The High Risk of Gay Black Men Getting HIV

CDC Report Highlights Intersecting Vulnerabilities Affecting Gay Men of Color

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On February 23, 2016, the Centers for Disease Control and Prevention (CDC) released a first-of-its-kind report assessing the lifetime risk of HIV in the U.S. by state, as well as by key at-risk populations. Not surprisingly, people who live in the South (the region known to have amongst the highest rate of new HIV infections) were seen to at greatest lifetime risk.

What surprised many was the fact was that one specific group—gay black men—was reported to have a startling one in two chance of getting HIV in a lifetime, irrespective of age or geographic location.

The CDC report, which analyzed national HIV surveillance data from 2009 to 2013, further highlighted the disparity in infection rates by examining risk by sexual orientation, race/ethnicity, and gender, wherein:

  • White gay and bisexual men were reported to have a lifetime risk of one in 11.
  • Black heterosexual men were seen to have a one in 20 lifetime risk (compared to a one in 132 risk in white heterosexual men).
  • Even injecting drug users (IDUs) were seen to be at lower risk, with male IDUs having a one in 36 lifetime risk while female IDUs had a one in 23 lifetime risk.

Causes of Increased Risk

Understanding the stark differences in lifetime HIV risk is not always easy. The common, knee-jerk response might be to conclude, dispassionately, that sexual practices paired with cultural attitudes and behavior are the sole factors that place gay black men at such profoundly high risk.

But the simple fact is that gay black men in the U.S. sit the epicenter of numerous intersecting vulnerabilities, which together make infection all but inevitable in certain individuals.

From a broader social perspective, it is known that any epidemic—be it HIV or any other communicable disease—tends to strike groups that are stigmatized well in advance of the disease event. This happens because there are generally few systems in place to intervene, either medically and legally, and often little interest to act from those outside the stigmatized population.

We saw this in the early part of the AIDS epidemic in the 1980s where gay men, just emerging from an era of police abuse and judicial apathy, were hit by a wave of infections with no means to stop it, There was nothing in the way of gay health services or advocacy groups to combat inaction on either the state or federal level.

So, with deaths rising from the hundreds to thousands, the gay community took it upon themselves (often with the participation of well-connected, high-profile gay men), to mount their own healthcare services (like the Gay Men's Health Crisis in New York) and civil actions groups (like ACT UP).

The same does not hold true for gay black men. While there has been greater effort made on the federal level to reach this population of men, there remains a marked gap in the number of community-based programs targeted specifically to gay men of color.

Unlike Elton John or activist-playwright Larry Kramer, there are few black gay heroes coming forward to speak to or on behalf of the community or many high-profile black celebrities advocating for the group (in the way that, say, Elizabeth Taylor did for the larger gay community in the early 80s).

As such, from the perspective of disease prevention, gay black men are isolated. Furthermore, the high rate of infection can serve to reinforce negative stereotypes, whereby gay black men are seen by some to be either "irresponsible," "promiscuous" or "getting what they deserve."

It's a vicious cycle that only further stigmatizes gay black men while fueling the already high new infection rate.

HIV Risk and Multiple Vulnerabilities

When we speak about intersecting vulnerabilities, we refer to the specific barriers to HIV prevention, treatment, and care within at-risk populations. The more barriers there are, the greater the risk. Conversely, identifying these barriers enables public health agencies to employ culturally specific programs and strategies to better overcome them.

Epidemiological and clinical research has shown that, as a group, gay black men are at a fundamental risk of HIV due to a number of obvious and not-so-obvious reasons. Among them:

  • Anal sex remains among the highest risk factors associated with HIV infection, carrying an 18-fold greater risk of transmission when compared to vaginal sex. Higher rates of co-occurring sexually transmitted diseases only increase the risk. The CDC reports that syphilis, chlamydia, and gonorrhea in black men occurs at six, 10 and 16 times the rate, respectively, of white men in the U.S.
  • High rates of poverty, unemployment, and incarceration in black communities are inherently linked to higher rates of HIV. Currently, the poverty rate among black Americans is 27.5 percent versus 9.9 percent in whites. Southern states can regularly exceed these figures, such as in Louisiana where 40 percent of the black population lives in poverty.
  • Gay men of color tend to have sex with their own race according to the CDC, meaning that their sexual networks are smaller and more exclusive. As such, the likelihood of transmission increases simply because there is an inherently higher rate of HIV already within the network.
  • Gay men of color often have sex with older men as results of these smaller sexual networks. As older men are more likely to have HIV, gay black men tend to get infected at a far younger age than their heterosexual male counterparts.
  • Higher rates of injecting drug use among black men in general, when compared to white men, translates to higher risk (as seen with non-injecting black women whose sexual partner is an injecting drug user).
  • Failures of social, police, judicial and public health services within lower-income communities tend to fuel a general distrust in government programs, including those aimed at HIV testing and prevention. As a result, an estimated 75 percent of black Americans age 18-64 have not been tested for HIV, while only 34 percent of those treated for HIV remain in care.
  • Distrust of public health authorities can often reinforce negative attitudes about HIV prevention and treatment, increasing denialism and even conspiracy beliefs. According to a study from Harvard Medical School in 2011, such beliefs contribute to decreased survival time in black men by discouraging appropriate treatment behavior, including the consistent use of condoms and linkage to HIV-specific care.
  • Stigma, both perceived and real, fuel HIV rates among black Americans fearing disclosure of their status. A 2008 study by researchers at Kansas State University suggested that strong religious beliefs were closely aligned with higher stigmatization of HIV. Compounding this the extensive stigmatization of gay black men on both the individual and community level, which further drives at-risk individuals from accessing care.

HIV Resources for Gay Black Men

The CDC has designed a number of initiatives to address these shortcomings, including the Testing Makes Us Stronger social marketing campaign aimed at gay black men aged 18 to 44. 

Spearheading activism and awareness in the gay black community is the CDC-supported Black Men's Xchange (BMX), which operates 16 chapters in the U.S., and the Center for Black Equity, which works with local pride organizations in 31 U.S. cities.

To find the programs and services within your community or state, contact your regional 24-hour AIDS hotline. For free, confidential HIV testing, contact 800-CDC-INFO (800-232-4636) for referrals or use the online AIDSVu HIV testing site locator organized by the Rollins School of Public Health at Emory University.

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