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The Rising Rates of HIV Among Black and Latino Men: What's Going On?

June 23, 2010

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Kenyon Farrow: Now, I want to move on to a couple of different kinds of trends in HIV prevention that we're hearing more about. As many of you know, the stories in the paper over the last couple of days have named a new HIV test that is able to test new infections faster than the test that we've currently used most readily, which tests for the HIV antibodies; and people seeing this as a way to test people earlier and get folks into care sooner, as a way of stemming the tide of the epidemic.

We hear a lot of folks talking about the community viral load, right? So, in a particular, either geographic, or community, or sexual network, or amongst, say, black or Latino MSM -- if we get people into treatment and lower the overall community viral load, how will that potentially decrease new infections?

And we hear a lot of those different components under this rubric of test-and-treat, right? As a new medicalized intervention model. So I would just like your opinion about the test-and-treat model as a potential way to decrease new infections, and whether you see it as useful, or where you see different problems with it. We'll start with Vaughn.

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Vaughn Taylor-Akutagawa: Well. It's interesting. Whenever I hear the test-and-treat concept, my first thought is to ask the question: What happened to primary prevention? It seems that we've just given up on keeping people uninfected.

While I think testing and treating is a great medical application of reducing community viral load, it does not in any way address access-to-care services from a client's perspective. Almost everyone said, "Let's partner with a medical provider, and things are going to happen. OK." Most of these testing services here in New York City have no clear mechanism for connecting someone who turns up positive to services after 9 p.m. at night. If you do a quick analysis of Web sites and where people meet, most of the time they meet under risky behavior after 9 o'clock at night.

"So while it's great to say that we're going to get people in there, and we're going to reduce the community viral load, most people can't give you a clear definition of what they consider 'community.' And for those who aren't out, they don't know the names or the status of their partners. They don't even ask. They barely ask about condom usage."
-- Vaughn Taylor-Akutagawa

The barrage of paperwork in getting someone access, too, is intimidating. So while it's great to say that we're going to get people in there, and we're going to reduce the community viral load, most people can't give you a clear definition of what they consider "community." And for those who aren't out as openly gay or bisexual, they don't know the names or the status of their partners. They don't even ask. They barely ask about condom usage.

So it's one clear platform. But I think there need to be more things used in conjunction with that to actually think about seriously reducing community viral loads.

Kenyon Farrow: OK. Sheldon?

Sheldon Fields: As a medical approach, yes; we have no doubt that if you test people, they get to know their status. And once they know their status, then one would hope that they would engage in preventive behaviors, or be brought into a system and taught preventive behaviors so that they do not pass their infection onto anyone else.

We also know that if we put people on antiretroviral medications, we decrease their viral load; we [decrease] the efficiency at which they are able to pass HIV infection onto another potential partner. Those are medical facts. We know that.

I agree with one of the things that Vaughn just mentioned, though -- which gets us into the whole: Do we test everyone for HIV? And I say, we only make HIV testing mandatory if there's an absolute guarantee of access to medical services. I think it's unethical to test someone, give them a diagnosis, and not provide them with treatment.

Now, as someone who also is very much interested in health policy, and is currently doing a health policy fellowship: There was a reason why a lot of things pertaining to HIV were not folded into health care reform. Because we cannot yet guarantee that the primary care workforce, those initial front-line people who are going to intake a lot of people into the medical system; we cannot assure that they have the knowledge and the ability to deal with people who actually have HIV. A lot of those providers have never had training in HIV, beyond what they got in either their medical program, physician assistant program or nurse practitioner program. They have no depth of knowledge.

Until we are able to provide that depth of knowledge to all primary care providers, we just cannot throw open that floodgate. Because you're going to have people who then are going to be severely mistreated and abused once they come into the system by people who just don't know any better. And once those people are turned off to treatment, it's going to be very hard to get them back in.

Kenyon Farrow: And Francisco, your perspective?

Francisco Roque:If you were to ask me, I would absolutely say to you I would want as many people as possible tested and treated. Right? That's absolutely certainly the case.

I think that we do a disservice to think that we can create this test-and-treat agenda as preventionists, and that we'll be able to successfully bully our way into having communities of color tested and treated. Right? There are certainly cultural factors at play here. And there is a lot of resistance in folks. Still, there's a lot of distrust of the medical institutions, and care.

