Earlier this year, the U.S. Centers for Disease Control and Prevention (CDC) announced that it is regarding racism as a public health issue and has committed to investigating the systems of racism to “achieve health equity for all.” Throughout the last year, we have witnessed Black and Brown communities suffer tremendous losses throughout the COVID-19 pandemic—loss of loved ones, jobs, and housing, far too often exacerbated by food insecurity and an array of other health disparities. Alongside this despair, we have witnessed the creation of innovative solutions prompted by the pandemic, some of which have forced us to think critically about ways to better our society.
For many of us, that innovation toward health equity starts within our own communities and through community participatory research. Recently, I partnered with Code Tenderloin, a Black-led, San Francisco-based nonprofit that provides job readiness training, to launch the pilot Empowering Black Youth, a program funded by the San Francisco Department of Public Health. The program was developed with a goal of decreasing sexually transmitted infections (STIs) in the county of San Francisco by the year 2030. Another aim: to engage Black youth to design and implement public health content that will be recognized on a local, state, and national level and implemented in communities—and demonstrate the importance of community participatory research.
With the thinking that intergenerational learning has had to take place to develop cultural paradigms that are respected by the Black community, the project is a collaborative effort between independent Black researchers, Black college students, Black high school students, Black elders, and Black stakeholders.
Black youth face significant and disproportionate barriers to HIV, STI, and pregnancy prevention services—and even adequate sexual-health information. So, as part of the project, I meet weekly with Black San Franciscan youth (our interns) ranging in age from13 to 20 over several months via Zoom, providing technology skills and public-health training in two phases. During the first phase, the interns receive education in sexual, reproductive, and LGBTQ+ health and learn how to use technology platforms such as Microsoft Office, Google’s G Suite, and iMovie. During the second phase, the interns merge sexual-health and coding education to create public-health education tools, including board games, pamphlets, brochures, short films, and word scrambles. Upon graduation in July 2021, select interns will be invited to become part of a Youth Council for the San Francisco Department of Public Health to spearhead their outreach efforts to reach more San Francisco youth.
Social Determinants of Health Are Inequalities
In San Francisco, Black households are persistently poor in a city where the average household income is among the highest in the nation. A recent study by the Brookings Institution puts the Black-white employment gap in San Francisco among the highest in the nation, along with Chicago’s. The economic fallout from the COVID-19 crisis has made the situation exponentially worse. These disparities render Black youth particularly vulnerable to HIV, STIs, COVID-19, and other health issues and less likely to seek or successfully obtain medical care due to discrimination, stigma, or a cultural disconnect with health care systems.
According to a 2019 report by the San Francisco Department of Public Health, the rates of chlamydia and gonorrhea among Black youth are 4.5 times higher than those among white youth, and the rate is 4.6 times higher for early syphilis. Add to these troubling stats that Black youth also face other complex challenges, including vulnerability to substance abuse, mental illness, and homelessness, alongside institutional racism.
Black people in San Francisco are also disproportionately affected by HIV. While rates of new diagnoses for Black men declined in 2019 after increases from 2016 to 2018, Black men and women still account for the highest HIV diagnosis rates by racial group. The stats go on and on: Fewer Black people have adopted pre-exposure prophylaxis, or PrEP, than other San Franciscans. Local data also shows that hepatitis C disproportionately impacts San Francisco’s Black population.
With alarming numbers like these, it is critical that programs such as the Empowering Black Youth pilot program are extended nationally to help reengage Black and Brown youth in a more uplifting and culturally competent way. Instead of lecturing students all day, teach them and allow them to design content that makes the most sense to them and to reach an audience that researchers, institutions, stakeholders, and professionals cannot always reach to make an impact on Black and Brown communities. Through this community participatory research, a new module for public-health education and technology is developing in one of the most powerful economic cities and resourceful cities in the country. Instead of shunning our youth, I believe we must reach them through social-media platforms they use daily—rather than through panels and conferences—in an effort to decrease STI rates in Black and Brown communities.
It Takes a Community
What makes the Empowering Black Youth program different is that we are teaching our youth qualitative and quantitative skill sets that fully engage them to understand sexual and reproductive health. With the interns learning an array of subjects about sexual/reproductive health and technology, the students can see tangible outcomes of their engagement, compared to other programs. Since the start of the program, our interns have gained essential insights into their bodies and how STIs can be prevented and managed (if they were to contract an STI). What’s more, they are learning healthier ways to communicate with their sexual partners moving forward.
With Empowering Black Youth being a pilot program, Code Tenderloin is in development and has been applying for additional funding to make the program a part of the Code Tenderloin curriculum. Through additional grants, we plan to expand our scope; if funding permits, our current interns would work with other communities of color to cross-collaborate on redefining social determinants of health in their communities. Our interns understand the vital importance of inclusion and know that members of their own community must be in the conversation to fully engage what resources best fit their community narrative. We are also building out opportunities for our interns to become fellows who will lead next year’s workshops.
As a Black queer male living with HIV, the Empowering Black Youth program’s mission has significant meaning for me. Diagnosed at age 19, I understand the lack of resources and opportunities for Black youth—and the lack of education on STIs and prevention. If you are someone who is interested in building out internships or opportunities for youth, remember, youth must be heard, valued, and uplifted. In my opinion and based on my research, engaging our youth is vital to addressing social determinants in their communities. The Empowering Black Youth program is an example of the Black community stepping in to say, “This is how we see ourselves, and this is what works for our community.”