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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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"Young, gay men just didn't experience the mass death of friends and lovers, and so on and so forth, in the 1980s and the early '90s, and so they don't have a relationship to the disease in the way that men who are older, who were sexually active adults at the time of the early part of the AIDS crisis."
-- Kenyon Farrow

Kenyon Farrow: One of the things I keep hearing a lot about gay men, in general, and the increase in new infections -- and particularly, people are often saying that young, gay men just didn't experience the mass death of friends and lovers, and so on and so forth, in the 1980s and the early '90s, and so they don't have a relationship to the disease in the way that men who are older, who were sexually active adults at the time of the early part of the AIDS crisis, do. We hear that myth a lot, that there's a disconnect, that people suggest that having that experience of so many friends and lovers and folks dying before the antiretrovirals, seeing a lot more people with KS [Kaposi's sarcoma] and any of the other markers of disease progression without medications, [makes a difference]. And so, I just want to ask you: Do you think that that's true for young, black and Latino, gay men? That they don't have a relationship to the disease in the same way, because of HAART [highly active antiretroviral therapy]?

It's open for anybody to take.

Sheldon Fields: I'll start. No. I think it's an oversimplification of the argument. While, yes, they may not have had a lot of personal experience with people dying, they most certainly have had a great deal of exposure to people becoming infected, and what that means for their life.

The medications are better, but the medications are still not harmless, in terms of the types of side effects that people get. We're talking about a generation who has not ever not known the presence of HIV in their life. We're talking about them being exposed to this knowledge at all levels within their schools, within the general media.

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I do not think it's a lack of knowledge. There's another factor here. Well, there are several other factors here. But it's not simply just a lack of knowledge, or a lack of experiential knowledge related to having had friends die. I don't buy that argument. The youth that I research, when I ask them about why they do some of the things that they currently do that we know still places them at risk, I get a lot of, "I didn't think about it," or, "In that moment, it just didn't seem that important." I get a certain amount of, "I feel like it was almost going to happen to me, anyway. So I might as well have fun."

And then, of course, as was brought up earlier, there's a great deal of substance use and abuse that is going on that alters their ability to respond to certain situations in the most coherent manner ... primarily of which, in the groups that I study, is a great deal of marijuana use. People just take marijuana for granted -- like, "Oh, it's not a drug that alters your thinking." And it really is.

Kenyon Farrow: Francisco?

Francisco Roque: I would echo: absolutely not. I think that while that is true that they did not certainly grow up seeing all these folks die around them, I think what is different about this generation is that they did, however, grow up with HIV. And so it is not a generation where HIV came along, and then they were impacted by it, as an occurrence. HIV has been with them all their life. They have been brought up around that. They have been brought up with the culture of use condoms, and the safer sex, and the messaging.

It's fascinating to me when I'm asked, "Well, what's the disconnect? What's going on with young MSM, or young, gay men? What's going on that they're not getting it? The information is out there."

I almost always turn the question around to whoever is asking and I say, "Have you ever had unprotected sex?" And nine times out of 10, the answer is yes. Sometimes they choose not to answer.

Kenyon Farrow: Which means yes.

Francisco Roque: But nine times out of 10, the answer to that question is yes. See, we look to be different from folks, often. We often look to see how we're different, before we look to see how we are the same.

"The truth is that young, gay men of color are having unprotected sex for the very same reasons that everyone else is having unprotected sex: for love, for connection, for intimacy, for touch, for sex, for pleasure. There's nothing different that's happening. And we know this."
-- Francisco Roque

The truth is that young, gay men of color are having unprotected sex for the very same reasons that everyone else is having unprotected sex: for love, for connection, for intimacy, for touch, for sex, for pleasure. There's nothing different that's happening. And we know this. More and more studies are beginning to show us that, in fact, gay men are practicing higher rates of safer sex than heterosexual folks. We know that, in fact, gay men of color are engaging in higher rates of safer sex than their white, gay counterparts.

And so there's enough data to suggest that it's the pool in which we're swimming. If there's more infection, then you're more likely to be exposed to HIV, given who you're having sex with. And so, given that, we need to begin to relate to people differently, youth and otherwise. We need to begin to see people as solutions, and not problems.

We continue to relate to folks as though they are doing something wrong or different than other groups. I think that that sets up this stigmatizing dichotomy that really is counter to what we are trying to do. And so I feel that it's very important that, in our prevention efforts, we look to lift people up and to highlight what is working, and to continue to give people information so that they can make informed decisions.

But under the framework of there's nothing wrong with you, and in fact, what you're doing is not different from what others are doing. I feel like that's missing. And oftentimes, it's interesting because we certainly do it with people of color. But then when we narrow it down even further to young people of color, we often look to be different from folks. And I just think that that is one of our biggest downfalls in HIV prevention.

Kenyon Farrow: Vaughn? Your thoughts?

Vaughn Taylor-Akutagawa: I'll echo what everyone else says, and add, briefly: Again, it's one of those research questions that are incomplete, that we've never really studied. We make an assumption that somehow young people don't get it. But we know that they can negotiate sex; they can negotiate resources; they learn enough to size up older men to use them for resources; they connect for various different reasons.

But we as men, or in the field of science yet, cannot definitely say, when a man has sex it's for this reason, XYZ. And we can even exclude biological exuberance. To say that they haven't experienced HIV death puts them in a box and, particularly for urban kids, excludes the reality that they've seen death. They've seen people get shot. People in New York have lived through 9/11. They see death left and right.

The way they may experience it, or choose to express it, may be different. But we never actually look at the number of support groups you have for people to cope with death.

We have kids that went through horrible situations that would make my hair turn gray ... and it's everyday life for them, because they know nothing different. If you really want to assess what messages have made it, we need to ask men across the continuum.

As a 42-year-old man, I can tell you: None of the messages I've ever seen have ever spoken to me, in any way whatsoever. Unless the guy was cute, and I can tell you what he looked like, I couldn't tell you what was on the message.

Kenyon Farrow: Funny.

Vaughn Taylor-Akutagawa: I'm being honest.

Kenyon Farrow: I know. It's real, right?

Francisco Roque: Mm. Yeah. You're 42? [Laughter.]

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