Again, this takes me back to the urgency around including community in the development of interventions and messaging, and the development of our approaches. We cannot expect that folks will just come along and begin to test and treat at higher numbers, because that's how we're promoting our services, and because funding streams are dictating that we simply test and treat.

I think that it becomes really important that we look for ways in which we can develop interventions that look to actually have an impact on a cultural level, on the dynamic of folks who are not looking to be tested and treated, as well. We certainly have access to care issues. I can certainly speak for myself; something almost needs to be falling off before I go to the doctor. That's the case for most men, and that's the case for, certainly, most men of color.

And then it becomes even more complicated when you think about the stigma related to HIV and homophobia, and what it actually looks like to access care consistently -- and the fact that we are conditioned to medicate ourselves with drugs and alcohol when we are in crisis. That becomes our go-to. Our go-to is often not to get into mental health services. It's just not.

Until we look to create some creative ways to address that, and model behavior for folks, and offer up options that meet people where they're at, we will not successfully test and treat high-risk individuals within our communities. It's just going to be extremely challenging. And we do a disservice to not address that tertiary area first.

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Reader Comments:

Comment by: Jack L (Vanwyksdorp) Fri., Dec. 28, 2012 at 12:48 am EST
just dropped in on this. While I agree about all the societal factors - homophobia > on the down lo > MSM etc. the thing that somehow is being missed is that sex is fundamentally about exchange of body fluids. Period. You can unpack this into power, feelings of completeness, powerful fantasies about sharing, possession and so on. Societal factors will increase the need. This is not to say good programs that make safety desirable can't have some impact. But lets recognize that sex is about exchange of body fluids and promote morning before and morning after solutions.
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Comment by: JC (Miami, FL) Fri., Jun. 3, 2011 at 11:27 pm EDT
This is a very old article but I still want to leave my 2 cents. I am a gay Hispanic male and in the Latino community there are a combination of family "honor", religion and culture factors involved leading men to live closeted lives (often married as well) resulting in these men seeking "men to men sex" through risky avenues which equals "the internet" period. There are tons of gay sex hookup sites as well as Craigslist personals and these men are on it - believe me on this. Some of these men use alcohol or drugs to over come their "fears or inhibitions" and "boom" the consequences of unprotected sex occur.
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Comment by: San (St> petersburg FL) Thu., Aug. 12, 2010 at 11:33 am EDT
Just wanted to support the comment from Drew(Sydney, Australia) . We need to make things happen... Dealing with churches is one of biggest chalenges.
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Comment by: WF (Baltimore, MD) Thu., Aug. 12, 2010 at 10:59 am EDT
All organized religions has historically been the cause of many events held in anathema today, and yes including perhaps as the cause for the rise of HIV rates among Black and Latinos, but some of the responsibility has to be taken on by the entire culture.

The stigma of being homosexual in these communities will perpetuate as long as homophobia is allowed to be a part of the community. Using terms like "DL", "MSM", "Same Sex Loving", do nothing more than support the denial of the reality that some men of color are gay, and fomenting the myth that only white men are be gay.

We are doing an injustice to ourselves, and the diaspora of the LGBTQ community by not addressing the real issues head on. Education about LGBTQ people in our communities is vital, and I will promise you that lifting the stigma of being gay will enhance self-worth and reduce unhealthy beliefs and behaviors.

People of color have to work at becoming a part of this society and end the self imposed apartheid. The LGBTQ movement is for all who identify as homosexual. Yes! Let's start using the term homosexual openly, and stop using these euphemisms that enshrines denial and ignorance. Until this happens the hiding, denial and the spread of this epidemic will continue to escalate.

I am a proud Afro-Caribbean, HIV poz homosexual man. I have nothing to ashamed about. I love men and will always to have sex with men. We have to stop coddling the low self-worth, bigotry and homophobia among our own people, and instead raise awareness of how these are elements of the rise of HIV in our communities; and that every man and woman has to take responsibility for their own behavior and well being. Self determination and responsibility will be a factor that will build a healthy community.

