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City of SecretsChristopher Myers

City of Secrets (continued)

Some of the factors that impair self-esteem are not unique to the African-American community. But racism, poverty and high unemployment are endemic in the inner city. Access to resources—and even public transportation—is an additional barrier to testing and care. For many young men, the hurdles to determining one’s status, let alone accessing care, are too discouraging to consider.

“When I talk to a lot of young people, they’re not worried about testing,” says activist Keith Holt, 26, who is HIV-negative. “They’re worried about living … ‘where am I staying at tomorrow? Will I have something to eat?’ It’s about what’s important to you at that moment. With HIV, it’s not something you think is affecting you right in the here and now, even though it is.”

And just as easily, discouragement can turn to anger, with deadly effects. “For people who have been kicked out of their house for being gay, or positive, or they can’t get insurance or medication or don’t know how to get it, they’re afraid they’re going to die, they’ve been through a lot,” says one HIV-positive community activist. “When you’re not getting help, and you have no one to talk to and you’re dealing with it by yourself … there’s a reason that people go crazy and have unprotected sex: They just don’t care anymore.”

And so the wildfire continues to rage.

For those on public health’s frontlines, spreading the test-and-treat message among Baltimore’s African-American MSM community is no easy task. That may be due to a lack of urgency on the part of younger MSM, who haven’t seen their peers die from AIDS in the numbers that older MSM have. Another barrier is that the African-American MSM community is so fragmented that an outreach effort or a single ad campaign is unlikely to reach all MSM.

“The conundrum of programs since I’ve worked in them here, in Seattle and New York, is that when we say we’re having a ‘gay’ event, we get men who identify as gay and it’s usually white or Asian gay men who make a certain amount of money,” says Anthony Morgan, an HIV health educator with the Lighthouse, a Bloomberg School project that conducts community-based disease reduction research and education in Baltimore. “And when you look around the room you notice that maybe there’s one or two Latino guys, and maybe a black guy. So do you say we’re just having a black men’s program, and see who is engaging in a certain type of sex? Do you say ‘MSM’ and risk that no one will connect with it? Or is that term too objectifying; does that just reduce you as a human to where you put your penis?”

There’s no shortage of groups that fall under the MSM banner. There are the out and open, who may well be in the minority; these include the club-goers who were recruitment targets of BeSURE’s cohort, and members of the ballroom scene, where “houses” compete in lavishly costumed and elaborately produced shows reminiscent of French haute couture runways.

But many African-American MSM lead fully or semi-closeted lives: professionals, college students, bisexuals, men on the “down-low” who meet regularly for sex with men in a tight-knit group that is never mentioned elsewhere. These groups are far harder to reach. In some cases, the reticence to discuss homosexual sex is so pervasive, it’s not even acknowledged by men who engage in sex with men as part of their work.

“One focus group we did was with men who sold sex,” says Latkin, an HBS professor. “And one guy brought in [male prostitutes] from The Block where they sold sex. What I found fascinating about that discussion was that here were six guys who knew each other, and nobody ever mentioned having sex with a man; they might say ‘a client,’ or ‘somebody,’ or this and that, but even in a group that was completely aware of each other’s behaviors, there was still a high level of stigma, of even talking about [MSM] for that group.”

Given this ongoing reluctance to self-identify sexual preferences or which subgroups one identifies with, behavioral interventionist Karin Tobin, PhD, says the best course might be to focus on education. She and Latkin have been piloting a program called Unity in Diversity, which targets African-American MSM (including MSM who also sleep with women) to educate them about their status, risk behaviors such as frequency of condom use and, most importantly, to encourage them to pass that information on to their social networks regardless of how they self-identify.

Tobin reports that three months after the seven group meetings, participants reported a reduction in the number of male sex partners and an increase in condom use compared to those in the control group, which had just a single risk-reduction counseling session. But what also caught her ear was how participants didn’t readily verbally identify with being gay or part of an MSM subculture. “In our experience with guys in Unity in Diversity, if we don’t bring it up, they’re not bringing it up. I’m not going to force a label on anyone,” says Tobin. “I think folks come in waiting for that shoe to drop, for you to put a label on them. And even if someone were to think, looking from the outside, that a person identifies as gay, he may never use the term, ‘I’m a gay man.’”

“Isn’t this some shit,
I’m track captain, president of my class,
But now everybody won’t see that,
just the gay black boy
that’s gonna die fast.”
—From the poem “My Experience” by Tavon Vinson

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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