The Enduring Battle Against AIDS
Richy Rosario; video by Dominique Spooner
African American males continue to suffer one of the highest HIV/AIDS infection rates of any demographic, even as NYC Black Pride wraps up another year of celebrations and acceptance of black and brown queer people, coupled with marriage equality and visibility increase.
The epidemic has not ended in the United States, especially among people of color here in our own backyard. The Centers for Disease Control and Prevention reports that in 2010, the estimated rate of new infections among African Americans was 7.9 times as high as the rate in whites, and young men who have sex with other men remain the most vulnerable. And for transgender women of color, the rates of infection are jaw dropping. In New York City alone from 2007–2011, 90% of newly diagnosed transgender women were Black and or Latina.
Harlem has one of the city’s highest rates of infection, especially when it comes to men and transgender women. According to Harlem United, a non-profit organization on 125th street dedicated to HIV prevention, Harlem’s rate of HIV infection is four to five times higher than the national average.
Even in our “out loud and proud” era, because of the shame that encircles gay black men and their HIV status, far too many men don’t get tested. “A lot of Black MSM in the Harlem area refuse to get tested because there is a lot of stigma,” says Robert Gamboa, a Community Recruitment Coordinator at Harlem Prevention Center, a research site for HIV related studies. “So at the same time you have guys walking around here infected and they don’t even know it.”
HIV finds the ideal incubator when a high infection rate intersects with low condom usage among people who don’t know they have the virus. That combination makes any unprotected sexually encounter particularly “risky.” In other words, the chance of having sex with an infected person in Harlem is “riskier” than in a community with a lower rate of infection. That means that protection is key. Which is why, like many other community centers in the area, Harlem Prevention Center does its best to promote safe sex around the neighborhood.
“We do community counseling in this area,” says Gamboa.“We go to local barbershops, and give them condoms and information. A lot of the businesses are open to this, which is actually helping black men in Harlem practice safe sex.”
But being poor can make both preventing and treating HIV more difficult. PrEP, the new pill that prevents transmission, has changed the face of HIV prevention in the past few years, but many men and transgender women uptown don’t have access to the medication or can’t afford it. The pills cost about $1,200 a month and $14,000 a year, with additional costs for follow-up lab tests and doctor’s appointments, according to The New York State Department of Health.
But luckily, New York State can fund a prescription for PrEP despite anyone’s health insurance status, and Gilead, the drug’s manufacturer also has a payment assistance program. Yet what makes accessing the medication hard for most Harlem residents is their lack of proper health care, and knowledge about it.
“We’ve come along way in the last few years in getting the word out but the uptake has been slow,” says Kimberleigh Smith, Vice President, Policy & Advocacy at Harlem United. “The early adaptors of PrEP seem to be white men who are more affluent, and not folks in communities of color. In terms of health care, it’s the access of equity in obtaining PrEP that reflects access to equity in health care.“
For some transgender women the risks are greater because they have to resort to sex work to survive, while facing other societal barriers. “I have clients who are very angry, they don’t even like tricking but it’s a means for survival. They go for a job interview and they are looked down upon because they are transgender,” explains Gamboa. “And once these trans-girls are high anything goes. They meet a john who does not want them to use a condom. So they wont even if they are infected, or they choose not to because it’s about making money.”
Those kinds of tactics for survival led Tamara Williams, a 25 year-old black transgender woman from The Bronx (and now out of the life), to HIV infection at age 22.
Despite the statistics and those out there with stories similar to Williams’, Smith believes the future looks good. “By 2020 the goal is to get the new HIV infections in the state of New York under 750, so that HIV will no longer be an epidemic in New York State,” she says. “We’re going to continue doing what we can to get to the larger state goal. I have no doubt that Harlem just like many other parts of the city will start to see the fruits of that labor.”