therapy? Is it a lack of access to culturally sensitive and appropriate health care? Is it the shame associated with sexual intimacy between men that arises from the homo-exclusive religious culture within black communities? Is it the stigma of having the "gay, white man's disease" and of taking the medications used to treat it? Are we skeptical due to our past negative experiences with medical science (i.e., the Tuskegee experiment)?
I would suspect that it's all of these things, and none of them at the same time. Historically, however, black men in America have fought hard to achieve the quality of life guaranteed to us by the U.S. constitution. We've done what we've needed to do in order to survive, and done it in spite of everything that suggested that we couldn't.
If we are to survive the devastating plague of HIV, our efforts at combating it within our communities must take on that same vigilance and determination. We cannot allow others, even those who look like us and share our cultural heritage, to convince us that our lives are not worth living ... or saving. We must engage with the health care system for ourselves and for those we love, and demand that the system engage us in a way that is both accepting and affirming. Then hopefully, 25 years from now, we will be able to say, in response to the most current HIV surveillance data, that what we did to stem the rising tide of HIV infections within our community worked!
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