The HIV/AIDS epidemic continues to have a disproportionate impact on Black and Latino populations. The Centers for Disease Control and Prevention reported that in 2004 among the 35 states that report confidential name-based HIV infections, 65% of people living with HIV are Black and Latino. Men who have Sex with Men (MSM) continues to be the predominant group of HIV transmission reported among men. HIV/AIDS interventions focused on behavior and education have been successful in reducing HIV prevalence rates among White MSM, but failed to reduce transmission rates among communities of color.
The epidemic among Black and Latino MSM has led researchers to use a psycho-cultural approach which includes psychological, social, cultural and behavioral factors, in developing more effective services for people affected with HIV/AIDS. In a 1998 book, Latino Gay Men and HIV: Culture, Sexuality, and Risk Behavior, Rafael Diaz examines the disassociations between men's intended behavior and actual behavior. His work emphasizes that sociocultural factors become internalized and affect the way an individual interacts with the community. Self-regulation, key to an individual's ability to practice safer sex, is dependent on one's intentions and interpersonal support.
But one's ability to practice safer sex can be affected by personal stress and social stressors. While Diaz focuses on gay Latino men, the model can be generalized to people of color and marginalized populations, since the same social stressors (racism, unemployment, homophobia, etc.) affect the ability to continue safer sex practices. Therefore, it is important to explore race, ethnicity, sexuality, masculinity, and religion in order to address the HIV/AIDS epidemic and empower people of color and marginalized populations.
Defining Racial and Ethnic Identity
Racial identity is defined as an individual's identification with a group based on the perception of a common racial heritage. Jean Phinney defines ethnic identity as identification with a group based on common ancestry and one or more of the following: "... culture phenotype, religion, language, kinship, or place of origin," and emphasizes that ethnic identity is not set. Rather, it is dependent on an individual's understanding of the self and ethnic characteristics. Racial identity generalizes populations based on race, and ethnic identity is an attempt to categorize populations within a race.
In an article in Medical Anthropology Quarterly, Nina Schiller states that one of the major problems hindering HIV/AIDS initiatives is the practice of creating generalized risk groups (e.g., Hispanic, Black) that fails to explore how oppression affects people of color and marginalized populations. Oppression hinders the ability of people of color to access resources such as employment, education, healthcare, and housing. Since the drive to meet basic needs overcomes concerns of exposing oneself to HIV, consideration must be given to the psychological and social factors that affect behavior among people of color based on ethnicity.
As Phinney indicates, ethnicity is composed of various factors that are not captured in nationality alone. Marginalized populations such as MSM, injection drug users, sex workers, and immigrants exist in every nationality. But HIV prevention efforts target populations that are categorized as broad groups. These efforts focus on the most accessible members of the population, offering services to only a limited section of the community while failing to acknowledge its ethnic diversity.
For example, the Mexican population in the U.S. is comprised of a myriad of ethnicities: Mexican, Mexican-American, Chicano, people born in the U.S. of Mexican descent that identify as American, and other Indian civilizations. HIV interventions targeting a Chicano population may need a political focus, while those intended for Mexican migrant workers may need to address housing, food, and employment. HIV service providers must develop a greater understanding of the ethnic characteristics of the population that they serve if they are to provide culturally empowering services for people affected by HIV/AIDS.
Sexual identity is another important characteristic to consider in understanding ethnicity. Sexual and ethnic identity has resulted in a dual identity process, which affects gay, lesbian, and bisexual (GLB) people of color in struggling to define themselves within such social networks as family, work, and friends. GLB people of color must also take into account how their sexual identity will affect their economic security, safety, and social status. Researchers Eric Dubé and Ritch Savin-Williams write that traditional GLB sexual identity models are composed of the following age cohorts: awareness of homosexual attractions, ages 8-11; homosexual sexual behaviors, 12-15; gay or lesbian identification, 15-18; disclosure to others, such as heterosexual and homosexual friends, siblings, and parents, 17-19; and development of homosexual romantic relationships, 18-20.
Research on sexual identity among GLB youth has found significant differences among various ethnic groups. A 1999 study of gay men found that Latinos were the first to be aware of their homosexual attraction at the mean age of 8, compared to 10 years of age for White, Black, Latino and Asian male youth. GLB Asian men reported having sex with a male for the first time at the mean age of 18, compared to 15 years of age for all gay males. Approximately half of the same sample of young men had a romantic relationship with a female, with a significantly lower rate among Asians. Black men were also significantly more likely to have had sex with a male before sexual identification and were the least likely to disclose their sexuality.
