By Blake Rowley, Nicolas A. Rango Health Equity Fellow, NASTAD
This February, we observe Black History Month, and today we recognize National Black HIV/AIDS Awareness Day (NBHAAD). Today represents an opportunity to mobilize members of the Black community to learn their HIV status and make decisions to live healthy lives, regardless of their HIV status. More than thirty years into the HIV/AIDS epidemic, Blacks are disproportionately affected across all stages of the disease (from diagnosis to viral suppression). The impact of the epidemic is more pronounced among Black gay, bisexual, and other men who have sex with men (MSM) who accounted for 36 percent of new infections among all MSM in 2009 (CDC). Even more startling, infection rates have dramatically increased among young Black gay men/MSM, who saw a 48 percent increase in new infections from 2006 to 2009 (CDC). As President Obama mentioned in his 2011 World AIDS Day address, “When new infections among young Black gay men increase by nearly fifty percent in three years, we need to do more to show them that their lives matter.”
The Shifting HIV Landscape
In 2010, President Obama released the National HIV/AIDS Strategy (NHAS), which specifically calls for efforts to address HIV/AIDS and its disproportionate impact on Black communities, especially Black gay men/MSM. NASTAD is involved in on-going policy and programmatic discussions and technical assistance efforts at the local, state, and national levels to ensure that the goals of NHAS are applied to Black gay men/MSM and their communities.
Health departments continue to pursue High-Impact Prevention approaches to reduce new HIV infections. According to the Centers for Disease Control and Prevention (CDC), using combinations of scientifically proven, cost-effective, and scalable interventions – targeted to the right populations in the right geographic areas – can increase the impact of HIV prevention efforts and is an essential step in achieving the goals of the NHAS.
We must also expand the conversation in the Black community about new biomedical advances such as Pre-Exposure Prophylaxis (PrEP), HIV home test kits, and consider the potential impact of these tools on preventing new HIV cases, and detecting early or acute infections. Educating Black gay men/MSM about these new technologies is a key step in addressing the epidemic in the Black community.
The Affordable Care Act (ACA) is an important and historic opportunity to expand access to routine preventative services such as screening for HIV and STDs, and vaccinations for hepatitis A and B, and to provide care and treatment for HIV, viral hepatitis, and other conditions. As states prepare for open enrollment in October 2013 through newly established state health exchanges, they must also consider how these new systems will address the unique needs of Black gay men/MSM. States must leverage these new health infrastructures and consider how these systems will encourage utilization, increase health outcomes, and reduce health inequities. The ACA can be used as a vehicle to reduce HIV incidence among Black gay men/MSM by increasing access to care and treatment. This is tremendously important, as the HIV treatment cascade (i.e., Gardner Cascade) clearly demonstrates that Blacks and youth drop off drastically when it comes to retention in care and maintaining viral suppression. The possibilities and opportunities for continued and sustained engagement in care for Black gay men/MSM through the ACA is the first step in NASTAD’s Getting to Zero policy statement.
In a shifting climate of policy change, new advancements in HIV/AIDS prevention, treatment, and access to care, it is even more paramount for Black gay men/MSM to be engaged in their own health. It is the responsibility of public health officials to examine our role, extend our reach, work across the silos of government, and the private sector to remove structural barriers and achieve maximum health outcomes for Black gay men/MSM.
How Health Departments Are Responding to the Epidemic Among Black Gay Men/MSM
NASTAD has long recognized the impact of HIV/AIDS on communities of color, particularly Black gay men/MSM. With funding from the Ford Foundation, NASTAD continues its technical assistance activities that assist health departments identify and tackle a variety of challenges, specifically in addressing the needs of Black gay men/MSM in their jurisdictions. These activities are designed to:
- Identify and remedy gaps in service capacity and delivery in reaching Black gay men/MSM
- Examine social determinants, particularly the role that stigma plays in elevated risk and vulnerability among Black gay men/MSM
- Provide training and technical assistance resources for jurisdictions to effectively advocate for sound public health policies at the local, state, and national level
- Encourage collaboration and innovation by partnering jurisdictions working on similar initiatives addressing Black gay men/MSM, and providing examples of successful models implemented across the U.S.
Examples from the Field
In our work with health departments, especially in the South, NASTAD provides technical assistance for developing programs focused on Black gay men/MSM. Examples of this technical assistance work includes:
- South Carolina – NASTAD supported a symposium designed to mobilize Black gay men/MSM and discuss strategies for overcoming barriers related to HIV/AIDS prevention, treatment, and care.
- District of Columbia – NASTAD supported “The ManDate,” an initiative of the health department, designed to examine Black gay men’s whole-health needs, and provide a forum for social, mental, and sexual support, regardless of HIV status.
- Wisconsin – NASTAD supported “Project YOU!” – an effort to educate young Black gay men/MSM about the impact of HIV infection in the Milwaukee metro region, and provide participants with information to make informed, voluntary, and safer choices regarding their sexual health in a safe environment.
On this National Black HIV/AIDS Awareness Day, let’s continue our shared focus of addressing the health needs of the Black community, especially Black gay men/MSM who continue to be infected at alarming rates. Let’s embrace the shifting prevention and care landscape, and dare to influence new health systems that are built to address the needs of the hardest hit communities.