In early March, researchers at the 2014 Conference on Retroviruses and Opportunistic Infections (CROI) revealed a stark 12.1% HIV incidence among young black gay men in Atlanta, Georgia -- the highest rate ever measured in any population of a resource-rich nation.
We turned to one of the early strategists of the HIV prevention justice movement, the Atlanta-based writer Charles Stephens, to weigh in on this data and to spell out (in a four-point plan!) what is needed for a more effective and just response.
In the research presented at CROI, researchers pointed to multiple structural factors including imprisonment, unemployment, and lack of health insurance as primary contributors to the high rate. Adding the growing recognition of high HIV infection rates among young black gay and bisexual men to persistent calls in Atlanta and across the South to expand Medicaid to provide critical access to health care, the study illustrates on how these factors are so strongly intertwined in perpetuating the epidemic.
Stephens weighs in on the implications of the study, revealing layered issues of collective trauma, cultural and sexual identity, intimacy and desire, structural violence, and the everyday stigma that young black gay men face. In this interview with HIV PJA, Charles challenges the institution of public health, calling for a deeper-level of understanding what young black gay men face. He discusses how a new era of prevention strategies -- in which promotion of resiliency is twinned with policy change -- could curb the rising HIV epidemic among young black gay men in Atlanta and beyond.
HIV PJA: What was your first reaction hearing about this study at CROI and the 12.1% incidence rate?
Charles Stephens: I've been hearing statistics like this, doom and gloom, my entire life. Initially, it was about gun violence, drugs, or incarceration. Then it was about HIV. Unfortunately, the counter to this is often rooted in incentivizing and affirming various kinds of institutional assimilation, representative of pictures of black kids getting into Harvard.
This "talented-tenthism" reproduces a kind of mythology that institutional access, no matter how limited, is an example of collective social uplift. I think it's very dizzying, these simplistic depictions (statistics are a form of representation too) that as black men we get shoved into. And HIV statistics also paint both a very clear, but also very narrow picture of what it means to be a black gay man, and certainly a young black gay/bisexual man in this culture today. It can feel very overwhelming.
HIV PJA: The research that came out of CROI, reinforces much of what we already know about how structural factors such as incarceration and unemployment impact a highly marginalized and misunderstood community. What do you think is contributing high incidence among young black gay men in Atlanta?
CS: First, the role of collective trauma as a structural vulnerability that impacts the lives of black gay and bisexual men, and even young black gay and bisexual men. This needs to be considered more. We still have yet to fully grasp the impact of AIDS and death on the 1980s generation of black gay and bisexual men, and all of that "unmourned grief."
My question is, what happens to a community or communities, a culture, when in a decade or more, many if not most, of the leaders, artists, visionaries, warriors, are taken away, and in a relatively short amount of time. How does that impact not only the cultural production, economic power, political force, of a people, but its spirit? What happens to the spirit of that community? The political will? The agency? The cultural landscape? I believe that collective trauma has functioned as a major structural vulnerability for not just individual black gay and bisexual men, but black gay and bisexual communities. It's insufficient to only speak of networks from a sexual risk perspective, without considering how trauma also impacts many of those networks, many of those groups. The problem isn't black men sleeping with each other, it's the environment that surrounds them.
Second, certainly having access to all of the tools that are currently available is critical. Expanding Medicaid in Georgia is essential, as is access to sexual health education, condoms, PrEP, PEP, Treatment and Care for HIV positive individuals, and everything else in our arsenal. We need every tool and resource available to us in the hands of young black gay men.
We also have to understand the ways that "no fats, no fems," and other forms of micro-aggression that we have absorbed from the dominant culture and reproduce among ourselves, diminishes our resilience and disrupts our agency. What does it mean to access an app looking for community, or even momentarily sexual pleasure, and be assaulted or affirmed based on your ability to embody the values of the dominant culture? We are rewarded and punished based on our compliance to narrow notions of desirability. Which I think also stems from early boyhood trauma and wanting to be accepted by other boys, or at least survive them. We must figure out ways to create healthier and more affirming spaces. Spaces where young black gay and bisexual men can be affirmed, feel valued, and feel recognized not just based on their desirability, though certainly eros is important too, but also their humanity.
Though I recognize that structural violence often takes the form of oppressive federal and state policies, we also have to think about structural violence as manifested ideologically and institutionally. Ideology is the hammer of structural violence, the boot, the fist, the Public Relations division. It's not enough to say: use a condom, get PrEP, fill out that housing application, fill out this treatment application, go see your Case Manager, call your therapist, go get insurance ... navigating bureaucracies, even the most culturally competent ones is an exercise in resilience for even the most empowered people. So we have to be willing to identify ways to build the agency of young black gay and bisexual men. Especially when so many forces around them tell them "no."
HIV PJA: Is there a hidden story? What do you think is not revealed in this study?
CS: We need to better understand how black men having other black sexual partners might describe some of the HIV vulnerability we are facing, while being careful not to stigmatize the intimacy between black men, which I think may be a kind of implicit assumption of this framing around sexual networks.
