Black Community Is Not Talking Enough About HIV, Activist Leader Warns

Q+A with Carlos Velez, Director of Technical Assistance, Training and Treatment for the National Minority AIDS Council

What do you focus on in your HIV/AIDS advocacy work?

As an organization, NMAC [National Minority AIDS Council] is building the capacity of small- to medium-sized minority community groups to provide HIV prevention and care to African Americans.

What is the most critical AIDS issue facing the African-American community?

Confusion about who is really at risk for HIV, with the result that HIV prevention and education are being focused in the wrong direction.

If you look at the HIV statistics for African Americans, something like 40 percent among men are men who have sex with men [MSM], another 40 percent are injection-drug users [IDUs], and then there is a percentage of heterosexual men. But what those statistics don't tell us is the risk of transmission for those men identified as heterosexual. Those men became infected with HIV from having sex with women. So it's important to recognize the risk of getting HIV from women as well as from men.

But the question is, who are the women infecting the men? The answer is, at least in part, women who are drug users, women who are the sex partners of men who inject drugs, women who are sex workers. But the statistics don't really reflect this reality.

How would you best address that?

That's a tough one. Recognizing the reality of who is at risk requires all sorts of discussion that, as a community, African Americans haven't had. Then, you don't see 40 percent of the prevention and education activities in the African-American community being devoted to the 40 percent of the MSMs who need them. The same with injection drug users, sex-industry workers, and so on.

People want to do prevention and education for young African-Americans teens who are still living at home with their parents, going to school, going to church. I'm like, "OK, they may engage in sex, but is that population at as high a risk as the women who are in the crack houses, having multiple sex partners, unprotected?" All interventions are important, but we should direct our attention to the most at-risk populations.

So you would say that the HIV prevention and education programs for African-Americans are not reaching the right people?

Well, when was the last time you saw in your neighborhood any kind of the HIV prevention or education directed directly to African-American women who inject drugs? For example, there is this popular intervention right now -- the Sista Intervention -- developed by CDC and based on HIV literature about African-American women. It is intended for women at highest risk for HIV, those with a history of incarceration. Some prevention providers, however, have used it for women at little or no risk. They use it to recruit women at a mall on a Saturday. And I'm like, "If you want to work with women who are at a mall on a Saturday with a brochure -- fine. But that's not targeting women who are at the highest risk!"

Where do you think the most progress is being made in combating the epidemic in the black community?

I think a significant sector of the African-American community has acknowledged that there is such a thing as African-American gay men, who don't have a lot of information, who don't have a lot of resources, and who are facing a lot of stigma in the community.

A lot of progress has also been made because a significant portion of the general population in the country has recognized that there is a serious problem with AIDS in the African-American community, whereas 10 years ago, people didn't want to talk about or acknowledge it.

What would you say are the top myths about HIV that you encounter?

"It's not going to happen to me," that's number one. Second one, "You can just say no" -- as far as I know, I don't know anyone who can just say no to sex or drugs. Also, "abstinence is great," and, "injection drug users will never change their behavior."

And what would be the best way to counter these myths?

To create programs that counter the stigma of HIV in communities of color, because all those myths are actually the result of stigma.

Having role models is important. For example, we can all think of injection drug users who have successfully kicked their habit and become productive members of society. Same with people who have been incarcerated.

Another strategy is role-playing -- imagining how you would deal if you had to work with someone from this community. It's a great stumbling block for a lot of us -- including people who do prevention and education -- who think we would never be able to deal with someone who's in prison because they were using drugs. So before we meet a drug addict or someone who's in jail, we can learn to deal with our feelings and reactions in order to get to know and serve these people better.

How is the HIV epidemic different in the black community than other communities?

The biggest difference is that, for the most part, white people with HIV have greater access to resources -- information, insurance, treatment, services, organizations -- than people of color with HIV. Whether they're women or gay men or MSMs or whatever, African Americans with HIV generally don't have anywhere near the same access to resources. So there's a marked difference in terms of time of testing, quality of care, and, ultimately, survival.

What could help African-Americans get tested -- and therefore treated -- earlier?

I went to a consultation with CDC [U.S. Centers for Disease Control and Prevention] on that one, and what people said was, "You need to make it a routine part of medical care that African Americans get, in whatever settings." Somebody else said, "You need to do it in the churches" -- that's an overarching theme whenever I go to an African-American meeting, like we have to go to the churches to do everything.

Again, as with prevention and education, both of those approaches may miss a significant portion of African Americans with HIV -- especially the MSMs. If they're not gay-identified, if they've got a female partner, they're going to say, "Well, I'm not going to get tested because people are going to know I'm having sex with men and say it about me, too." Some recent literature says that to really reach these guys, you need to go to where they are having sex, when they are having sex: If you know of a park at 4 a.m., you go and recruit them there. So I think it's not just one or two, but, in fact, many different strategies that are needed.

Do you think the "down low" is as serious a problem as the media has made of it?

No, I think that's been sensationalized. It's something that a couple of people are making a lot of money out of, giving speeches and writing books on being on the down low, and people who know them will tell you they've never been with a woman in their life! I'm not going to say that it doesn't exist, but I think it's blown out of proportion, and I think it's something that exists in all communities. There are white men who do the same thing -- they call themselves "bi-curious." In the African-American community, it's just known as "being on the down low," and that's even become a trendy thing.

There's still a lot of stigma to being gay, no matter what community you come from. Being "bisexual" looks and sounds cooler than being gay. So that's a very big thing, especially among younger people who haven't really decided. Or even among male sex workers who only have sex with men. I'm not saying that's the way it always is, but there's a lot more folds and layers to the issue than just saying there're all these men on the down low out there.

What are your fears and hopes for the next generation of African-Americans as they face the risks of HIV?

Well, you know, the issue of race hasn't been resolved, and won't be resolved in our lifetime. When you hear that every one out of three black men will be in prison by the year 2010, that's scary.

And it's not only these black men who go to prison who will face a much greater risk of HIV. The women who date them when they come out will, too. When it's one out of three, and it's like a revolving door, where the men are going in and out of prison and the women are dating them! That's why we have a program that promotes planning for people with HIV who are in prison, so that they get into care as soon as they get out.

Do you think activism is an effective way to fight the epidemic?

Yes, if it's directed the right way -- not just outward to policymakers, but also inward to the community. That is to say, injection drug users and gay men are a part of our community, and if we ignore them, they're not going to just go away. It's our responsibility to address the needs of all our community members.

Can you recommend one action that we all should take to end the epidemic?

Overcome homophobia. Some people still have a fear that they or their kids are going to be infected with homosexuality. It's not a fear about being infected with HIV -- and dealing with HIV in a rational way as a health issue -- but it's more about "people are going to think I'm gay." As soon as we, as a society, overcome homophobia, it'll be better for everybody.

Click here to e-mail Carlos Velez.

Carlos Velez

About Carlos Velez

Velez is the former director of technical assistance, training and treatment for the National Minority AIDS Council (NMAC), a Washington, D.C.-based organization founded in 1987 with the aim of building leadership in communities of color to fight HIV. NMAC sponsors three influential annual conferences: the HIV Prevention Leadership Summit, the United States Conference on AIDS, and the North American AIDS Treatment Action Forum.