When the Center for Disease Control and Prevention released its latest estimates of HIV infection earlier this month, it made unexpected headlines with a startling finding: 30 years into the epidemic, researchers have found a burgeoning epidemic among young black gay and bisexual men. This week, at the agency's massive annual convening of HIV prevention scientists and experts, federal health officials rolled out a rare national campaign targeting black gay men.
According to the CDC, new infections among black gay and bisexual men under 30 years old shot up by 48 percent in recent years, rising from an estimated new 4,500 infections in 2006 to an estimated 6,500 in 2009. The findings--which also confirmed the U.S. continues to log 50,000 new cases a year overall, roughly half of which are among African Americans--prompted many to ask the perennial question: Why is this happening and what can be done about it?
The CDC has pointed to several factors, including limited access to both HIV testing and sexual health education, stigma surrounding HIV and homosexuality that has gone unchallenged in communities of color and a higher incidence rate of other sexual transmitted illnesses, which have been show to facilitate transmission of HIV.
But many prevention experts say it's also a result of public health's slow start on specifically targeting gay and bisexual men of color with efforts that speak to their lives and their needs. "We've been behind about 10 years," says Heriberto Sanchez Soto, executive director of the Hispanic AIDS Foundation.
"The initial response to HIV prevention was largely targeted at gay, white, and upper middle class, who were very well-connected socially and politically," Soto adds. "It was only when it was recognized that we had an epidemic emerging in IV drug users that African-American and Latino women, by association, emerged as a huge group of those infected. Black men who have sex with men populations began to be addressed afterward, but we still fail to recognize youth in this equation." (Public health researchers often use the term "men who have sex with men" as a broad term to encompass gay and bisexual men as well as those who reject gay identity but still have same-sex relationships.)
Presently, one of the biggest concerns for prevention campaigns of all sorts is funding. Federal and state budgets have significantly reduced HIV-prevention for the 2011 fiscal year and beyond, limiting the chance that programs targeting communities of color are funded.
Nor can organizations doing prevention work count on private funders and donors to fill the gaps, says Soto. "While there are a number of two-to-three year grants available, there are not enough to fund every program," he explains, "and once they end, many organizations cannot sustain their operating budgets."
CDC officials said in a press briefing at this week's HIV prevention conference that it will meet the increasing budget constraints by targeting resources where they are most urgently needed. That includes a national campaign to encourage HIV testing among black gay and bisexual men, and to counter both homophobia and stigma around HIV among black men. Richard Wolitski, a deputy director in the CDC's HIV/AIDS Prevention Division, spoke with Colorlines.com about the Testing Makes Us Stronger campaign and the CDC's concern over the increase in HIV infection rates among black gay and bisexual men.
Why is the Testing Makes Us Stronger campaign significant as an effort of the CDC to reach black gay and bisexual men?
Wolitski: Testing is a critical part of what we can do to reduce HIV risk because knowing one's status is important in order to get medical care and treatment for their infection. The CDC has shown that people who know their status engage in behaviors that significantly reduce risk for others of contracting HIV.
And the reality, based on 2008 data out of the National Behavioral Surveillance System surveying 21 major urban areas, is that 59 percent of black men who have sex with men who tested positive for HIV were unaware of their status.
The testing campaign uses images that show black gay men alone and as couples. How was the visual design conceived? Why is this particular design so useful?
Wolitski: Testing Makes Us Stronger builds on the strengths of young black gay and bisexual men. This campaign was developed based on extensive input by a panel of 19 black men who have sex with men who are leaders in their community. The CDC then used these recommendations to expand the formative research to develop images and final concept for final campaign with 400 men participating by the end.
We believe that the message of this campaign is affirming. We wanted to show black gay couples who are loving and supportive and, at the same time, we wanted to document a diverse range of strong men in community. We hope to show that their isn't one idealized form of masculinity but men who represent different forms of strength that come from a place of affirmation.
What role, if any, is social media playing in shaping this campaign?
Wolitski: In our initial research phase, we looked at the different types of channels and sources of information for black men who have sex with men. Clearly social media is one of the major ways that particularly younger men are getting information, so it was a no-brainer that we want to maximize use of social media. While we're primarily utilizing Facebook and Twitter, we're also working with bloggers to get banner ads placed on websites that are frequented by younger black men who have sex with men. We also think it is vital to reach out to larger black community to get everyone more invested in this issue.
How does the campaign respond to the role of homophobia and discrimination that have been shown to increase rates of HIV infection?
Wolitski: I think it would be naïve to assume any one campaign could undo years of damage related to homophobia and discrimination that black men have experienced. But we hope that this campaign will show the positive aspects of the black gay community. Ideally it would play a small role in breaking down these issues in the community. Part of why we think Testing Makes Us Stronger can be successful is that the models chosen in this campaign are real people. Our hope is that black gay and bisexual men and others outside of this community will be able to relate. Through this, we hope they can feel a connection to their experiences and struggles.
Let's the shift the focus more specifically on youth, who suffer from the highest rates of new HIV infections. In particular, CDC showed in a 2009 survey that eight out of 10 students were harassed at school and one out of five had been physically assaulted. How does this data relate to HIV infection?
Wolitski: It's clear that bullying, harassment and rejection lead to higher rates of HIV infection. Those that suffer from bullying at school are far more likely to experience depression, suicide attempts and engage in unprotected sex, which increases HIV infection risk. The same has been shown for families who reject LGBT youth. Our data here have shown they are three times more likely to engage in unprotected sex.
What ways can we begin to combat these specific types of discrimination?
Wolitski: The CDC offers a website with links to resources for youth, families, administrators and school educators. But we recognize that we're not going to erase homophobia and discrimination overnight. Respect and building strength of LGBT youth must begin at home and include the broader educational community as well, centered around policies that help reduce bullying and discrimination. There is not one single approach that will solve all of the problems related to homophobia.
Right now we face challenging economic times, with budget cuts and higher rates of unemployment, poverty and homelessness. Can you speak more to these challenges?
Wolitski: Unfortunately, we've found that higher rates of HIV prevalence can be attributed to unemployment [2.6 percent vs. 1 percent of those who are employed], poverty [2.3 percent vs. 1 percent of those employed above the federal poverty level] and homelessness [3.1 percent vs. 1.7 percent who are not homeless; see study here].
At the same time, people are making hard decisions, given that we face a large debt. Particularly state and local governments are making hard decisions about the efforts that they have to support HIV prevention. We've seen dramatic reductions in state and local funding for HIV prevention as well as a growing number of people living with HIV being put on waiting lists for treatments.
Is there a silver lining to all of this? What specifically can be done to overcome all of these challenges?
Wolitski: It's important to take a big picture perspective. We're seeing many fewer newer HIV infections now versus those occurring in the mid '90s. In particular, we've greatly reduced rates of transmission between mother and child and among injection drug use. And while there are budget cuts, the Obama administration has consistently shown strong support for HIV prevention efforts and this is reflected in the president's budget request for 2012.
Yes, the number of infections is much too high. But it's not 1986. In those early days there wasn't any funding at all. What I saw during that time is a community coming together to raise awareness on HIV while demanding action and accountability. Today that sense of community ownership is lacking. The reality is we all have to be doing a better job to help turn this epidemic around.