A 2004 study of both men and women also found that Black youth were least likely to disclose their sexuality to others, but found no difference in sexual identity, sexual attraction, and sexual behavior between Blacks, Latinos and Whites. Research in both studies corroborates the milestones specified by Dubé and Savin-Williams, providing greater understanding of the sexual identity development process among various populations.
Oppressive factors such as homophobia, discrimination, and lack of resources may cause people of color to have homosexual encounters prior to the development of their sexual identity. Dubé and Savin-Williams indicate that men experiencing this reported difficulties in adjusting to their sexual identity, more homosexual encounters, and more heterosexual encounters. Sexual identity disclosure to others is associated with one's adjustment to his sexual identity and men of color were found to be more susceptible to internalize homophobia and poor mental health. Future research is encouraged to explore the identity processes GLB youth experience to strengthen initiatives in developing services for the community and assist youth to navigate through the dual identity process.
Masculinity among Latino and Black men has been stigmatized as self-destructive and research has failed to acknowledge its positive traits. Special consideration must be given to the historical context (slavery, colonialism, etc.) as well as existing oppressive structures such as racism, discrimination, and homophobia when discussing development of masculinity among Black and Latino men.
"Machismo" has stigmatized Latino men as individuals who like to prey on the weaknesses of others and has played up its relation to domestic violence, substance abuse, and tyranny in the home. But studies have also identified positive traits related to machismo, such as a strong work ethic and commitment to roles as family provider and protector. One must take into consideration that the definition of masculinity is influenced by beliefs and values within a historical, social, psychological, and racial context. Research has also found that gender roles can transfer to homosexual encounters and relationships -- the active (insertive) male taking the masculine role and the passive (receiver) male taking the feminine role. Status among MSM in Latin America is granted to the active male who never gets penetrated -- he may be perceived as heterosexual in the Latino community, regardless of whether he has ever had a sexual encounter with a female.
A 2005 study identified four unique components in identifying masculinity among Black men: 1) manhood is interconnected with the self, God, family, community and others; 2) manhood is a fluid process; 3) manhood is a process for redeeming oneself within one's family or community, and 4) manhood is a constant process of maintaining one's independence and productiveness.
Masculinity exists among all racial and ethnic populations and it is essential to emphasize its positive characteristics as well as its negative. HIV interventions need to be culturally sensitive and careful not to reinforce oppressive structures among the populations served. Service providers must increase their emphasis on empowering communities and dispelling the stigmas and stereotypes imposed on men of color.
One must always consider religion when discussing characteristics of ethnic identity. Religion and spirituality continue to have a strong influence among Latino and Black communities. A national survey found that over 76% of Americans identified as Christian. Among Latinos, 57% identified as Catholic, 22% as Protestant, 5% as another religion, and 12% as having no religion. Another survey indicated that Blacks in the U.S. reported being raised in the following religious denominations: 80% Protestant, 11.6% Catholic, 1.2% Christian, .9% Muslim/Islam, .7% other, and 5.6% not religious.
A 2004 study found that organized religion played a significant role in the lives of Black and Latino MSM. Latino MSM expressed internal conflict between their homosexual desires and religious rhetoric that reinforces heterosexuality, leading to increased risk behavior. Additionally, a 1998 study indicated that Black MSM identified the church as a source of community and an important outlet for coping with racial oppression and discrimination. The men also stated that church is a good way to divert the community's attention from their sexuality while providing an opportunity for them to meet other men. At the same time, Black MSM report significant levels of homophobia in the church.
A 2002 study found that religious Black men had greater homophobia toward gay men than they did toward lesbians, in comparison to religious Black women. Frequent church attendance was also associated with homophobic attitudes in the Black community. Among sexually marginalized populations such as Black and Latino MSM, exposure to homophobic attitudes was associated with internalized homophobia, low self-esteem, psychological stress, and HIV risk behavior. As the literature demonstrates, religion has both positive and negative influences among Black and Latino MSM. Providers are encouraged to establish relationships with religious congregations in an attempt to address homophobia in the community and strengthen services for people affected with HIV/AIDS.
Societal oppression affects every aspect of the lives of Black and Latino MSM. HIV services addressing the needs of people of color are challenged to develop culturally empowering programs. Providers must identify and reinforce the positive factors in each community, acknowledge the heterogeneity of the target population, and involve members from the community when developing programs. Providers can assist gay, lesbian, and bisexual communities of color with services to address the personal conflicts associated with race, religion and sexuality. Masculinity among Black and Latino MSM is not necessarily self-destructive and providers can develop programs for men to embrace their masculinity and sexuality. Finally, religion plays a significant role in the lives of Black and Latino MSM, and providers are encouraged to collaborate with religious institutions in addressing homophobia in the community and providing services for communities affected by HIV.
Moctezuma Garcia is a Ph.D. candidate at the CUNY Graduate Center.