Helping Young Gay/Bi Men of Color to Stay HIV-Negative

Research yields new approaches as we mark National Black HIV/AIDS Awareness Day.

Posted Feb 06, 2018

The Centers for Disease Control and Prevention (CDC) says that if current rates of new HIV infection continue, one in six gay or bisexual men will be diagnosed with HIV in their lifetime. 

If that’s a startling statistic, consider this: As of 2014, African-American gay and bisexual men accounted for 32 percent of the estimated 615,400 gay or bi men in the United States living with HIV, 56 percent of everyone living with HIV in the country. The CDC forecasts that today’s numbers portend a future in which 50 percent of Black/African-American gay or bi men, and 25 percent of Hispanic/Latino gay or bi men, will become infected with the virus.

As we mark National Black HIV/AIDS Awareness Day (February 7), the CDC urges us to join it in “celebrating progress in HIV prevention among Blacks/African Americans, and taking actions to expand progress.” That progress is evident in the 20-percent decline in new infections among African-American women. 

But progress is not so apparent among African-American gay and bi men. Although HIV diagnoses have “stabilized” among African-American gay and bisexual men as a whole, the CDC reports there was a 30-percent increase in new infections among 25 to 34-year-old African-American gay and bi men.

One segment of that population is the young men who participate in the drag and ball culture that dates at least as far back as 1920s Harlem, and was most vividly depicted in the 1990 documentary Paris Is Burning. Like other LGBT community institutions, the balls and drag houses serve to support their members' ability to survive, and even thrive, in a hostile world. The fact that their participants are largely young gay men of color and limited financial resources testifies to a powerful resilience worthy of further attention.

In fact, a survey of 263 ball and other community event attendees in Los Angeles found that participation in balls and drag houses offers support and a positive identity. The respondents — 83 percent Black/African American, 7 percent Latino, 66 percent identifying as gay or some other same-sex sexual identity, and averaging nearly 24 years old — commonly reported experiences of rejection, racism, and homophobia. When asked what brought or attracted them to the ball community, they typically described feelings of acceptance and lack of judgment — the opposite of what they had felt from family, friends, and their communities based on their sexual identities. When participants who actually won a ball were asked to describe how they felt after winning, they reported feeling validated, important, and recognized for their efforts. 

It “may be a sign of resiliency,” say the researchers, for the young men in the study who seek refuge in a subculture, like the houses and balls, where they can become a part of a group or family whose membership reflects their own interests and beliefs. The house and ball communities offer “a safe space and an alternative to the discrimination and potential social marginalization that young African American men who have sex with men face.” In particular, the idea of shamelessness, or pride in oneself — a core value of the community — “can potentially counter the effects of homophobia, both external and internal, as well as depression and other mental health conditions.”

The researchers recommend that service providers and others working with young African-American and Latino gay and bi men encourage them to be “shameless” and express their true selves. They liken shamelessness with regard to sexuality to ethnic pride, which has been identified as a protective factor among adolescents for risk behaviors, such as substance abuse and sexual risk.

In Chicago, other highly effective means are being used to support young gay and bi men of color in staying healthy and HIV-negative. At the AIDS Foundation of Chicago, a campaign aimed at promoting PrEP (pre-exposure prophylaxis, a daily dose of the HIV drug Truvada) for gay men and women, including transgender individuals, focuses on “the good things that make us happy,” explains Jim Pickett, the foundation’s director of prevention advocacy and gay men’s health. “We characterize gay men’s problems all the time,” said Pickett in an interview at his office. “Can we focus on resilience? Strength? It’s not ignoring the problems. It’s your frame. If you’re a young African-American gay man, honey you are resilient!” 

The “PrEP for Love” campaign is about engaging vulnerable African-American communities in particular in conversations about PrEP with popular individuals they know. Campaign posters, with taglines like “Transmit love,” “Contract heat,” and “Catch desire,” feature men and women of various sizes and skin tones represented in sex- and body-positive images. Pickett points out one of the key differences between the new PrEP campaign and past campaigns. “So many things have been negative, focused on fear,” he said. “Let’s focus on our strength and joy, not on ‘risk.’ This is a great example of resilience and taking a positive frame, not a loss frame.”

Pickett said we need to focus on what keeps gay men negative. “What assets are in place that people are able to rely and thrive on?” he asked. “We want people to learn about PrEP, but we have to remember that HIV prevention is not the only thing on people’s list of challenges. It may not be at the top of their lists, either. If you don’t address people that way, as myriad and complex, but only as potential vectors, you are not respecting them.”

On Chicago’s South Side, John A. Schneider, M.D., MPH, an associate professor of epidemiology and medicine at the University of Chicago, researches networks and how to use them to create positive, health-promoting change. His clinical work with largely young African-American gay and bi men has yielded intriguing findings about how best to support those at greatest risk. Schneider has found, for example, that the more men there are involved in a young man’s life — straight or gay, and especially male kin, fathers, and also brothers or male cousins—the more inclined he is to protect himself if he is HIV-negative and adhere to treatment if he’s positive. “Some of my very young guys have come in with their fathers,” said Schneider. “There is something powerful about that.”

A good deal of Schneider’s recent work has focused on the ball community. There, he said, it’s hard to predict when someone tests HIV-positive how well he will respond, whether with resilience or what Schneider calls “non-resilience.” Whether the man responds with shame or self-esteem depends largely on his sensitivity to stigma, “the threshold of resilience,” Schneider said.

He sees in the young black men he works with from the ball community the resilience they developed, too often from having to fend for themselves and simply growing up black in a  society preoccupied with skin color. “I think there are survival skills the young black guys develop even before they realize they are gay,” said Schneider. “So having a gay identity may be just another issue that comes up for them.” The ball community itself is a source of resilience. “Vogueing and dance are very liberating and healing activities,” said the doctor.