by Sarah Albert
Researchers from the New York City Health Department surveyed 541 gay
and bisexual men, and found 33 percent of African American respondents
tested positive for HIV, compared to 14 percent of Latinos and 2 percent
of Caucasians. The results were released in late January.
While some forum attendees argued the merits of the media coverage of the survey, given the small sample size, the sentiment of attendees was very much the same. "It was not a surprise to me. Was it a surprise to anyone in the room?" asked the forum moderator, J.E. Miles, Jr., program director of the Village Well, Lesbian, Gay, Bisexual & Transgender HIV Prevention Initiative of Harlem United. The answer was no.
Based on personal accounts and anecdotal reports, many in the community were already well aware of the problem -- black and Latino MSM are becoming infected with HIV at higher rates than white MSM. And while the problem has received some media attention, much more funding, organizing, outreach and activism are required.
Yet it is premature to say that one in three black men in NYC has HIV, said Timothy Benston, Program Manager, GMHC. "Did anyone question that sample size? We need to do our own research," he said. Of the 541 men surveyed, 222 were Latino and 130 were black. No one is saying that the sample size is small because it might minimize the alarm, he added.
Two other studies, however, were released in the last couple of months that reinforce the dim findings of the survey in New York City.
A six-city study of gay and bisexual men released on February 6 found that 30 percent of African Americans, 15 percent of Latinos and 7 percent of Caucasians were infected with HIV.
Just last week the Centers for Disease Control and Prevention (CDC) published a report that found that, despite declining rates of syphilis overall in the United States, African Americans, Latinos and MSM are at a disproportionately higher risk of getting syphilis. In fact, African Americans were 30 times more likely to have syphilis than whites in 1999. And co-infection with HIV and an STD like syphilis can make HIV easier to transmit.
"Itís time to improve the efforts in these communities regarding
syphilis elimination. We have a real obligation to eliminate remaining
racial disparities," Catherine McLean, MD, medical epidemiologist
with the division of STD prevention at the CDC in Atlanta, told
Safer sex is clearly a big hurtle -- 58 percent of all respondents to the New York City survey admitted to having unprotected sex with a male partner within the previous six months.
And what about other risk factors that can make sex more risky? More
research is necessary, according to forum participants, to find out
exactly what risk factors there are for black and Latino MSM. "What
about douching?" asked Miles. How often do black and Latino men
douche? It is a factor that may contribute to HIV
risk. "Black and Latino MSM are obsessed with cleanliness and they
always douche before sex," said one participant. Others, however,
didnít think so. The point is, the research isnít there.
"Safer sex as [meaning] use a condom all of the time is simplistic. You canít talk about safer sex without talking about desire and pleasure," said Ralph G. Horton, Phd, director, Access and Assessment Services of the GMHC. We need to provide a safe place for African American and Latino men to explore these issues, he said.
And just what is safer sex? "Is there ever a time when two men can have unprotected sex and itís safe?" asked Miles. What about sex between two men who have tested negative for HIV? What about two partners who are monogamous?
This is one of numerous dualities in the struggle toward HIV
prevention. How do you support MSM in their sexual pursuits while also
discouraging risky behaviors? How do you reach MSM who identify as gay or
bisexual as well as those who donít?
Reaching Closeted Men
What your family, church and community expects from you is also a very important factor in the Latino and black communities. Often families discourage people from coming out as gay or bisexual. "The black and Latino community reward people for lying. Do whatever you want -- just keep it quiet," said Miles.
Furthermore, discrimination and homophobia make an intense combination. "Why open up another venue of discrimination. Youíre already black, why come out as gay also?" asked one participant.
Yet the recent studies of MSM have been among men who do identify as
gay or bisexual. Even men who are out, and who have access to information
about safer sex,
are engaging in risky behaviors.
Lectures Don't Work
Perhaps that is why Harlem United abandoned a behavior modification series because no one was attending. Instead they started a more "sexy and exciting workshop series" that incorporates some of the behavior modification. Harlem United has a prevention office, with support groups for black men and transgendered women and their partners. But again, programs such as this one often wonít reach MSM who are closeted or who donít identify as gay or bisexual.
Sexual orientation is not the only factor at play in the black and
Latino communities. There are also disproportionate rates among
heterosexual black women. "How does the black community value health
in general?" asked Benston. "Weíre still over-represented in
most diseases and illnesses. What is it about black women that they are
over-represented in HIV?
Itís not [sexual orientation]. That also sometimes gets lost," he
Another participant said HIV
must be targeted to all blacks and Latinos -- gay, bisexual and straight.
"We need to get the community to value the life of our gay men. We
can no longer segregate populations from the communities they are
in," said Benston.
Al Sharpton will speak out about racist hate crimes, but what about how AIDS is killing people in our community, asked Dr. Horton. "Some of our solutions have to be very confrontational."
Coming up with a prevention plan is crucial. Programs like GMHC, which is community and volunteer based, need to be developed within the black and Latino communities. "That has worked for white gay men -- and it is the same response we need for African American and Latino men," said Dr. Horton.
"We need to come together with a very clear [set of expectations] for the churches and organizations," urged Dr. Horton. "Everyone is not just from Harlem. We are all over."
Updated: Friday, 2 March 2001
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