More than two years ago, a young African-American man walked through the doors of the San Francisco AIDS Foundation. Frederick was living with HIV, and like many other men we see, he was at a crossroads that threatened to put his health in serious jeopardy. Due to a series of setbacks, he was facing life on the streets in San Francisco's gritty Tenderloin neighborhood. He urgently needed help. Unfortunately, stories like Frederick's play out in communities around the world where, all too often, proper networks of support for young black gay men are weak, if they exist at all. After 30 years of HIV/AIDS, it doesn't have to be this way.
Today is National Black HIV/AIDS Awareness Day. Really, it should be Global Black HIV/AIDS Awareness Day, because gay black men are among the most marginalized worldwide. And if we truly desire to create an AIDS-free generation, it is essential that the unique needs of all marginalized gay men around the world be addressed to reduce new HIV infections and improve access to life-saving care.
We can do this. We have the knowledge to do it; now we need the will. Two recent experiences have shown me, in clear relief, that the needs of this population are strikingly similar all over the world.
In early January I traveled to Bangkok to take part in a meeting with the leaders of the MSM Global Forum ("MSM" is a clinical term for men who have sex with men). The group includes representatives from MSM organizations that address life-and-death human and civil rights violations in countries across the globe.
Not surprisingly, the group is made up largely of men of color from low- and middle-income regions in South Asia, China, Africa, Central America, and Eastern Europe. Thanks to critical resources from the Global Fund in the mid-2000s, many of these countries witnessed great progress in the fight against HIV/AIDS. Those resources even forced many communities to acknowledge that gay men actually exist within their borders and comprise a visible population that deserves services. The result was an explosion of MSM and transgender health-related activities.
But the current economic turmoil is now jeopardizing that progress. Like many other organizations, the Global Fund is facing hard times. It recently announced that it will cancel its 11th round of funding, and Executive Director Michel Kazatchkine has announced his departure this coming March. Even more troubling, there's mounting pressure for the Global Fund to reassess its funding criteria -- which, if not carefully managed, could deliver a lethal blow to organizations doing critical work advocating for gay men of color around the world.
The survival of these organizations is critical, and any reductions in support would be a dangerous step backwards. In some of these countries where Global Fund assistance has been making measurable progress, there is now active consideration of legislation to criminalize gay people and their sexual relations, and sexual activity by HIV-positive people. This type of discriminatory legislation exacerbates HIV stigma and makes it far more difficult for people living with HIV/AIDS to access treatment and care.
Back here in the United States, anti-gay rhetoric is still a staple of electoral politics of the right. Self-described conservative candidates advocate the reinstatement of "Don't Ask, Don't Tell" and support constitutional amendments to prohibit and dissolve existing same-sex marriages, deny adoption rights, and criminalize consensual sex for HIV-positive people. These persistent messages of isolation, stigmatization, and exclusion from mainstream American life are a painful reminder of the unequal status that gay men, and particularly black gay men, share with other men in communities around the world.
This was at the forefront of discussions at another meeting I recently attended in New Orleans: the African American MSM Leadership Conference.
At the meeting, we discussed the best prevention tools to fight HIV among black people and ensure access to proper treatment for those living with HIV. These include pre-exposure prophylaxis (PrEP), whereby HIV-negative people take antiretroviral drugs to protect themselves from infection, and "test and treat," an approach that supports early access to antiretroviral drug treatment as soon as they are diagnosed with HIV infection. Both are scientifically proven tools designed to stop the spread of HIV and dramatically improve health outcomes, but serious questions remain about implementation, feasibility, and availability, particularly among black and other populations with complicated lives that could impact adherence to a regular drug regimen.
As I sat in both forums in Bangkok and New Orleans, I reflected on the similarity of concerns and the commonality of the circumstances of gay men of color globally. The sense of marginalization from mainstream society is overwhelming; the loss of social capital even within their own ethnic or racial groups is profound. They all have a love-hate relationship with the infrastructures developed within their communities to combat HIV disease.
For example, the best of those infrastructures address poverty, homelessness, drug use, unemployment, and low literacy -- all known drivers of new HIV infections. But in New Orleans, streams of black gay youth decried what they feel is an overemphasis on HIV and the pathologizing of their sexuality in the social and public health infrastructures targeting them. They want and need programs that simply affirm and support their development as young black gay men. They feel that their talents or progress in other areas, such as artistic expression, education, mental health support, and job training, are often largely ignored or discounted because of an overriding imperative to focus on HIV. They know that stopping the spread of HIV must be addressed in a social and cultural context, but cash-strapped community-based organizations are not funded to do so.
This problem brings me back to Frederick, the young man who was facing homelessness when he walked through the doors of San Francisco AIDS Foundation. Sadly, his story could happen anywhere around the world. But unlike in many other communities, when Frederick reached out for help here, he found it.
Thanks to the staff and community members of our Black Brothers Esteem program, Frederick immediately found temporary housing. A few months later he was in a stable home.
Frederick credits the foundation for saving his life. When people are stably housed, we know they are more likely to take their medications, see their doctor, and take care of their own health and the well-being of their sex partners.
Here's the best part: Frederick now takes everything he's learned from his involvement in the foundation and spreads messages of good health to his peer group. With every contact he makes with another person, he touches a life and changes our city for the better.
Frederick is like many other young black gay men I encounter these days. Despite ongoing marginalization, they are displaying tremendous resiliency and courage, taking the lead in advocating for their own rights. They aren't complaining about what's not happening in the fight against HIV/AIDS. Instead, they're developing better ways to serve men of color and bring us closer to the day when HIV is no more.
This is how we will truly end AIDS -- one person at a time, one community at a time, always with a collective goal in sight. When we support organizations around the world that fight stigma and marginalization, and when we address the holistic needs of young black gay men, we tear down the barriers to education, social capital, and high-quality, comprehensive medical treatment and care. Yes, we have a lot of work to do. But my experience with Frederick teaches me that when we provide resources to empower one black gay man to take charge of his physical and mental health, we witness a multiplying effect. We have the knowledge. Now is the time to muster the will.
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