The HIV infection rate for young black men who have sex with men is growing at an “alarming” rate.
That’s according to a report released this month by the Centers For Disease Control and Prevention. The CDC studied HIV infection rates from 2006 to 2009, and found that the rate increased by 48 percent for 13 to 29 year-old black men who have sex with men. Meanwhile, infection rates have remained relatively stable for all other groups.
Healthcare providers and organizers in D.C., where 3 percent of the population has HIV/AIDS, are seeing the trend. Justin Goforth is the director of community health at Whitman-Walker Health, a center offering medical, counseling and legal services to D.C.’s LGBT community.
“This is who we see come in every day that’s testing positive: young black gay men,” Goforth says.
Below are five factors contributing to higher infection rate among this group:
Most first sexual encounters are with older men
According to a D.C. and George Washington University study, the District’s young black gay men tend to have their first sexual encounters with “significantly” older men, who are the most likely group to already be infected with HIV — 31 percent of men of color over the age of 30 have the disease. Young white gay men, however, tend to have their first sexual encounters with other young men, who are less likely to be infected.
Older men tend to have resources and be established because they have finished school and have jobs, Goforth explains. Young men, however, are on much shakier ground, particularly if their families or communities have shunned them.
“The power dynamic is not with the young one to say, ‘Let’s use condoms,’ because the older man has the resources the young man needs,” Goforth says.
Discovering HIV-status and committing to care
Getting young black gay men to get HIV-tested is only half the battle; health workers also struggle with ensuring young men continue to get tested. The D.C. Department of Health recommends being tested twice a year. And then there’s getting those who do test positive stay on treatment plans, which can be a challenge for many young black gay men, Goforth says.
“They’ll come to a couple of appointments, maybe get started on meds, and then maybe we won’t see them for 10 months,” he says. “Then they’ll come back and say, ‘I didn’t want to deal with this. I didn’t take meds.’”
In response to treating “our most fragile clients with HIV,” Whitman-Walker Health has started a mentorship program called +1. Clients are matched with mentors in the same demographic group, and the pairs meet weekly outside of the clinic.
Homophobia, still an issue for society at large, creates unique challenges within the black community, where institutions such as the church are so important. Many young black gay clients are hesitant to come to the clinic or get tested because of the social implications; some fear being shunned in their communities or families.
Goforth relates the story of a young black teen he took under foster care, who tested positive for HIV at 16. A month later, his mother died. His grandparents rejected taking care of the teen because he was gay. Meanwhile, his HIV-infected sister, who was a drug addict, “is very welcome in their home,” Godforth says.
Despite the challenges, in the past couple of years Goforth has seen “a dedicated upswing in how the black churches want to be a part of this.”
“The black churches have really started to reach out to places like Whitman-Walker, saying ‘how can we help?’” he says. “That really should have been happening for 30 years, but I think that’s going to be a big game-changer.”
Historical healthcare disparities
There are documented disparities in healthcare for minority groups — racial minorities have poorer health and consistently get lower-quality treatment. This, and a history of medical experimentation on black people, has lead to distrust of the healthcare establishment among some in the black community.
“We need to work on better quality and access, and then we have to educate a whole community of people on what it means to access healthcare,” Goforth says.
D.C. is a small city
D.C. isn’t a large city, with a population of about 600,000 people. But it can feel even smaller when folks stay within their neighborhoods or social circles.
“If you have created the perfect storm for HIV and you’re in a very small, confined community, then the prevalence of HIV gets so high in that community that it almost becomes inevitable” for the rate to get so high, Goforth says. “… Everybody is one or two people removed from the person they date.”
Us Helping Us, People Into Living: A D.C. organization providing case management and counseling to black gay men.