adults
HIV/AIDS Prevention
The HIV transmission rates that have sky-rocketed among young African American gay and bisexual men in Milwaukee since 2000 require the attention of the many people whose lives are intertwined with theirs. That means everyone in Wisconsin. Each of us enjoys their contributions to our community, culture, workplaces, educational institutions, places of worship, safety, family life, and friendships. We count on them each day, but their plight in HIV prevention has generally gone unnoticed, or worse – ignored and met with indifference.
African American gay and bisexual men in Milwaukee have HIV infection rates that rival or exceed the rates found in sub-Saharan Africa. But as recently as 2008, less than 4% of federal domestic spending on HIV focused on the prevention of new infections among this population nationally. The Black AIDS Institute has noted that if Black America were a country of its own, it would likely garner greater concern and assistance from the federal government than African Americans do right now.
In Wisconsin, the picture is not really different. While overall state funding for HIV prevention programs appears to parallel the epidemic among various racial and ethnic groups, the situation for African American gay and bisexual men is much different. Targeted HIV testing programs have yielded results in finding new HIV transmissions among them, but little funding is devoted to HIV prevention education programs that they need to avoid becoming HIV positive in the first place. Over the past decade, HIV program funding through the City of Milwaukee has plummeted.
The picture for other gay and bisexual men – including whites, Latinos, Asians, and Pacific Islanders – is similarly awful, though the rates of increase have not yet hit those of young African American gay and bisexual men. Good minds, good people, and good intentions have led to interventions that are apparently ineffective. All groups of these men see rates of infection that are rising.
At the center of this resurgent epidemic is gay oppression. For young African American gay and bisexual men, gay oppression is yoked with racism.
Gay and bisexual men are marginalized and sensationalized simultaneously. They are marginalized as dangerous, untrustworthy, laughable, decorative, and ineffective. They earn less money, are less likely to finish high school. They are at greater risk for having been injured in fights with heterosexual peers. As youth they experience disproportionate rates of homelessness, limited in-school safety, and fewer supports from teachers, administrators, and other adults in their lives.
Gay and bisexual sex is still made exotic in media. Anal, oral, and manual sex are derided and joked about as somehow unique to gay men, while these behaviors are widely practiced in the US and around the world. Scandals involving same-sex behaviors by prominent political or community figures attract added attention only owing in part to the status of the individuals; a great deal of this titillation appears to somehow reflect on gay and bisexual men in general.
African American gay and bisexual men have possibly been even more greatly demonized and vilified. Social exclusion and avoidance have prompted some to limit their disclosure of their sexual orientation. Some may boast of non-existent opposite-sex attractions or experiences as a means of diverting attention from their same-sex interests. Fewer still may develop an opposite-sex relationship or even marry. However, the wide-spread analysis of this phenomenon is to decry their actions as “on the Down-Low” further marginalizing and excluding these men, and then extending this analysis to most or all African American gay and bisexual men even when they are not sexually active with women at all. This pattern of response also reinforces old and unwarranted fears of African American men, fears that have been used as a pretext for their subjugation for decades.
Schools, the historic site of public health education for children and teens, have not sufficiently addressed the issue HIV prevention and gay oppression in Wisconsin. While laudatory efforts have been made by Milwaukee Public Schools, Madison Public Schools and others to increase programming for teen pregnancy and sexual transmitted disease prevention, the content of many school-based sexual health messages generally assumes heterosexuality. The school environment is also too often hostile: bullying is ignored and name calling persists. Furthermore, student bullying behaviors then become the focus of the school intervention to the exclusion of more systemic problems that include inadequate school policies, limited or begrudging commitment to sexual minority youth, inadequate curricular materials, untrained faculty, and the refusal of all levels of educational administration to provide even nominally equitable supports to LGBT youth.
But the issues contributing to HIV risk among gay and bisexual men in Wisconsin go beyond limited family and school supports.
Some have hypothesized that the young African American gay and bisexual men contracting HIV in the past five years are engaging in riskier behaviors than their peers. Others think that they are perhaps at greater risk because of differing levels of substance use. But these theories are not borne out by the facts; actually, these young men are less likely to use substances and are no less likely to use condoms. The real issue seems to be that the high rates of HIV in their sexual networks make their average adherence to prevention techniques insufficient to remain harm-free. It would appear that pundits fail to remember that HIV is a virus and acts like a virus.
The same problem with recall is true for people’s beliefs about HIV transmission among other gay and bisexual men. While Wisconsin youth risk data does show greater levels of binge drinking and earlier debut of alcohol use among young men who have sex with men, their heterosexual peers who are sexually active and binge drink do not run the same levels of risk of transmission from the same frequencies of risk behavior; again, HIV is a virus and acts like one. If there is not virus prevalent in the community, sexual sampling in that community will not result in the high rates of transmission as it would in a community with high prevalence.
Still, the human immunodeficiency virus exists in communities that are more or less robust – and more or less supportive of gay and bisexual men. Just when young African American gay and bisexual men could use more support from family, friends, the gay community, and faith communities, many of them experience far less. Racism, homophobia, and age discrimination too often put these young men in an untenable position. Some are even forced to trade sex for housing or food. We have more than a decade of data that has shown that gay and bisexual males are disproportionately at risk of homelessness, either as runaways or throwaways.
So the story goes like this. Young gay and bisexual men get marginalized and excluded from the systems and resources that could keep them safe. Families, faith communities, schools, and community agencies do not or cannot step up when these young men need them most. The current skills these men possess and use are insufficient to meet their needs of staying healthy. They contract HIV and are held completely responsible for that outcome. Those closest to these young men experience the personal crises associated with this serious, life-threatening disease. Our city, state, and country also experience the public cost of their disease. We do so by assuming a part of the burden of their life-long care and the terrible limits or loss of their contributions to us all.
It is imperative that more resources be found to address HIV prevention needs of gay and bisexual men in Wisconsin. But additional resources cannot fill the significant gaps in government, school, family, neighborhood, and faith that are the backdrop of this disease. These gaps contribute to making the lives of these young men similar to those in so-called third world countries. These serious gaps in our social integrity must be addressed by our coming together in care.
