Thursday, August 18, 2005

46% - "The Sky Is Falling! The Sky Is Falling!"

HIV Prevalence, Unrecognized Infection, and HIV Testing Among Men Who Have Sex with Men --- Five U.S. Cities, June 2004--April 2005

"So Goosey Poosey joined Cocky Locky, Henny Penny and Chicken Little, and they went along as fast as they could."

Remember the folk tale Chicken Little? Well I have been living a Chicken Little nightmare for the last 10 years or so. A lot of Black gay men have AIDS and HIV. So what else is new? Well, a study published in the most recent MMWR in which 46% of Black gay men in 5 cities were found to be HIV positive, that's what's new. Now, Chicken Little, Henny Penny, Cocky Locky and Goosey Poosey all have articles, open letters, social marketing campaigns, and subsequent research designed to address this new and emerging issue. How sweet. The only crazy thing is that this is not a new and emerging issue!!

As recently as 2004 an article published in MMWR suggested that a third of Black MSM at an Historically Black College somewhere in the Carolinas were HIV positive.

In 2002 we heard about young Black MSM in six cities who tested positive: Out of a total 920, 150 tested HIV positive! That's 16% and nearly all of them were unaware of their status.

Remember in 2000, in response to an MMWR article, Chicken Little (All Ya'll), Penny Henny yet in tow, was busy again running to tell the king that the sky was falling.

Again in 2000 we heard that racial and ethic minority men were accounting for an increased number of infections and that among these men African Americans were the most impacted.

For the last 10 years my Chicken Little nightmare has been the image of me working my a#% off to prevent the spread of HIV and every two years looking up to see the motley crew, Chicken Little, Henny Penny, Goosey Poosey, and Cocky Locky running to tell the king that the sky is falling!

Now once again we're running to tell the king.

"The sky is falling!" cried Chicken Little. "We must tell the king."

"I know a shortcut to the palace," said Foxy woxy sweetly. "Come and follow me."

"But wicked Foxy Woxy did not lead the others to the palace. He led them right up to the entrance of his foxhole. Once they were inside, Foxy Woxy was planning to gobble them up!

The question that remains for me is: How many researchers, MMWR articles, and morbid study findings do we need to know that it's bad. How long will our HIV prevention efforts be reactionary and guided by hysteria? I've often wondered what kind of a living I could make as a researcher if I, once every two years sent out an email that said: "It's bad, and it's getting worse." I think I could save CDC and countless universities millions of research dollars. Dollars that could quite possibly go to fund the prevention efforts of the organizations that would be charged to react to my declarations.

I say all this to say: It's bad, and it's getting worse. We can't possibly be surprised when these data emerge to remind us. So why are we all running around with chicken little screaming "The sky is falling!"? The sky has been falling for a while! I say, "To hell with the king", cover your head!

"After that day, Chicken Little always carried an umbrella with her when she walked in the woods..."


Anonymous said...

You're right...the sky is falling and has been falling, and hopefully soon something will happen to get folks to realize that they probably should walk around with umbrellas!

CS said...

I work in HIV prevention, and have been for the past 13 years. You're absolutely right, it's nothing new. What do you think we need to do differently to affect change in a meaningful and lasting way? What do you think is behind these continuing rates of infection? What do the brothers need that they're not already getting, and what are your thoughts about personal responsibility in the face of all of this data? I mean, it's not because we're not out there doing the work. Is something missing in our work, or is something else going on?

Ynkuya said...

Hello CS,

I'd like to spend a couple of minutes trying to address your questions.

1) What do I think we need to do differently?

I believe that we need HIV prevention programs that are based on the needs of Black Gay men. The beginning of creating these kinds of programs is to stop assuming that the method of prevention that most Black gay men are going to adopt is condoms. Years of increasing incidence have shown us that this assumption is faulty. So if black gay men are not going to use condoms after decades of informational and behavioral interventions then we need to start talking about how to make sex without condoms safer.

2) As you can tell in my comments above, I believe that black gay men have failed to curb HIV in our communities. Until we, Black Gay Men prevention professionals, accept our failure we cannot begin to speak in ernest about changing our strategy.

The failure is in our inability to see or our unwillingness to acknowledge that our prevention efforts have not been working. We need to stop trying to force condoms down everyone's throat and push non penatrative forms of sex, oral sex, pulling out, lots of lube, STD screening and treatment, regular HIV testing, all of these things together can help to curb the spread of HIV, even among men who refuse to use condoms.

3)Brothers need to know that they are not doomed to be positive. We need new messages that focus on postie issues within our community. Fear, and DONT is all our prevention messages communicate. We need sex positive preventioin messages. We need cum positive prevention messages. We need to hear that our sex is not perverse when we desire to be touched more intimately than a condom will allow. We need all of the information that will keep us safe not just the information that CDC and the PRevention Industrial Complex deem prudent. IF we had begun teaching Black gay men who bareback how to bareback more safely back in the 80s I wonder who we would not have lost.

4)I think there is a big something missing in our work. It's needs based prevention. I have read so much needs assessment data that is supposed to be connected to programs. I read the data, then I look at the program and I don't see the needs being addressed in the programs. I conducted a needs assessment just before I left AID Atlanta. We read the data, I developed a program that would respond to the needs of the community and I put it on the shelf to remain until CDC realizes that 3MV an intervention developed in the northeastern corner of our nation in a small college town with a small number of Black gay men cannot possibly meet the needs of all Black gay men in this country. We may, as black gay men, -I have to be careful about how I say this because I don't want any of the kids to suffer heart attacks- have to begin funding our own salvation and stop depending on CDC money. We may have to start saying "no thank you" to CDC money that does not fund programs that meet the needs of our people.

Thanks for your reply,