For the first time in 30 years, Black Pride during Memorial Day weekend in Washington, D.C. was cancelled, amid fears of a COVID-19 outbreak. As COVID-19 cases and deaths continue to rise—with a heavier impact on Black people—event organizers will soon need to be making decisions to cancel Black Pride celebrations in cities like Chicago, Los Angeles, Atlanta, and Dallas. Unfortunately, a by-product of cancelled Black Pride events will be the loss of a bulk of the necessary outreach work to increase testing, prevention, and linkage to care of those who test HIV positive—a loss that may be dire if organizations don’t strategize the 2020 approach to HIV care.
The reopening of the United States has been a sliding date since the president “in jest” announced he would have the country reopened by Easter Sunday. Currently, most of the country is still living under some form of stay-at-home order, with Los Angeles County recently extending theirs until July 8. Although many states are starting to roll back restrictions in an attempt to reopen the economy, it is clear that COVID-19 will be a problem until a vaccine or an effective treatment is approved. And until that happens, most large-scale events will likely be canceled until 2021.
These large-scale events include Black Pride celebrations. In addition, the cancellation of traditional and more mainstream Pride parades—which often have more predominantly white attendees—will also hurt prevention efforts for the LGBTQ community as a whole. Black Pride celebrations have been known to bring crowds of as many as 100,000 Black LGBTQ people together to celebrate queer culture and history and support a rather large party and club scene.
These events have also become a staple in HIV and sexually transmitted infections (STI) testing efforts for decades, not only for Black-centered AIDS service organizations and community-based organizations, but for larger health care facilities that provide HIV services. According to the Centers for Disease Control and Prevention (CDC), if current trends continue, 50% of Black men who have sex with men (MSM) will contract HIV in their lifetime.
With testing ultimately being the most important component in HIV prevention, these yearly events have become essential in locating newly diagnosed HIV-positive people, as well as those who have been previously diagnosed but need help connecting to HIV care. Dissemination of prevention materials such as condoms, lube, dental dams, and information about pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) has also aided in the reduction of new cases that could occur from sexual activities among those who may be positive but unaware of their status.
Many of these nonprofit organizations centered on HIV work are locally, state, and federally funded. Meaning that funding is often attached to metrics and goals, including the number of people tested, number of clients connected to care, and number of those who test positive, as well as prevention efforts such as condom distribution, educational programming, and connection to other services, such as those for substance abuse and mental health. Failure to comply with agreed-upon metrics could result in loss of programs and reductions in grant dollars to continue running the organization—although some health departments are helping organizations adjust their testing and linkage-to-care goals due to disruptions caused by COVID-19.
Us Helping Us continues to serve as the largest Black gay community-based organization devoted to HIV work for Black LBGTQ people in Washington, D.C. As a former director of testing and counseling at UHU, I planned several strategies around Black Pride testing—which for decades served as the largest testing effort each year for the organization. I spoke with F. Antonio Burt, the current quality assurance manager at Us Helping Us, to discuss how they are approaching their first year with no Black Pride.
According to Burt, “Program and promotion is key,” referring to how organizations have to stay connected to the communities they serve during the COVID-19 epidemic, when people can’t come into their space to be served during shelter-in-place measures. “If you don’t have a successful social-media outreach and promotion function, you may as well just stay in bed,” he said. Burt has served in many capacities throughout his decades-long career in HIV work, including as UHU’s director of testing and counseling, as well as developing contact-tracing strategies to find undiagnosed people with HIV through social networking, which usually involves newly diagnosed positives providing the contact information of sexual partners so that they can be reached for HIV testing.
COVID-19 has severely affected hospitals beyond capacity, with many health care providers classified as essential workers across the globe contracting the virus during their treatment of COVID-19 positive patients and, unfortunately, dying from the virus themselves. Those in HIV work are no different. The work in treating and diagnosing new positives is still essential even during a pandemic, meaning that staff—who, in many cases, are underpaid—are putting their own health at risk for the sake of community.
“In a way, COVID-19 challenges many of us around why we chose to do this work,” states Burt. Despite warnings about having sex during self-isolation, with guidelines issued by many states about prevention, Burt says, “We must be honest with ourselves in understanding that people are still having sex and hooking up during this time. Staff has to check-in with [themselves] to see how they can be effective and treat MSMs with new infections of HIV and STIs while being protected from COVID-19.”
Acknowledging the severe effects of not having Black Pride as a place to do testing, Burt shared techniques the organization is using to still remain as effective. “It truly breaks down to a client-centered approach, following up with former clients, creating safe ways to treat clients by using appointments, and also creating a safe space in the office/clinic where clients will still be inclined to come in on their own.”
The real takeaway from this is simple. COVID-19 may forever change the way we approach HIV work. Testing, in many cases, has not become a normalized reality in the communities most affected by HIV. Meaning, it has not become part of the regular continuum of health care for Black LGBTQ people as much as it has been a reminder of the risk involved with sex as a Black queer person.
Much of this can be attributed to stigma from the height of the epidemic, medical distrust, and multiple barriers to care that have always plagued Black people. However, agencies must use this moment to create new systems and strategies to adapt to not only the current situation, but to evolve from the use of large-scale events as the bulk of the effort—rather than creating sustainable yearlong systems that potentially have greater effectiveness.
Currently, it is recommended that if you are a Black MSM who is sexually active, you get tested four times a year. From experience in the field, this wasn’t a common practice, nor were regularly scheduled testing appointments. It is common that more services are available once a person tests positive versus with preventative care, which has always been a hurdle for organizations doing grassroots HIV work. However, testing is still the greatest tool, and with that, strategies need developing as the landscape of HIV continues to change.
Another strategy that has often been key in grassroots work has been outreach. When the target demographic is unwilling to come through your doors, you go through their door. Although COVID-19 has prevented much face-to-face contact for safety reasons, it doesn’t mean prevention supplies such as condoms, lube, etc. can’t be mailed to those in need. This is why having a database of clients in addition to social media is a must.
Testing and prevention will need to mirror case management post–COVID-19. Black Pride events should be viewed for their ability to increase testing numbers, but for a robust testing and prevention program, a yearlong approach is needed. It’s a matter of consistency versus focusing on a high-volume-event approach. Currently, case management for most organizations is for those who are either HIV positive or using PrEP. Testing has been more of an additional service offered rather than a client-centered component of ongoing support and case management for those who are HIV negative.
It is during times like these that we will need organizational restructuring as we work to End the Epidemic by 2030. We need to accept the hard truth that due to COVID-19, things will not be returning to normal anytime soon. As we know, COVID-19 already harms Black and Brown people at higher rates, much like HIV.
It is time to strategize a new way forward, or we will not be ending any epidemic anytime soon.