This role often renders them unable to negotiate safer sex due to pressures to maintain a relationship at any cost, particularly during times of economic scarcity.23 Asking a partner to use a condom can be construed as both accusatory and an admission of infidelity, possibly resulting in violence and/or abandonment. The latter may be particularly troubling for many Black women due to the ever-shrinking pool of African-American men, who have higher mortality and incarceration rates than men in other ethnic groups, especially in areas of lower socioeconomic status.24
Prisons and jails often offer inmates an opportunity to engage in consistent HIV treatment and care, as well as discharge planning to ensure that they can maintain their health after their release. At the same time, incarceration does place inmates at risk for infectious diseases, such as hepatitis, tuberculosis, and sexually transmitted diseases, which can facilitate transmission of HIV during sexual encounters and tattooing.25 In these instances, heterosexual and gay men26 often leave jail unaware of their HIV status, or unwilling to disclose their status to partners and access treatment and care upon returning home, leaving them at risk to progress to AIDS and/or infect others.
Black MSM have been most heavily impacted by HIV/AIDS in their community. Though only 4 percent of males ages 13 and older in the United States are MSM, they accounted for 61 percent of all new HIV infections in 2009. African-American MSM represented the majority of these cases, with 60 percent of all new HIV infections occurring among young Black MSM ages 13 to 29.27
Curtis, diagnosed in 2006, has benefited from the care and services provided by It Takes a Village, a subgrantee of the Denver Part A Transitional Grant Area. To watch his video, visit: http://hab.hrsa.gov/livinghistory/voices/curtis.htm.
High rates of HIV among African-American gay men stem from a number of factors, including a growing sense of complacency around HIV. This is particularly true among younger generations of African-American gay men, who often consider HIV a disease that happens to other people and can be easily “fixed” with medication. They often point to basketball player Earvin “Magic” Johnson, who announced his HIV status in 1991 and has seemed healthy ever since beginning highly active antiretroviral therapy (HAART).28 As one advocate notes, “He is doing well and doesn’t ‘look’ like a person you think has AIDS. It doesn’t appear to affect his quality of life. So folks look at that and don’t think that AIDS is that bad—that you can just take a pill.”
As a result, many Black MSM do not know they have HIV until later in their infections. In the CDC’s Young Men’s Survey, conducted from 1994 to 2000, Black MSM were diagnosed with HIV at rates five times those of their White counterparts. Yet of the young men that have sex with men (YMSM) of color who tested positive for HIV in that study, 82 percent said they did not know they were infected, and most did not believe they were at risk for HIV in their lifetime. Only 15 percent were connected to HIV primary care and treatment.29,30,31
Homophobia also plays a major role in preventing Black MSM from understanding their risk for HIV, or accessing HIV prevention, testing, treatment, and care services. Rejection by their friends and families often forces them to leave home at an early age, and many end up homeless and engaging in sex work to survive. One nurse at a Ryan White provider site shared how he found a young Black man diagnosed with HIV and syphilis, who had been lost to care and living at a shelter; his mother had died shortly after he learned he had HIV, and his grandparents had turned him away for being “gay with AIDS.”