The face of AIDS as imagined by some in America is that of a black gay or bisexual man. Indeed, black gay and bisexual men, or men who have sex with men (MSM), have the highest HIV rates in the country. Black MSM are commonly portrayed as as "down low brothers" who transmit the disease to women by having unsafe sexual relationships with men on the side, or even as carriers of the disease by default, somehow. These stereotypes treat the epidemic as a result of ignorance about safe sexual practices, or of homophobia, and in doing so they offer an overly simplistic solution to a far more complex problem.
What all too often goes unaddressed is the fact that black MSM tend to be at the intersection of multiple identities and challenging circumstances -- racism, homophobia and economic disenfranchisement -- that adversely affect their access to HIV testing, prevention and treatment. That intersection is a very dangerous place, and our various communities and the federal government have yet to respond adequately to address our health and service needs.
Unquestionably, misinformation has run rampant about black gay and bisexual men and how they are contracting HIV at alarming rates. The typical response from outside the community is to educate them on how to protect themselves from the dangers of HIV. But as two people who work with young black MSM, we can testify that many of them already understand the risks of HIV and know how to protect themselves better than many HIV educators presume. The lack of preventative care at the individual level, then, may have something to do with factors beyond what we typically teach, such as the effectiveness of safer sex practices. Indeed, what we have learned is that HIV is but another serious challenge that many black MSMs face daily at that aforementioned intersection. The fight against HIV will never be effective if we only address HIV without also responding to the structural issues that affect the lives of black MSM, including limited access to affordable housing, homelessness, extreme poverty, poor education options, lack of health care, lack of family support and more.
And depending on coming events in Congress, that intersection has the potential to become even more dangerous. Even after a string of victories for Democrats, the Affordable Care Act and LGBT equality in this year's election, the "fiscal cliff" and the possibility of draconian federal budget cuts through the sequestration process are looming. While such cuts would be damaging to most Americans in ways too great to list, sequestration would literally endanger the lives of young black MSM. The federal programs to be drastically cut include the Center for Disease Control's prevention grants, which support the majority of HIV prevention services across the country, and the Ryan White CARE Act, which has provided vital HIV medication, care and services to hundreds of thousands of Americans with HIV. And if that wasn't enough, all federal Health and Human Services programs will be dramatically reduced, gutting key support for HIV treatment, housing and services.
Among the many who most need and rely on health and services programs supported by federal dollars, MSM of color figure large and will benefit enormously when additional provisions of the ACA, such as the expansion of Medicaid, go into effect in the next few years. But black gay and bisexual men, along with other high-risk populations, stand to suffer most if those programs are cut.
As Secretary of State Hillary Clinton and President Obama proclaimed last year, and again in the just-released "blueprint" to combat AIDS, we now have the means and power to end the HIV epidemic, but we can only achieve this goal if we speak out about the underlying issues that contribute to it -- issues of underlying poverty, weak health care infrastructure and more. We have examples to look to, such as the Black Men's Xchange (BMX), an organization founded by activist Cleo Monago as a support system for and by black gay and bisexual ("same-gender-loving") men. Community-based organizations like BMX are working daily to improve, understand and connect with black MSM and doing everything in their power to combat the AIDS epidemic, for they understand that this crisis cannot be solved simply by throwing money at it; any solution must be carefully tailored to the meet the needs of a given community. A one-size-fits-all approach to AIDS treatment and prevention will simply not suffice, nor will treating AIDS as an isolated problem that can be solved without addressing underlying structural problems.
As we near World AIDS Day, we must ensure that our resources, both those provided by community organizations and those provided by the government, are not only preserved but expanded. Comprehensive and culturally appropriate HIV prevention, treatment and services need to be available to all. It is time to ensure that those disproportionately affected by HIV can survive at the intersection.