When the HIV/AIDS epidemic hit some 30-ish years ago it brought a lot of fear with it, fear of death, fear of loss, fear of the sexual body, you see where this is going. Thankfully, science and public health prevention efforts have brought us to the remarkable point that we’re at now – people are living longer with HIV for a range of reasons, there is less false information about HIV in the general public, and science is making remarkable strides toward finding better treatment and hopefully a cure (think The Berlin Patient). With that said, the discussion around HIV prevention has slowed in many realms, more specifically in ‘larger’ public health forums. Folks have begun to shift HIV/AIDS out of the realm of death sentence to ‘chronic illness’. I want to say that for many, this re-shifting is true, and as I have said earlier folks with HIV are living longer lives but what do the majority of those folks look like? See, shifting toward a chronic illness framework makes assumptions that folks are already in care or well on their way, it assumes that folks are set up to deal with the day to day trials of being positive, it assumes that positive people can afford to move to epicenters of care (San Francisco, Boston, etc). Even this article shows that even if you live across the bay from San Francisco in Oakland, your access to care is already slashed. So the issue begs us to think about new ways to shape our conversation about HIV/AIDS while also finding innovative research and intervention strategies because for millions of underprivileged HIV positive folks the chant resounds “We’re Still Here!”
Many of you know that I’m currently the Health Disparities Research Fellow at a non-profit in Cambridge, MA and a significant portion of my job is to read the American Journal of Public Health (AJPH) from front to back covers. As I’ve been doing this I keep asking myself “who’s reading this?” because in reality, not everyone has access to the AJPH for various reasons (for me, it’s the price). I bring this up because there is A LOT of very useful information regarding how we might think about moving forward to bridge the gap in health disparities. What follows are reviews of a few articles that I thought were extremely helpful. (Note: In many of the proceeding reviews the term MSM is used. MSM (Men who have Sex with Men) is on an epidemiological level as any other term (Heterosexual, Injection Drug User, etc) in an effort to pinpoint which populations act as facilitators for disease transmission. It is also currently used in many public health settings to help diffuse the stigma of gay & bisexual within Black/AfAm communities).
Structural and Social Contexts of HIV Risk Among African Americans.
American Journal of Public Health, 2009. Vol. 99, No. 6, 1002-1008 Samuel R. Friedman, et al.
To highlight sexual and drug-injection networks as requiring as much focus as behavior in the transmission of HIV.
Identifies Black MSM sexual and IDU networks as a key facilitators in the transmission of HIV. Also identifies themes of ‘Survival, Propriety, and Struggle’ within Black communities and suggests ways it could lead to reinforced sexual and social networks.
Accessing Black MSM sexual networks in conjunction with traditional intervention models could prove helpful to prevention efforts over time. Reforming social, economic, and other racialized structures may also lower existing barriers to accessing Black MSM.
Public Health Responses to the HIV Epidemic Among Black Men Who Have Sex With Men: A Qualitative Study of US Health Departments and Communities.
American Journal of Public Health, 2009. Vol. 99, No. 6, 1013-1022 Patrick A. Wilson, Terrance E. Moore.
To understand the challenges facing health departments and community-based organizations providing services to Black MSM.
Providers describe DEBI project interventions that are typically mandated by the CDC to receive funding often are not relevant to Black MSM communities. Providers also identify lack of cultural competency on the organizational level as a hindrance to creating sustainable programming. The primary investigators also describe macro-level social processes (surveillance, etc.) as unfairly targeting Black communities and add to existing barriers when attempting to access these communities.
More cultural specific training is crucial to creating and sustaining interventions aimed at Black MSM communities. There should also be a shift in hiring practices especially those employees undertaking ‘frontline’ work. More CBOs should document their work within Black MSM communities and make this information readily available to the provider community because although researchers and providers are aware of work being done to slow the spread of HIV within Black communities, little is published.
Drug Use and High-Risk Sexual Behaviors Among African American Men Who Have Sex With Men and Who Have Sex With Women.
American Journal of Public Health, 2009. Vol. 99, No. 6, 1062-1066 Dorothy C. Browne, et al.
Investigate covariates related to risky sexual behaviors among young African American men enrolled at historically Black colleges and universities (HBCUs).
Young Black MSM were only more likely to engage is risky sexual behaviors (identified in this study as condom nonuse, engaging in sexual activity with multiple partners, and history of a STD/STI) than Black MSW when the consumption of alcohol or drugs was reported.
Services focusing on prevention of STDs should be provided to all male college students, regardless of the gender of their sexual partners. Such a general approach should also address drug and alcohol use before sexual activity.
Put together, these all point us in the direction of prevention. It tells us that Black/AfAm gay & bisexual men are no more likely to engage in risky behavior but because of incompetent existing interventions continue to be over-represented in the reported epidemiological data. Instead of putting blackface on a DEBI (Diffusion of Effective Behavioral Interventions) and calling it ‘culturally specific’ or ‘culturally competent’ we need to do some really nitty-gritty work to listen how our brothers talk to each other and maybe then we can figure out ways to frame prevention work in more useful ways.
Until next time, take care of yourselves. Remember we are our brother’s keeper.