That is clearly the course of action that must be taken by each individual; and those that are in the position to educate have the responsibility to impart this knowledge and stop beating around the bush.
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Replies to this comment:
Comment by: NCFred (North Carolina) Sat., May. 14, 2011 at 2:45 am EDT
You have explained the problem in an excellent manner. I am a masculine African American man who is openly gay and HIV positive. I have been attacked by black churches because I asked several black ministers to include HIV awareness and prevention information with other information that they have at the church. The responses I got include things like "If a person has AIDS he deserves it because of abomination." None of the black churches in my town will even mention the word AIDS unless it is to condemn the people who have it. They don't understand that AIDS is not a "gay" disease. It is a blood disease. Because AIDS was initially associated primarily with gay white men, many black organizations such as the black church are refusing to participate in AIDS prevention and treatment efforts.


Comment by: gurlzone (New York) Thu., Aug. 12, 2010 at 10:44 am EDT
Just want to say that this is an amazing and thoughtful article. These men articulate the most important ideas I have heard yet about MSMOC and HIV. Is there a way to put this on my fb page?
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Comment by: MoreAnon (SoFlo) Mon., Jul. 26, 2010 at 7:05 pm EDT
Thank you gentlemen for the forum.
I must say that religion and the church is often accused of enforcing the many clandestine behaviors that oftentimes perpetuate the spread of HIV/AIDS, especially among men of color.
Pointing to the government [Drew AUS] as a source of this kind of societally influential pressure is, in my view, trying to find yet another scapegoat to point an accusatory finger at. I am aware of how vulnerable MSM, bisexual and gay men are to the pressures that are exerted by this[ese] group[s], but I believe that in 2010 (and beyond), it is FULL time now for this community to mobilize and become better informed LONG before sexual practices are even considered (this point was alluded to as a common thread throughout the article).

I also see where one of the panelists made a very key point: many people cannot even DEFINE what a community is, or where to find the people that comprise it much less to enforce and build on the information about STDs and the treatment base that is needed. My solution to this is that we need to encourage open dialogue with young men and women from an early age in the school AND church structures about sex, sexuality and the risks that are out there when such activities are taken into consideration.
Just like how various forms of prevention programs that exist start at an early stage [take for example, immunizations], we as a people need to start addressing a population that knows less and less about patience and seek all the pleasures that come with instant gratifications.
People need to be reminded of the ramifications of sexual practices in their various forms and be reminded of HOW it actually feels to be infected with a disease that has no cure as yet. When that point is driven home, I think more people will indeed start to wise up.
Thanks.
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Comment by: Drew (Sydney (AUS)) Thu., Jul. 8, 2010 at 1:47 am EDT
I think the elephant in the room with a rise in African American /Latino is the role of "the church".

In the African American Community the Protestant Churches in particular the Baptist Church has played a large role ..think Civil Rights Movement

And in the Latino Community the Roman Catholic Church plays a large part in family life.

The Church promotes a homophobic view point that makes it hard for many Gay black or latino men to come out ...thus creating an environment of denial. This can be seen with the concept of "the down low" where many Black and latino men who are in a heterosexual marriage have sex with men on the side.(MSM)

Just some food for thought. Im glad I now live in Australia with an HIV rate of 0.01% one of the lowest in the Western World, due to a proactive progressive Govt(Hawke / Labor) in the early 1980's unlike the denial illustrated by the Republican Reagan Admin, in the early days.

The Christian Churches in the United States have a strangle hold on the Republican Party...spewing hatred...very Un-Christian indeed.

Whereas here in Australia we have our First Female PM who is an out proud athiest...This would be political suicide in the United States.

Enjoyed the article.

Cheers Drew xxx
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Comment by: D. Smith (New York) Wed., Jun. 30, 2010 at 3:09 pm EDT
One of the main factors contributing to the spread of HIV in the minority community is "culture". Culture as I define it would consist of practices, behaviors and rituals which have become norms within our community. This factor alone sets in place an array of other conponets that operate to our community's detriment. Culture is continuously being create and influenced by powers which only desire to exploit our human capital potential for the maintenance of its prisons, judicial system, etc.

Freedom from HIV begins with our communities examing and creating new culture. We need to abolish behaviors (and I'm not speaking against peoples sexual freedoms, nor for the adoption of any fundalmentalist religous viewpoint), which lend themselves to our self destuction. Truthfully cultural practices that sustained us yesterday, may not work for us today. We must evolve in our thinking or risk self genocide.
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