Much hasn't changed.
With the release of the state of HIV in America and the black gay community, two trite sayings come to mind: "the more things seem to change, the more they stay the same," and "a definition of madness is doing the same thing repeatedly with an expectation of a different result every time."
When the U.S. Centers for Diseases Control and Prevention (CDC) released the results of their 2006 to 2009 study on Aug 3, showing that the numbers of new HIV infections are approximately 50,000 per year, a general sense of "What's new?" seemed to greet the announcement. The news that these infections are concentrated among black gay men, and more pointedly, that the numbers of those infected with the virus are disproportionately affecting young black men between 13 and 29 who have sex with other men is on the rise has been muted, as if nonchalantly, "So what?"
Since the U.S. government's acknowledgement of the HIV epidemic 30 years ago, the U.S. Department of Health has become like a lactating cow and the CDC the perpetually filled udder, with a multitude of agencies, organizations and assorted individuals sucking voraciously at its many teats.
Some committed HIV advocates and activists are ringing their hands and scratching their heads: wondering what more they could have done and what else to do. Others, who pretend to be concerned, because of the government's free hand in doling out grants for HIV prevention programs, shrug their shoulders and grin. To them the report means that their grant applications would continue to be approved and money would continue to flow from the engorged teat.
Together, for a variety of reasons, some simple and others complex and convoluted, both government and independent agencies have failed the black gay community. Many black gay men, who have survived the devastation of the 80s and 90s, look on these numbers with skepticism, reflecting that nothing much has changed for them; younger black gay men, on the other hand, have a nonchalant attitude.
This CDC report expanded the results of a study released in 2008 by the New York City Department of Health and Mental Hygiene, which had concluded that in New York City not only was HIV infection concentrated in the black community, it was particularly endemic among black men who have sex with other men, regardless if they identified as gay, and that the rates of infection were increasing among young black men between 13 and 22. According to the report out of NYC, HIV infection was three times the national rate, at 72 new infections per 100,000 people as opposed to the national rate of 23 per 100,000 people.
The CDC estimates that 300,000 people are infected with HIV but have not been tested and do not know they are infected. Additional statistics also suggest that every day, at least 50 people become infected with HIV.
Published statements from those at the CDC demonstrate more of the same. Kevin Fenton, MD, director of the CDC's National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention said in the CDC statement that while there is encouragement on prevention efforts to help avoid overall increases in HIV infections in the US and the significant reductions in new infections from the peak in the mid-1980s, "We have plateaued at an unacceptably high level."
"Without intensified HIV prevention efforts, we are likely to face an era of rising infection rates and higher health care costs for a preventable condition that already affects more than one million people in this country," Fenton said.
Again, what's new? Was there a redoubling of intervention efforts to prevent HIV infection?
For years, there have been ways of doing business, with the overwhelming government bureaucracy ensuring that there is no change in how multi-year HIV grants are executed. Many organizations, to get access to CDC funding for HIV, started programs purportedly for HIV prevention. With skillful grant writers and applications many received funds for HIV prevention, which they used either to support budgets reduced in other areas or enabled unscrupulous heads of non-profit agencies, with the collusion of sympathetic or terrified government grant administrators, to live extravagant lives with inflated salaries and generous expense accounts for nebulous conferences.
One cudgel hanging over the heads of grant administrators is that if they question or deny an application, they risk being accused of subtle racism against the black community and inherent homophobia toward the black gay community.
HIV funding has spawned its own cottage industry: from providing minimal services in communities for a short time which then becomes defunct for lack of funds, to grant writers specialized in how to tell a particular narrative in compliance with grant requirements, to conferences with the many associated costs, all paid for by funds earmarked for HIV prevention. For many organizations, the only requirement that they are complying with the stipulations of their grant is to have some event or activity labeled as HIV prevention or set up some ad hoc testing to serve as justification for their grant reporting. The CDC and the respective states that have disbursed funds would readily admit that they lack the manpower or resources to monitor and ensure that the grants being awarded were being executed as they should.
Yet, the numbers of those with the virus continue to rise. But when examined closely, the CDC's numbers are in some way questionable: in 2008, along with more refined testing methods, they began using a new formula for measuring the numbers of those infected with the virus, which revealed that more people were infected than before. The question now is, how many of this 50,000 is based on the new testing methods and how many are based on a pre-2008 formula?
National HIV/AIDS Strategy
After calls and demands for a national HIV/AIDS policy, in July 2010 President Obama issued a national HIV/AIDS strategy. Some of the same groups and organizations that called for the policy decried it, claiming it was limiting in scope and didn't really offer or suggest much, but as a policy document it demonstrated a strategy for addressing HIV infection on a national scale for the first time.
Among the recommendations the strategy demanded that mental health needs of young black men needed addressing as a way of intervention and prevention of the HIV epidemic. It recognized that for a variety of reasons, young black men are susceptible and vulnerable and needed mental health intervention at the level where they could get counseling. But, it didn't call on mental health professionals and Medicaid to step up to deal with the number of mental health issues in the black gay community, especially among young black gay men who contribute and lead to HIV infection.
