Denial
New HIV diagnoses in Bedford-Stuyvesant and Crown Heights are the highest in Brooklyn. Why?
By Shrai Popat
The offices of the Gay Men of African Descent are purposefully difficult to find. Housed in a generic office block and sitting at the end of a basement corridor, the lack of natural light is the necessary compromise for ensuring that no one walking past can catch a glimpse of those visiting the center.
Vaughn Taylor-Akutagawa, GMAD’s executive director, says that the organization is close to a number of subways lines and “right by the Barclays Center so that if you come here it’s not obvious that you’re coming to the area to get tested or for counselling.” The task of striking a balance between discretion and notoriety proves central in tackling the disproportionately high incidence of HIV diagnoses in Bedford-Stuyvesant and Crown Heights, which remains the highest in Brooklyn and the second highest in New York City.
The latest set of HIV Surveillance statistics from the city’s Department of Health reported that 129 of the 171 new cases of HIV in Bed-Stuy/Crown Heights were black; most of these cases were men who have sex with men. There is nothing new about this finding. In fact, while the number of new HIV diagnoses across the city has decreased steadily since 2001, the one group for whom the numbers remain disproportionally high are black men who do not necessarily identify themselves as gay, even though they have male sexual partners.
That pattern of denial, in turn, makes it so much harder for advocates like Taylor to get the men he sees at the center to appreciate that while sex comes with risks — especially when it’s unprotected — it needn’t result in an HIV diagnosis. While the greater LGBTQ community is aware of such revolutionary HIV prevention regimens as PrEP — pre-exposure prophylaxis, with the antiviral medication Truvada — many of the men whom Taylor worries about are either uninformed or skeptical.
One such man, who asked to be identified by the pseudonym Kiefer, said that the perception of PrEP among his gay friends of color is that men who start the treatment are “fucking around.” Kiefer, who came for counseling at GMAD’s came to Brooklyn from Antigua to attend Fordham University on a scholarship, apologized for using a profanity, but then went on to explain that for many of his friends, men who medicate to prevent HIV suggest voracious sexual behavior. And that, he adds, is behavior that some black men avoid. It had long been so; years ago, the same perception of promiscuity attached itself to men who grabbed a handful of condoms when they visited the center.
To understand that thinking, it’s important to understand how being cloested has fitted into black male identity. When J.L. King published his 2004 book, “On the Down-Low,” it left a lasting impression on gay black men and their straight neighbors: that there existed a subculture of black men who had even as they maintained relationships with women, also secretly had sex with men. Those lives were veiled in shame which, in turn, left many such men rejecting an impression of being gay and pushing them further into the closet. It was a distinction that was unique to black culture, and even now, it is one that advocates like Jason Walker have to confront.
Walker, an HIV/AIDS policy coordinator at Vocal NY, a grassroots organization which advocates for marginalized people affected by HIV/AIDS, says that the stigma of being seen as gay is one that must be unlearned. “We need to make space for sexual fluidity” among black gay men, he said, if they are to begin accepting how they can avoid being infected.
PrEP is a misunderstood panacea. It is only effective if someone knows how it works and how to use it. That educational task falls to people like Vaughan Taylor-Akutagawa, who sees a lack of a “candid practice of asking and answering questions” among men having casual sex with one another. Simply put, a man may say he’s on PrEP and may believe he is, even if has no idea of how to use the regimen effectively.
PrEP works only when Truvada is taken for seven days before engaging in unprotected sex, and must be taken in every day subsequently to prevent infection. And that, Taylor says, can be a challenge. “I simply ask if they think they really can stick to PrEP?” he said. It is not just daily medicating, he explained, but the fact that PrEP must be taken with food — it requires approximately “456 grams of food to digest PrEP.” And given that many of the men he sees live erratic lives with volatile living situations makes it that much harder for them to stay on the daily regimen. PrEP may be effective — it can reduce the risk of HIV infection by 92 percent — Taylor realizes that many of the men he sees are unaware of how their lifestyles undermine that effectiveness.
So Taylor has begun suggesting to the men he sees to stick with condoms. For those who say they want to go on PrEP he uses what he calls, with a smile, his “Jelly Bean Test:” take seven black jelly beans — Taylor’s least favorite flavor. Take one each morning after breakfast. Come back a week later and report whether you took one every day, without fail. If they could not, they cannot be on PrEP — if “they can’t take something every day that has no effect on their health,” he said, “how is antiviral medication going to be the best solution for them?”
Taylor is conscious of the varying “seduction cycles” of many of the men that he helps. “We’re seeing the 4S’ crop up time and time again when men describe their habits prior sex” he said before elaborating that these entail “snorting, sniffing, smoking or sipping.” These are the ways that many of these men are getting high before unprotected sex, meaning that they are not planning a prevention strategy.
“Substance misuse is the problem here,” said Shawneil Campbell, a consultant for GMAD. “It’s what is leading to unprotected sex that is the problem.” And that, in turn, is compounded by the fact that the sexual activity remains by and large within the community.
In fact, men of color are not having unprotected sex with other men at higher numbers, says Dr. Maria Gwadz, a professor and the associate dean for research at New York University’s Silver School of Social Work. Rather, the problem “has to do with stigma, the size of social networks, and who is in their social networks.” Understanding the community is integral in determining how to tailor interventions.
It is one thing to be a gay man living in, say, Greenwich Village or Chelsea, says Walker, and quite another to be living a far more complicated existence in Bed-Stuy or Crown Heights. Neighborhoods with historical large gay populations are easier for interventions. “But for black gay folks who are so embedded in our own communities, public health officials are saying ‘we can’t find you,’” he said. “These officials need to work with local organizations because we know where to find them.”
On the border of Bushwick and Bedford-Stuyvesant sits the After Hours Project, and on a typically busy Friday, Hector Quinones, the organization’s director, sits in his office cubicle surrounded by paperwork and a cacophony of voices ranging from administrators to walk-in clients. He exudes a knowing temperament when explaining the financial squeeze that local organizations combating HIV are experiencing.
Out of the 26 community based organizations that were granted city wide funding by Public Health Solutions on behalf of the Department of Health to offer free testing, only “one funding contract was awarded to a center in Brooklyn in June 2017” he says. As a result, the After Hours Project, which offers free mobile testing that goes directly to at-risk areas like Bed-Stuy and Crown Heights, is seeing a reduction in their testing outreach due to a lack of funds.
Quinones says that After Hours saw dramatic results from their syringe exchange program, which resulted in the sharp drop in the number of IV drug users contracting HIV throughout the city; only 1.01% of new diagnoses in 2016. Still, he says, it is difficult when everyday concerns “like food and rent” are more of a priority than testing.
While the need and obstacles to promote prevention are clear, Taylor says, he is uninterested in having staff that are merely “perpetuating compliance.” Instead he is searching for people who can truly speak to their clients — ethnically diverse and comfortable with a lot of cursing while administering a blood test.
While better known — and Manhattan-based –advocacy groups like Gay Men’s Health Crisis and SAGE have benefited from funding over the years, GMAD still struggles. As a result, they have changed their business model, and have become a primary care facility for mental health services which will allow them to offer free services through the money generated by charging subsidized fees for others.
As Taylor prepares GMAD’s transition to a mental health center there is an urgency as he looks up from his laptop screen and talks about the young men who walk through the center’s doors.
Many others, however, never do.
Follow Shrai Popat on twitter @shraipopat
