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City of SecretsChristopher Myers

City of Secrets (continued)

The numbers have remained consistent and horrifying through eight years and three separate research cycles by Bloomberg School scientists and colleagues from the Maryland Department of Health and Mental Hygiene.

According to the Behavioral Surveillance Research Study (BeSURE) sampling completed last December, 48 percent of African-American men who have sex with men (MSM) in Baltimore City are HIV positive. That’s far higher than the average of 28 percent found in the 20 other cities participating in the National HIV Behavioral Surveillance in 2008. (Researchers in Baltimore, like those in the other cities, recruited most MSM study participants from clubs and venues that might attract people who engage in higher HIV risk behaviors.) The prevalence is even more troubling when compared to the two other cohorts in the BeSURE sampling; African-American MSM surveyed in 2011 were infected with HIV at a proportion more than three times that of injection drug users, and eight times that of heterosexuals considered at high risk for infection. Baltimore’s MSM community is, in one sense, a microcosm of a global issue; a recent Lancet article authored by Bloomberg School faculty noted that in countries like France, Australia, and the U.K., the overall HIV rate is declining in populations with the exception of one group: MSM.

In Baltimore, a key challenge for reducing HIV among the MSM community is testing. More than two-thirds of those surveyed with HIV had no idea they were infected prior to testing in the study. That means many African-American MSM are not receiving critical HIV care services, says BeSURE principal investigator Danielle German, PhD ’09, MPH. “It is also a challenge for preventing HIV transmission to partners,” she says. BeSURE participants “get the full scope of pre- and post-test counseling, referral services and linkage to care. That aspect of our activities is as much of a priority for us as the data gathering.”

BeSURE is working on the problem because there’s little doubt that knowing one’s status greatly lowers transmission risk. The transmission rate for people who know their status is 2.7 percent, versus 10.4 percent for those unaware, says David Holtgrave, PhD, an HIV researcher and chair of the Department of Health, Behavior and Society (HBS). But the appalling infection rates don’t seem to be attracting larger community or public health attention. “If the rate of infection in the African-American inner city male population was the same in medical doctors in Baltimore,” says Carl Latkin, PhD, an HBS professor, “it would be considered a national emergency and a huge amount of attention and effort would be put into combating it. And from the inside, there’s a lack of effective grassroots organizations that have demanded that the city address it as a public health issue.”

That lack of community cohesiveness is perhaps the natural outcome of how MSM are seen by those in Baltimore’s African-American culture. To delve into that culture, to understand the stigma that in many influential corners is still attached to homosexuality, is to glimpse the nature of the challenge facing public health workers trying to encourage MSM to know their status and protect both their health and the health of the community.

“You’re taught as an African American that you need to be a man and create and take care of your family. And now you’re going to come out and say you’re what? You’re gay?” — Carlton R. Smith

At 49, Carlton R. Smith is old enough to remember when HIV was a death sentence. That it’s not anymore—at least for those who get tested and treated—is a message he conveys via the organization he founded in 2002, Baltimore Black Pride.

Consider the picture that Smith paints of the rejection a young, gay African-American male often encounters in the inner city. “It comes some out of the churches,” says Smith. “They preach out of the book of Leviticus that you’re an abomination. People who don’t have an understanding of the [religious] context hear that word and think they’re a blight on the planet. Sometimes, there’s a community sense of, ‘How dare you!’ You’re taught as an African American that you need to be a man and create and take care of your family. And now you’re going to come out and say you’re what? You’re gay? A homosexual?! Well now you’re useless to the community. You can’t produce children. Like a preacher said, ‘two spark plugs can’t get it together.’ So now you’re seen as disassembling the family and taking away from the community.”

Comments

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  • Mary M. Thomas

    Sch. of Public Health 10/03/2012 10:14:47 AM

    Well written and very informative. This is an mind opening article.

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