Perhaps the strategy was limiting because the government is afraid of awakening and reopening wounds of oppression, racial discrimination, bigotry and economic dispossession in the black community, which for centuries has been buried under layers of adaptive behaviors, and which has festered and suppurated for generations.
Failure of Black Gay Organizations
Many in the black gay community would say very little is being done to provide actual HIV intervention and prevention. But as things seem to change, really they remain the same.
Many in the New York City black gay community cannot forget the betrayal by many of the so-called leaders who are alleged to have betrayed, mismanaged and embezzled CDC, state and city funds for their own gains. This came to light with the spectacular collapse of People of Color in Crisis (POCC).
Many in Chicago, Los Angeles, Atlanta, Philadephia and communities with large black and black gay populations would recall the organizations that closed its doors because the management had misappropriated funds granted for development of HIV prevention programs. Instead, many would recall how the leaders of these failed organizations have morphed into other agencies and continued to perpetuate milking the system.
Many would also recall the National AIDS Education & Services for Minorities (NAESM) led by Rudy Carn, which, according to published reports, obtained funds from the city of Atlanta for a center and, even though a house was eventually obtained, funds were misappropriated and the organization investigated by the city. Carn did a classic reinvention: he minimized his operations in Atlanta, moved to New York City and with the help of two former POCC employees (one who is on his organization's board) tried to step into and claim a piece of the CDC, state and city HIV funding pie. Along with hosting a number of conferences at big name hotels, NASEM's Brooklyn office on Atlantic Avenue is reported to have closed, and yet the organization, partnering with the Black Gay Research Group, is gearing up for another conference in New Orleans.
Yet, many in the NYC black gay community have wondered what has NASEM and Carn done for the community and how much money they have been able to collect from federal, state and local governments supposedly for HIV prevention?
Earlier this year, a prominent national black HIV/AIDS organization purportedly hosted a conference in the Caribbean. Reports from some who attended claimed that except for one day of some quasi-serious discussions, it was like a vacation where the attendees sampled the delights of the available men on the beaches. Funding for this jaunt was obtained because the head of this organization is a friend of a vice president of a non-profit organization committed to the global fight against HIV/AIDS, from whom he was able, in two weeks, to get the required funds to pay for the entire vacation cum annual retreat.
Also, in what is seen as duplication and a waste of desperately needed funds, two black gay organizations each had conferences about the same time with almost identical agendas.
According to reports, when many in New York were celebrating gay pride and the recently passed same-sex marriage legislation, that the legendary Gay Men of African Descent (GMAD) was unable to pay its staff, yet were able to fund a float for the gay pride parade.
There are many, who despite recognizing the admirable hard work and commitment of some of the GMAD staff, have wondered about the organization's HIV prevention programs. Their website is vague and sketchy, but it is common knowledge that GMAD continues to receive HIV prevention funds from the CDC, the state and city. Also questionable is how GMAD is able to get grants when there's no transparency of their accounts, similar to other non-profit organizations who post their financial statements on their websites. A search of IRS records does not show any 990 filings.
Looking at the membership of a number of state and national black gay organizations, one is likely to find some of the same people on various boards. It is as if they have created a tightly woven network and look out for each other. Over the years in these networks it has become common that in the event one of their members becomes sloppy and is caught misappropriating or embezzling funds, he is welcomed and encouraged to set up an agency in another place under another name and is never held accountable.
This was evident when the NY State Black Gay Network filed for bankruptcy and dissolved in 2009. The collapse revealed the close ties of leadership personnel and co-mingling of funds with POCC, which some claim is normal and usual inter-agency relations. Audit reports materially questioned disbursement of funds, the absence of transparency, and yet, no one saw these activities as conflicts of interest.
Teens and HIV
Recently, the 2007 movie Girl, Positive, featuring Jennie Garth as a teacher and Andrea Bowen as a student, was on television. At one point, Garth said to Bowen, "HIV is no longer the death sentence it was." But what emerged in the movie was an accurate representation of what is happening among young people. Bowen echoed the feeling of many of her generation when she said, "Why should I take the [HIV] test, only to find out and live a life different from everyone else and have others look at me different as I'm looking at you?"
Many in their teens and 20s, who obviously had not witnessed how the gay community was ravaged by HIV, how it decimated many black gay men, cutting them down in the prime of their lives; are oblivious and blasé about HIV. To many, the public service announcements and the specters of death and dying have lost their sting and relevance.
Remarkably, what has seemed to work are the public images of young same-sex couples, which seems to have slowly reduced the levels of stigma, discrimination and homophobia, and a growing sense among many that sexual preference or orientation is not such a big issue. Still persisting, however, many young people don't want to take a test: they don't want to know if they got the "monster", as knowing would alter their outlook on life, especially their perception of their sense of invincibility and longevity, dreams of children and a long term partner for the future.