I believe that the prevalence of HIV in sexual networks of black men is perhaps descriptive, yes, but I worry that this descriptor may tumble down into the realm of causation, which I think can lead to some conclusions that might reproduce the things we are attempting to interrupt.
HIV PJA: How do you think the results and conclusions of this study impact HIV prevention efforts in Atlanta?
CS: I think if anything, it should inspire us to take action. And not merely having more testing events, or more social marketing campaigns. We need community development and community restoration, which must be a public health priority for black gay and bisexual men.
I think that we need to do a better job of not merely proliferating interventions, which in my opinion, only address the problem partially, and absolutely committing to the building of community institutions. The investment in interventions leads to this kind of "trickle-down" approach to Public Health, where the large community organization gets funded and creates a program, which is usually under resourced, to serve the population. They will at best hire a community member or volunteer to run the organization, at best, but at the same time erecting a number of institutional obstacles for them to run the program. Or the smaller minority organization is funded, but again, the expectations around infrastructure and administrative burden becomes unmanageable. So my question is, what other models can we imagine to invest in young black gay and bisexual men, and how do we best implement that?
In Atlanta, the "black gay mecca," there should be a black LGBT community center, where young black queer folk can learn about their history and culture. There needs to be an LGBT Center on the campus of one of our many HBCUs in Atlanta. There should also be funds for social entrepreneurship, to adequately grapple with this issue, we want to inspire young black gay and bisexual men to not just strive to be middle or senior managers within already established and in many ways compromised bureaucracies, but leaders, entrepreneurs, and visionaries. Innovation should be the goal, constantly.
Though I recognize the value of strategies like PrEP, we must remember that PrEP is a valuable strategy, clearly, an effective strategy obviously, but not a vision. We need to have a vision for young black gay and bisexual men. We need to also commit to investing in young black gay and bisexual men, not merely "protecting," them from HIV, but seeing them as valuable as we are all valuable, and seeing their humanity. The question shouldn't stop at how do we prevent them from getting HIV? Though yes, that's a question we should ask, but also and I think more fundamentally "what is our vision for young black gay and bisexual men?" A conversation that obviously young black gay and bisexual men should be leaders in.
HIV PJA: What recommendations do you have for public health and policy?
CS: Though I recognize at grappling with HIV from the policy level is important, evident in the calls for advocates to ensure the expansion of Medicaid in states like GA, and greater access to PrEP; we cannot afford to ignore the importance of intervention on the cultural level. We must find within black gay and bi men's culture, the sacred spaces, rituals, narratives that can serve as sources of resilience, inspiration, and provide the blueprints for our collective protection.
We must also better understand what's working, how young black gay men are remaining negative. Especially in these high-risk areas. We should also have discussion circles, across generations to share strategies for remaining negative, among black gay and bi men.
We need to develop learning communities particularly across the south, bringing together researchers, journalists, people from the private sector, community activists, funders, artists, for a robust response.
It's also critical to not only recognize the importance of and commit to investing in better educational outcomes for young black men, but also investing in the health of young black men. I see them as intricately tied. The same structural factors that drive poor health outcomes also drive poor educational outcomes. They reinforce each other. We want to think about all of the vulnerabilities that young black men in this country face, including those that are queer.
HIV PJA: What can we do to effectively address the epidemic among young black gay and bisexual men more effectively and fundamentally?
CS: Our work is to do four things:
- Work on the policy level to ensure access to all of the HIV prevention tools we have in our arsenal. Ensure that there is access.
- Work to build and sustain black gay and bisexual men's institutions, and not just interventions or programs, but actual community institutions. More faith spaces. More cultural spaces. More community meeting spaces. Civic organizations. Think Tanks. Places where culture can thrive, stories can be passed on, intergenerational dialogues can happen, art can be produced.
- Develop a research and policy agenda for young black gay and bisexual men where we understand more fundamentally what's happening with them. There is still so much we don't understand.
- Develop interventions that are centered in pleasure. I think there has been a false perception that gets circulated that young black gay and bisexual men are not sufficiently "afraid," of HIV, and I think that's inherently problematic. What I find is a kind of spectrum of emotion from intense fear to powerlessness to a kind of numbness. Part of the impact on structural violence on our lives is that it inhibits our emotional spectrum. We are often in a state of anxiety or ambivalence.
My generation of black gay men, those of us that were born in the 80's and came into our sexuality in the late 90's and early 2000's, the Post-Protease generation, have been bombarded with these apocalyptic depictions of our desires. We learn shame and fear before we learn pleasure and I think that significantly diminishes our agency. For those coming out now, in this current landscape, it's even more abysmal, since they have fewer examples of thriving black gay men's communities. They are facing a moment where certainly there are more athletes and entertainers that are coming out, but fewer actual places where they can be affirmed.
Webcast from CROI 2014 on this study is available by clicking here.