Monday, May 02, 2016

The Perfect HIV Storm Facing Black Men

Prior post has noted the high risk black males have to contacting HIV - and the inadequate measures being taken to address the epidemic.  Among the causes blocking necessary measures and creating toxic conditions are conservative politics, religion, stigma, and racism - especially in the South where HIV infection rates are the highest and access to medical treatment is the lowest due to Republican refusals to expand Medicaid and provide needed funding for necessary programs.   Candidly, if the epidemic were hitting whites in such numbers, it would be far more likely that needed steps would be taken.  Here in Hampton Roads, Virginia, the situation in dire.  The Advocate has a lengthy article that looks at the huge and frightening problem.  Here are excerpts:
Half of black gay and bisexual men in the United States “will be diagnosed with HIV in their lifetime” if current trends continue, according to analysis by the Centers for Disease Control and Prevention. The study was presented in late February at the Conference on Retroviruses and Opportunistic Infections in Boston, and was described as “the first-ever comprehensive national estimates of the lifetime risk of an HIV diagnosis” in every state.  
To offer some perspective: The nation with the highest rate of HIV prevalence is Swaziland — a tiny, landlocked kingdom within South Africa — at about 27 percent prevalence. The second-highest rate is in nearby Botswana, with 25 percent. If America’s black gay and bisexual men comprised a nation unto themselves, that nation would soon have the world’s highest rate of infection — twice as high as its closest rivals.
The financial burden would be staggering. The CDC estimates the average lifetime cost of treatment in this country to be about $400,000. Thousands of new cases a year means billions of dollars for HIV treatment alone. And those figures don’t account for treatment for other illnesses, lost wages or productivity, or the emotional costs of depression, stigma, and anxiety.
African Americans and other black communities represent only 14 percent of the nation’s population but account for a staggeringly disproportionate 44 percent of all new HIV infections. Black MSM — especially teens and men in their 20s — face the brunt of the epidemic. A growing body of research has made the case for years now.
Black MSM have been more affected by the epidemic than any other population in the world, the Black AIDS Institute reported four years ago in a study released at AIDS 2012. An estimated 1 in 2 black MSM are HIV-positive in some cities, the study adds. This was less than one year after an August 2011 CDC report noted an “alarming increase of new infections” among black MSM ages 13 to 29. 
“Why isn’t this a public health emergency? This probably has much to do with race and class,” says Ramon Gardenhire, the AIDS Foundation of Chicago’s vice president of policy and advocacy.
There is not one specific reason new infections are increasing among black MSM. The data show that black MSM do not practice more of what has been described as “risky behavior” — multiple partners and intercourse without protection — than their white counterparts. Black couples were actually “more likely to use condoms,” according to a study by San Francisco State University researchers.
The release of the CDC’s lifetime risk estimates — without explanation or context — isn’t just peculiar. It feeds “into the narrative across popular culture and the media that black men and women are hypersexualized, criminals, and sexual predators,” says Ravi K. Perry, Ph.D., an associate professor of political science at Virginia Commonwealth University. 
Many researchers believe a “perfect storm” of health, racial, and socioeconomic barriers — including limited access to health care and insurance, unemployment, poverty, housing insecurity, incarceration rates, homophobia, stigma, and racism — has fueled the epidemic across black communities. These factors have been exacerbated by inadequate federal, state, and local funding, as well as generations of government neglect. 
Unemployment rates are usually higher among black MSM youth. “Because they are less likely to be employed, they are less likely to have health insurance, and to be diagnosed in a timely manner. So there are very high rates of unrecognized infections among young black gay men,” says Gregorio Millett, M.P.H., the American Foundation for AIDS Research’s vice president and director of public policy. “Then they are less likely to be in care, which means they are less likely to be able to be taking medications so they will not transmit HIV to their partners.”
“The Department of Health and Human Services found that although black MSM comprised half of the new infections in the African-American community, most of the prevention programming was going toward heterosexuals,” he says. “That is a historic imbalance that is born of homophobia.”  
The states with the highest lifetime risk of seroconversion — with only some exceptions — are all Southern.
“About half of the people living with HIV are in the South. Most of them are black,” says Treatment Action Group’s Farrow. “We see very high numbers in places like Atlanta, Miami, Baton Rouge, New Orleans, and Jackson. Those cities have become the epicenter of the epidemic. It’s no longer New York or San Francisco.” 
The South is also the stronghold of the Republican Party. The Southern states’ rejection of expanding Medicaid eligibility under the Affordable Care Act — despite residents in those states being overwhelmingly poor and underinsured — is another critical factor behind the increase in black MSM infections.
“The lack of health care infrastructure in the South has particularly impacted black gay men,” says Farrow. “Under the Affordable Care Act, anyone who is HIV-positive can get insurance. But in [almost] all of these states the Republican governors and legislatures have refused to expand Medicaid.”
It’s going to take “a multi-pronged approach to improve health outcomes, health access, health literacy, and [reduce] stigma” among black MSM, says Orlando O. Harris, Ph.D., a TAPS Fellow at the University of California–San Francisco’s Center for AIDS Prevention Studies, who has researched African-American and Caribbean MSM communities. “We cannot have a one-size-fits-all intervention strategy [and we] must recognize there are many separate communities. Caribbean Americans often feel left out of prevention. The conversations have to be across generations,” he adds. “We also need to have sex-positive conversations with young people.”  
The introduction of the antiretroviral Truvada for prevention — known as pre-exposure prophylaxis, or PrEP — has marked a historic shift toward a biomedical HIV-prevention model. Truvada is more than 90 percent effective in preventing HIV infection if taken at least four times per week. Several states and municipalities — including Washington State, San Francisco, and West Hollywood — have created PrEP access programs. But many of these regions are largely white. White gay men also enjoy better access to health care and insurance.
“This is extremely problematic,” says UCSF’s Harris. “We have created a new disparity for black MSM. They are facing the brunt of the epidemic but cannot access [PrEP] as readily as white MSM.”
“We need to begin a national conversation around PrEP just like we had a national conversation around safe sex,” says Farrow. “Everyone needs to know what it is. We need someone from CDC to go on all the black talk-radio shows — like Tom Joyner or Rickey Smiley — where millions are listening. The fact that they haven’t done this is a failure of vision and leadership at the CDC.”

The data is disturbing and depressing.  Sadly, in much of the South - and certainly rural areas of Virginia - Republican politicians are virulently anti-gay.  Add their overt racism to the mix and the situation is truly toxic.  Sadly, some in the GOP (and, of course, white fundamentalist churches) are probably pleased with the decimation hitting the black population.  A slow genocide is just fine with them. 

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