Getting Heterosexual Black Men Involved in HIV Prevention, Part 1
Read any report on HIV in black America, attend any HIV conference or look up at an HIV prevention billboard and it's clear who is most impacted by this epidemic in the U.S.: black men who have sex with men (MSM) and black heterosexual women. Perhaps that heavy focus, along with homophobia in the black community, is what led to the belief in the down-low phenomenon, according to which duplicitous and sinister bisexual men are sleeping with men and also having unprotected sex with women.
And while so many in the African-American community buy into this myth, science demonstrates that that just isn't so. The down low is not fueling the HIV epidemic among black women. So, if it's not about men on the down low and the main source of HIV transmission among black women is heterosexual contact, at what point are we going to address the elephant in the room?
Heterosexual men do have HIV, and they are falling through the cracks.
In order to fully address this epidemic head on, we have to include heterosexual African-American men. But how do we go about doing this given the stigma and homophobia in the black community? What work is being done now that is making an impact among this demographic? And where are the heterosexual men living with HIV who will speak out?
Participating in this discussion on the subject are Ingrid Floyd, the executive director of Iris House in New York City, and Larry Bryant, the national field organizer for Housing Works in Washington, D.C. Bryant has been living with HIV since 1986.
Kellee Terrell: Ingrid, what are some of the major barriers that you face when getting heterosexual black men to get tested for HIV, use condoms or even come forth with their stories of being positive?
Ingrid Floyd: One difficulty that we face is that this conversation has traditionally been centered around men who sleep with men or gay men. And so a lot of heterosexual men tend to think that HIV doesn't affect them, that they are not impacted by HIV because of their heterosexual behaviors. They don't see themselves as being at risk.
I also think that, particularly in the black community, there is a taboo around condom use. There is the perception that someone who uses condoms is promiscuous, or you only use condoms if you're not trying to get pregnant. And so we have not made condom use a social norm in our communities.
So the fact that they don't see themselves at risk and the fact that condom use isn't a social norm make it even more difficult to get people to come in to get tested and learn more about HIV.
And definitely, because of the stigma around HIV, it makes it even more difficult for anyone who is living with HIV to come forward. It takes a little longer for us to get them to a point where they want to come in for supportive services, as well as to make sure that they're maintaining medical services.
Larry Bryant: I have to echo what Ingrid said about stigma, and the environment within the black community around homophobia, and just that acceptance of being able to talk about HIV and sexuality among men. Looking at how men and their sexuality have been historically represented in movies, such as Shaft and Mandingo, coupled with other stereotypes, such as the strong, silent black man, we have not yet been comfortable communicating our sexuality, or issues related to sex and identity. And nowadays, we repeatedly see images in videos and music that convey the macho, kind of non-emotional, non-communicative man -- you know, monosyllabic in communication.
But I think that economic disparities and educational disparities among black men also play a factor. For many, sexual health is not even a priority among the things that they need to deal with. It's about getting a job, getting an education, and making ends meet; it's about survival. HIV and STDs [sexually transmitted diseases] are just not on their radar.
A lot of young men, especially in the inner city, don't even expect to live into advanced stages of adulthood. It's almost a kamikaze attitude with some young black men to not anticipate having a long life.
Kellee Terrell: While too many African Americans are disconnected from the health care system, underinsured and uninsured, what little health care we do get seems to be geared toward women, due to this culture that doesn't promote health among men. They seem to have less of a connection to the health care system. Ingrid, in the work you do, do you find this to be true?
Ingrid Floyd: Definitely in family situations, we see that as the case, where black women are more inclined to make sure that the family is taken care of. So, what's the health of my family? What's the health of my children? What's the health of my husband?
What we have seen in some of our HIV testing programs is ironic because the majority of the people that we test are men of color. I think we're getting more awareness out about HIV testing, but Larry brought up a good point, which is that men's health is definitely not a priority across the board when we look at it from a public health perspective and when we look at it just in our communities. Men's health has traditionally not been a priority. Once our young men age out of pediatric care, it's hard for them to get back into care on a consistent basis. So they go without and it's not until something is wrong that they go and seek medical care.
Whereas, for young women, and for women in general, there are preventative services that you go to every year. You go see your OB/GYN. You're probably more inclined to go have a physical. For men that's not the same; they don't have those annual visits that we would want them to have where somebody talks to them about HIV or STDs. So, men's health normally takes a back burner unless there's an issue.
Kellee Terrell: This reminds me of that shocking, and somewhat depressing, report from last year that claimed that black men can live longer behind bars than they can in the general population, because of the health care they receive in prison. In prison, they are getting physicals, HIV testing, you name it.
Now, looking at the connection between HIV and prison, a lot of people believe that straight men go into prison HIV negative and leave HIV positive because they are sleeping with men while locked up. When in fact, there are many straight black men who were HIV positive before entering prison, but because of a lack of access and this belief that HIV is not their issue, the first time they are ever being tested for HIV is when they enter the criminal justice system.
Ingrid Floyd: Right. And to that point: The reason they have better health care in prison is because they are insured in prison. Most black men in our communities who are unemployed are uninsured.
