What Can We Do to Improve the Health of Gay Black Men?
On February 7, we commemorate National Black HIV/AIDS Awareness Day. Black men in the U.S., especially young gay and bisexual men, are disproportionately affected by HIV. It is estimated that, in the U.S. between 2008 and 2010, 75 percent of all new infections were among gay and bisexual men, with young black gay and bisexual men having the highest rates of infection. Clearly, we need to do more to address the unique challenges to health that black men in America face. But what are those issues, how are they related to increased risk of HIV, and what can we do about it?
BETA posed these questions to three experts—in community education and outreach, research, and policy—and asked them to weigh in about the state of black gay men’s HIV health. We asked what we can do, and are already doing, to improve HIV prevention and treatment for black gay men in our community and country.
Empowering and Supporting Community Members
“One of the issues I’ve run into, are people who say, ‘Why don’t black people get that this [HIV] is important? Or that this is something to worry about?’” says Karl Knapper, Black Brothers Esteem (BBE) program manager at San Francisco AIDS Foundation. “But you really have to make the connection—that for a lot of black people, in San Francisco and other places, it’s not just about HIV—it’s about other health disparities.”
He says that for many community members who attend BBE events, HIV prevention or treatment may fall lower on their list of priorities when considering the entire scope of life challenges. “They have diabetes. Or heart disease. Or no money to eat. People who don’t understand the community—they don’t get that.”
So Knapper, through the foundation’s long-lived and well-loved BBE program, strives to empower the African American men he meets to get the information and community support they need to take better control of their own health and wellness. In small to mid-sized groups, BBE brings men opportunities to socialize in addition to education about HIV treatment and prevention.
Knapper sees the positive influence that these individual, personal interactions and events can have on people’s lives. He points to the importance of establishing trusted communities that provide people at risk with the support and resources they need.
“Living in this neighborhood [of the Tenderloin in San Francisco] can be rough. So we need to help our community rather than wait for other people. It’s about having a sense of community, of belonging, of being supported. We can prevent HIV in our community by empowering our clients to go out in the community, to educate others.”
Improving the Cultural Competence of Research and Practice
“I don’t think that any other risk groups face the same challenges that we do as African American gay men,” says Chauncey Watson, who’s been conducting HIV prevention work with black gay men for the past 15 years. Watson has been involved in everything from designing and implementing HIV prevention programs to conducting clinical research as part of the HIV Prevention Trials Network.
One of his primary concerns is making sure that people in public health and research are aware of, and are able to incorporate, culturally competent approaches in their work. “You have to understand the intersectionality that exists between being black and being gay. It’s going to take a multi-pronged approach. Black gay men have many needs. They face everything from social stigma to internalized homophobia to structural racism. We need to think about—how to translate these macro-level issues to micro-level interventions.”
He says that researchers and providers must consider the contextual factors, like home life and peer acceptance, at play in the lives of young gay black men. If he’s promoting PrEP, for instance, and educating research participants or patients about a pill that can be taken daily to prevent HIV, Watson says that the conversation “is going to be different than just simply, ‘here’s a prescription, go get it filled, take the pill every day.’ What if the man you’re working with doesn’t have a place to stay for the evening? What if he’s staying with his parents—and isn’t out yet? He may be fearful of being discovered because he’s bringing the medication home. He may be fearful that he’s going to be judged—because he’s black, and gay.”
To improve health research and services, Watson says we have to understand what he terms the “lived experience” of black gay men—the context in which they make decisions about their health, their lives, and their behaviors. “We really need to understand the cultural nuances that make this population more vulnerable to HIV acquisition,” he explains.
Using this approach, Watson sees an opportunity to respond to the fear and mistrust that black men may have about the health care system.
He believes that future efforts should focus on engaging men into a system of care that they can trust and rely on. He wants to foster trust and engagement with the health care system among young gay black men by expanding the continuum of care to include men who may be at risk of—but don’t have—HIV.
“Historically, you get an HIV test and you get a result of negative or positive. If you test positive, there are all these services that are opened up to you, there’s a continuum of care. But if you test negative, there’s a question mark. You might hear, ‘come back in six months, what you’ve done has worked well.’ We have this new prevention toolbox that includes biomedical strategies—we have all these different services. Let’s begin to keep men engaged an on a continuum that keeps them negative.”
Incorporating Structural Approaches into Public Health Efforts
Ernest Hopkins of San Francisco AIDS Foundation also has his eyes on the broader landscape of HIV. As director of legislative affairs, he is engaged in congressional and federal administrative health policy discussions that impact HIV programs and public health resource distribution. Hopkins chairs the National Black Gay Men’s Advocacy Coalition and the Communities Advocating for Emergency AIDS Relief Coalition, two national coalitions that focus on federal health policy issues that shape the social, political, or economic structures that influence HIV health and risk of HIV acquisition.
“When you look at how a person was raised and how they’re living—these things influence a person’s resiliency, his sense of self-worth, and his ability to engage in protective factors for his health,” he explains. When black men, especially young men, struggle with problems related to affordable housing, food insecurity, education, and job readiness, protecting themselves from acquiring HIV—or living healthy and well with HIV—may not be a top priority. This means that social determinants of health, such as poverty, incarceration, unemployment, racism, homophobia, and fear of health systems are at the root of HIV transmission.
One example Hopkins cites is the common occurrence of young gay black men, seeking stability and basic life needs, who partner with (and oftentimes acquire HIV from) older black gay men as a factor that contributes to rising HIV rates. He describes this as a challenge that transcends public health solutions.
Implementing cross-cutting policies, he says, that act to better the lives of those most at risk are one effective way to enact change and improve health outcomes. One promising initiative designed to address these social and health disparities among black gay men is being created by the White House Office of National AIDS Policy.
As Hopkins explains, “It is the first federal initiative to lift HIV out of a solely public health context and incorporate policies and resources of key governmental departments into a comprehensive solution addressing the needs of the population.”
This recently-announced four-year demonstration project will support state and local health departments in addressing the array of health and socioeconomic needs of young black gay men whose circumstances make them vulnerable to HIV acquisition. The funding will, for example, support community-based services that help men get linked to health care and care for HIV, in addition to other social services for things like housing, substance use help, and mental health treatment.
The implementation of this demonstration project is exciting, says Hopkins, because “It makes sense. It has a logic to it—it’s responsive to what we continue to hear from our communities. So it’s not just grasping at straws, it’s soundly based in the research and what’s being requested from the field.”
San Francisco AIDS Foundation facilitates health, education and social support programs for black gay men. Find more information about the Black Brothers Esteem program for African American men who are gay, bisexual, or same-gender loving. And learn how the DREAAM Project serves younger African American gay, bi, and trans men.