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What's Goin' On? Lessons From the Book of Real

Critical Conversation Produces Critical Reflection

September/October 2010

Keith Green As cliché as it may sound, I stand firm in the conviction that the only way to reach our young people today is to keep it real with them. I'm also clear that, in order to keep it real with them, we must make a conscious decision to always keep it real with ourselves!

I was recently engaged in conversation with a young man interested in participating in one of the research studies that I oversee. Incredibly inquisitive, with an impressive degree of insight, his questions challenged me to contemplate the difficulty associated with HIV acquisition. From his perspective, the statistics give the impression that HIV is easy to get -- it's estimated that one out of every four young Black men who has sex with other men (MSM) in his age group in Chicago is living with HIV. His personal "high-risk" sexual behavior, however, which includes frequent unprotected receptive anal intercourse, seems to contradict this idea.

So, how exactly has he been able to remain HIV-free up unto this point, he asked me? Could it be something genetic? Or had he simply been lucky?

Without any information to support that he has some type of genetic protective factor, I deferred to my toolbox of basic HIV-transmission information. Premised by very clear-cut categories around modes of transmission and infectious fluids, the level of risk that he reportedly assumes would make luck (and perhaps a grandmother's prayers), the only logical explanation for this young man's ability to remain HIV-negative.

My efforts to help him to understand how such a thing might happen forced me to take a critical look at the messages that are often given to young men who have sex with men about the risks associated with their sexual practices. For the most part, we teach them a public health rendition of the old trusty ABCs (Abstinence before marriage; Be Faithful to one's partner; and always use Condoms). All other practices are then demonized and sure to result in HIV infection. The blame (and stigma and shame) is then placed on those who are HIV-positive for contracting a virus that is 100% preventable.

What we often neglect to teach young people, however, is that even when an unwrapped, cum-filled, newly infected penis penetrates a tight, throbbing, bubble-shaped rear-end, the finished product does not necessarily result in transmission. We don't explain to them that there would need to be a rupture or some type of irritation to the "pink parts" of that rear-end, in order for HIV acquisition to occur. Granted, the actual act of penetrating the rectal cavity can cause such a tear or irritation, as can the cleansing routine used to prepare it for penetration and a myriad of other things (including the presence of sexually transmittable infections such as rectal gonorrhea or chlamydia).

The truth of the matter, though, is that as risky as the act described above is, it is not always the catastrophe that people like me have been programmed to teach other people that it is. And, more importantly, knowledge of this can help those who opt out of using condoms, for whatever reason, make better educated choices about the way that they engage in sexual activity.

And this is where I was forced to get real with myself.


Understanding the alarming infection rates among men who look like me, and being heavily involved in a pre-exposure prophylaxis (PrEP) study for the past year, I've become a staunch advocate for concepts of biomedical prevention (microbicides, PrEP, etc.). I've been saying for years that what we are currently doing is obviously not enough to curb the epidemic, and that biomedical interventions, if proven efficacious, could become powerful tools in our proverbial toolbox of HIV prevention interventions.

What my encounter with this young man made me realize, however, is that we haven't been making the best use of the tools that we already have. This young man has been involved in several of the HIV prevention programs offered throughout this city. But, for whatever reason, HIV transmission and acquisition had not quite been broken down to him in this way. As a result, the world is now beginning to believe that the only hope for him is medicalized HIV prevention (at least as a temporary fix until he is able to make "better choices" to decrease his risk).

If he's not given better information, though, he can't make better choices. And, if he can't make better choices, then what happens? He'll either eventually seroconvert, or be on a pre-exposure prophylaxis regimen for the rest of his life.

In my humble opinion, neither of those options is acceptable or feasible. Therefore, the real in me has returned to the drawing board to strategize more efficient methods of information dissemination ... THAT KEEPS IT REAL!

If knowing is half the battle, then our problem is that we are ill-equipped for war. And that's "realer than real deal Holyfield," as Snoop Dogg would say.

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This article was provided by Positively Aware. It is a part of the publication Positively Aware. Visit Positively Aware's website to find out more about the publication.
See Also
Quiz: Are You at Risk for HIV?
10 Common Fears About HIV Transmission
More Viewpoints on HIV Prevention for Young People

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