Larry Bryant: And then, the other thing as well, is the lack of focus on sexual health among men. I grew up playing sports and we had these basic, stand-in-line, assembly line kind of physicals that didn't really focus on covering healthy sex, or education. And obviously, there are going to be some legal issues around HIV testing for use in that scenario. But it's an opportunity to at least have the discussion about safe sex on college campuses, where a lot of young men and women are beginning to explore, or are certainly having unprotected sex, and aren't fully educated on or aware of what the risk factors are and how to protect themselves as well as others. I know, having attended a historically black university, Norfolk State, that the old-school mentality of some of the administrators and college leadership really downplays the epidemic as it appears on college campuses today, and doesn't put a whole lot of emphasis on that.
For a young black man in school in that time and exploration age, it's an incredible opportunity to not just educate, but to equip that young man -- and that young woman -- with this kind of knowledge.
Kellee Terrell: We touched on it briefly, but I want to hone in on homophobia, specifically our obsession with the down low. How has it served as a barrier to getting black straight men engaged in this conversation?
Ingrid Floyd: Are there men who sleep with women and men? Yes. Just like there are women who sleep with both men and women. But I was never one who bought into the down low. The problem is that people feel the need to put labels on everything in order to have a way to describe and to categorize people.
Our homophobia and the down low have created another label. And this label creates another barrier to why people won't come in and get tested and why people won't learn more. This label also gives people another reason to say, "It's not me, and hence, I don't need to get tested. I don't need to know my status. Because I'm fine."
Larry Bryant: Beyond the whole "It's not me," the down low focuses on blame instead of accountability. Almost 10 years ago, when the quote-unquote down-low phenomenon was popularized, it took the place of intelligent conversation around solutions in the black community, particularly the rising epidemic among black women, and focused instead on blaming black gay men for infiltrating the community.
It's one of those bridges that we need to build, and rebuild, in the black community, when we're talking about collective positive outcomes in the community.
Kellee Terrell: Does the lack of data around black heterosexual men add another barrier? There are some CDC [U.S. Centers for Disease Control and Prevention] data out there, but when we talk about what data are really pushed, it's usually about black women or black MSM, especially young MSM. I don't see a push for data around heterosexual men, and it makes no sense, since in a ranking of who is most impacted, black heterosexual men come in right after black women.
Larry Bryant: I think there are multiple layers there. It starts in the community with a young man who identifies as heterosexual, who is either asking questions, seeking answers, or wants to get tested -- or even finds out his own status, like I did. Where do you go? Most visible programs and organizations don't speak to straight men. There are just not a lot of open doors that straight guys feel comfortable going through for HIV information, education, care or services.
So the data are absent because a lot of guys don't even show up. And over the years, there hasn't been specific information targeted at straight men or men in general. I think a lot of the pressure of identification comes along with that, which fuels the stigma that already exists in the community. So you get men that just don't show up, period, whether they are straight or questioning, especially when you're talking about young men.
I was watching TV the other day, and saw the Charles Barkley commercials: "Lose like a man." I've seen two or three of them and what I found interesting is that they are all of black men who are focusing on losing weight and being healthy. They don't imply anything about the men's sexuality, but we know who Charles Barkley is. And this other guy is a DJ from Detroit. I wonder if we had very straightforward campaigns like that, that focused on HIV, or testing, or had strong, identifiable male leaders in the community or nationally, whether they be sports figures or elected officials who stood up in a very real, non-dramatic way and just said, "Hey, I'm getting tested, and this is who I am," would guys show up. I feel like they would.
Kellee Terrell: It's just really interesting because here we are, so close after the 20th anniversary of Magic Johnson disclosing his HIV status back in 1991, and we still don't have many messages, if any, that are geared toward straight black men or men who identify as straight, but might have slept with a man.
Ingrid Floyd: Who else who is heterosexual besides Magic Johnson has come forward to disclose his status and have an impact on this demographic?
Kellee Terrell: No one. And frankly, I don't believe that he doesn't exist -- it's not possible, given the HIV rates in our community. In the end, there is so much stigma around this disease and what kind of man can contract HIV, that there is a fear that everyone will think this generation's Magic is lying about his sexuality.
Larry, I know you have come in contact with other heterosexual black men who are positive. What has been their fear? What have they shared with you about being afraid to disclose, or being afraid to be a public speaker or be an advocate?
Larry Bryant: Sometimes it's the heat of the speculation. You know, it's standing in front of a crowd and talking about oneself and knowing that there are whispers in the back of the room saying things like, "Yeah, right."
But I think it's also the additional social issues that exist. Because a lot of guys, particularly guys I know, aren't just living with HIV -- they're living with HIV and have a history of addiction; they're living with HIV and have a history of being incarcerated; they're living with HIV and have mental illness and other health issues. It's also, in some ways, pressure from their own families, from their spouses or people they are dating, or from folks in their support system, to not be out with one's status, because they don't want to be associated with that spotlight.
There are also a lot of guys who just don't want to deal with the backroom questions or the judgment that comes from different places. It's tough, because if there were straight men out there, it would help broaden the conversation. But I also want to point out that it doesn't have to be a celebrity. Like I said before, it can be a pastor or an elected official; everyday people we see in our community can be impactful.
Read Part 2! It covers initiatives to get more straight black men tested and involved in this conversation.
This transcript has been lightly edited for clarity.
Follow Kellee on Twitter: @kelleent.