Saying Structural Violence Impedes HIV Care for Black Gay Men, Advocates Urge a Broader Approach

Charles Stephens of Counter Narrative Project
Charles Stephens of Counter Narrative Project

According to Charles Stephens, executive director of the Counter Narrative Project, structural violence -- the subtle social structures that harm vulnerable communities -- may prevent black gay men (BGM) from accessing or remaining in HIV care. For that reason, asserted Stephens and artist Cory Bradley in a recent webinar, taking action outside of the care setting may be what it takes to close the care gap between African-American, gay men and other men who have sex with men (MSM).

According to the U.S. Centers for Disease Control and Prevention, 37.6% of the 29,771 new HIV infections in MSM diagnosed in 2014 were among African Americans -- 7% higher than among whites (30.3%). That gap persists when comparing AIDS classifications in MSM among races (in 2014, 38.1% of those with AIDS were African-American, 31.3% white).

To address this issue, coalitions across social justice movements, including the #BlackLivesMatter movement, are necessary, Stephens said in the webinar "Beyond the Clinical Narrative: Black Gay Men and Barriers to Care." He called on health care providers to be "culturally literate" -- to have a deep understanding of the history and culture of BGM communities, rather than just surface cultural competence. HIV care must also be informed by the sometimes subtle traumas experienced by people of color, he said.

Stephens believes that art and culture must be integrated into prevention, treatment and care in order to empower this population. He suggested that waiting rooms could be decorated with images of powerful African-American men in order to affirm patients' identities and to inspire them. Partnerships with other organizations are also important, he added, to provide young BGM educational opportunities or to help them navigate large bureaucracies, such as the health care and educational systems.

Bradley contributed another example of empowering men in the black, gay community: Have blood work done in a community center where young BGMs hang out, rather than at a clinic, and send the results not just to the doctor, but also to the patients themselves. He noted that health is a multi-faceted concept beyond a single illness such as HIV. The full view of the "health project" includes diet and exercise, emotional self-care, social support, stress reduction and a person's sense of purpose and meaning, he explained.

Bradley noted that some religious institutions and persons are complicit in the structural violence affecting BGMs, but said that religion and spirituality also offer a way of coping with stress and making sense of the world. The prevalence of religion within the African-American community, as well as the stigmatization that BGMs may experience within that culture must be acknowledged. Nonetheless, culture and art are important in reaching African-American MSM, Bradley believes. He rejected the segmentation inherent in the mind versus body duality and called for "the integration of the whole being."