One stigmatizing effect of being HIV positive is that many often feel as though they have been given a death sentence, the possibility of living a normal a life as possible has been removed, and for many, in an act of either revenge, anger or resignation, feel it is a license to have unprotected sex.
Advances in HIV Treatment
With advances in HIV treatment, results have become more accurate and quickly available, compared to the time when a person had to wait 14 nail-biting and nervous days to know whether or not he or she had been infected. Additionally, improvements in HIV treatment medications are now one per day for those who are taking treatment for the first time with the increased likelihood of reducing the presence of the virus in the blood to undetectable, thereby re-opening more life possibilities, as opposed to the handful of pills many had to take, which while killing the virus, poisoned the person's body and left them more ill than healthy.
While these advances have produced results, enabling those infected with the virus to live longer more productive lives, albeit with a lifelong disease, it is now more manageable, akin to someone living with diabetes. The flip side of these advances is that they have encouraged a false sense of complacency and security which has crept into the evolution of thinking about the effects of HIV and AIDS. Today, those who believe they have been exposed to the virus could go to the emergency room and take a pill, like a morning after pill, immediately and for a prescribed number of days to counter any possibility of infection.
These advances have spawned an attitude change of less concern about using protection and contracting HIV. Increasingly, many men who have sex with men are today eschewing condom use, preferring instead the pleasure derived from skin on skin contact. An examination of several gay sex sites would reveal the numbers who post in their profiles, while stating their HIV negative status, "Anything goes" (this means they are willing to engage in bareback, raw or unprotected sex). On the online sex sites, where once it was middle-age, elderly, and some young white men who advertised for unprotected sex, now there are increasing numbers of young black men, in their late teens and early 20s whose profiles say they prefer unprotected sex.
A City for the HIV Infected
Amazingly, another social component to HIV infection, is that in cities such as New York provide programs which include housing, cash payments and access to medications and healthcare, that many are choosing to contract HIV as a way of living off the system. Additionally, the prohibitive cost of combination HIV anti-retroviral treatment or HART can average more than $40,000 annually, which places it outside the affordability of many who may only be able to pay for their treatment by being enrolled in the state's healthcare programs. In the meantime, those states without comprehensive healthcare coverage for their HIV infected citizens have seen a growing waiting list in recent years for the Ryan White Program or ADAP, which today is upward of 9,000.
One perception of a simple rite of passage today for someone who is gay is to become HIV positive. In the black gay community, at least three in five are infected, with the chances of someone becoming positive increases.
Among many, there is the belief that if one has unprotected sex with someone else and sero-converts to becoming HIV positive, all the infected person has to do is get tested, take a pill and go on treatment. Research suggests that those on treatment are less likely to engage in unprotected sex, but the reality is that many taking medication feel a greater sense of empowerment and invincibility, and as a consequence continue to engage in condom-less sex.
While those already on treatment know the routine, often those who think becoming infected as the fad of the day do not know or understand the discipline involved in maintaining a regimen: taking pills at a certain time every day for life. Many are not only afraid, but are reluctant to allow themselves to be subject to such a regimen, which does not permit them to forget or miss a dose, or the consequences could be grave - the virus multiplying and possibly becoming resistant to that particular treatment.
What's new to deal with this?
Ron Simmons, Ph.D., executive director of the Washington, DC-based Us Helping Us, suggests that there is need and time for a paradigm shift in addressing the increasing numbers of HIV infection in the black gay community. Simmons says that prevailing research points out that because of the concentration of the numbers of those infected in a community, any one person has a greater chance of contracting the virus.
He suggests on his Facebook page: "I want us to be aware of the 'paradigm shift' in HIV infection among black gay men. Our comparative sexual risk behavior doesn't correlate to our infection rate. Studies have found that black gay men use condoms more than White or Latino gay men and have few[er] sex partners. The problem we face is structural and environment[al], i.e., sexual ecology. Because of the higher prevalence of HIV and STD's in our sexual networks, we face greater odds of exposure to HIV even though we use condoms more. Addressing this problem will take many approaches, but it is important that we don't think that the problem is because we are self-hating sluts who don't care about HIV. That is what the media is going to imply and we have to let each other know the facts so we can decide what we must do about it."
In what is seen as more of the same, as if to rekindle the fires of interest and commitment to fighting HIV, the CDC has unveiled a plan to launch "Testing Makes Us Stronger", on Sept 27. The campaign is part of a five-year $45 million campaign initiated by the White House in 2009, and is intended to use social media and networks to increase awareness and encourage black gay men to get tested. One wonders how much more effective this campaign would be and what happens beyond receiving a test result.
An independent film, "Slow," written and directed by Darius Clark Moore and produced by Moore, Rodney Parnther, and Mykwain Gainey, acknowledges sex between two black men and seems to want to break the stereotype of black gay men as people only concerned with having sex. The premise of the film, based on an assignation from an advert on a gay sex site, seems to follow what has become the norm in "hooking-up" with the fast paced insta-sex mental programming that goes with it, and departs instead from this expectation by suggesting slowing down and getting to know the person before having sex.