Activists Combat AIDS and Eschew 'Stigma 101'

Philadelphia activists alarmed at the skyrocketing rate of HIV among the African American community have decided to take their message of safer sexual practices to young gay men and MSMs where they live: On the street, at the gym, and anywhere else guys gather or cruise for sex, local newspaper the Inquirer reported on July 6.

Better still, they have established a safe space where young men can come to get fact-based information, HIV testing, and the companionship of others who will accept, rather than judge, them.

Noel Ramirez and Quincy Greene established Q Spot at Philadelphia's Broad Street Ministry to provide an alternative to sex parties, sex clubs, and other sex-based social activities. It's not because they think people should not have sex; it's more the case that they feel it's not enough to let young gays and MSMs think that their sexual identity is all about sex and nothing else.

"You'd better not get HIV," Ramirez recalled his mother telling him when he told her that he was gay. "And don't trust anyone, because they'll drug and rape you."

Her reaction might have been understandable given that Ramirez's uncle died from AIDS. But Ramirez, who was one of his uncle's caretakers, wanted more than to be seen in the light of the disease, he told the Inquirer.

"[T]alking to young people like that, sexualizing them, assuming that their identity is clustered around that disease -- it creates shame and guilt, social isolation, and unhealthy relationships," Ramirez said. "It's like Stigma 101."

Taking the sting and the stigma out of the subject of safer sex and healthy, intimate relationships might be one way to reach young MSM of color. The issue of HIV in the African American community is complex, and blanket messages about the morality of sexual practices have seemingly not helped matters but, rather, driven male to male sexual encounters underground -- a dangerous result, given that people with HIV are much more likely to pass the disease along to others if stigma and shame prevent them from getting tested and getting treatment.

Black men who have sex with men are up to five times more likely to contract HIV than other MSMs. A recent study offering insights into the disparity has appeared at multiple online health sites, EDGE reported in a May 2 article.

One puzzling aspect regarding the higher rate of HIV infection among black MSMs is that the demographic practices safer sex at comparable rates to other groups. Johns Hopkins researchers have determined that a number of factors may account for the higher HIV rates, including how black men who have sex with men -- including gay men, bisexuals, and heterosexuals who do not regard themselves as gay or bi despite their same-gender sexual conduct -- choose their partners and judge the risks involved.

"These men show a clear preference for masculine men, while also equating masculinity with lower HIV risk," the News Medical.net story said. "This dynamic, the researchers say, can help explain why young black MSM contract HIV more often than their counterparts from other races."

The perception that "masculine" men are less likely to carry HIV, coupled with the choice to leave decisions regarding condom use to the discretion of the partner rather than insisting upon it, help account for the disparity in HIV rates, the study's authors suggested.

One powerful message to help counteract such attitudes: Sex is each individual's choice, and safer sex each person's own responsibility.

To get that message where it needs to be heard, Ramirez and Greene are willing to go out and around the city, leaving safer sex kits at the places where young MSM are likely to look for encounters. The kits contain condoms, but they also include another powerful tool: Information about where to go and who to talk to about testing and other needs.

A young man's needs extend well beyond sex, and Q Spot attempts to answer some of them. Q Spot is a twice-monthly forum and social space. Beyond testing and relationship counseling, there's also a chance for guys to find help with housing and other problems -- or just hang out and watch television, the article said.

Q Spot's being housed at a house of worship is not so surprising. As the tide of new HIV infections has continued to ravage the African American community, anti-gay rhetoric has started to give way to compassion and service and black churches have begun the hard work of confronting the problem head-on with solutions, rather than excoriation.

But the anti-gay strain runs deep in the African American religious community, and condemnation has not disappeared; Greene, whose parents emigrated from Guyana, was advised by his mother to "reject" his sexual orientation, the Inquirer article said. She was parroting the views of anti-gay preacher Harold Camping.

"The stigma of HIV keeps many people from talking about their status, even to their sex partners," the article noted.

And indeed, that silence contributes to the spread of HIV, the virus that causes AIDS. Researchers recently warned that anonymous sex isn't the only risky kind: Significant others in serious relationships can also pass the virus along.

Gay men who enter into relationships may be prone to drop their guard, engaging in unsafe sex practices without knowing their HIV status out of a belief that being in a committed partnership automatically protects them from the virus, a June 2 Medilexicon posting said.

The problem is that an estimated 80% of young, HIV-positive gay men do not know their status -- and that means they aren't getting the treatment they need to preserve their own health and cut the risk of HIV transmission to others, the article noted.

"Being in a serious relationship provides a number of mental and physical health benefits, but it also increases behaviors that put you at risk for HIV transmission," Northwestern University Feinberg School of Medicine's Brian Mustanski said. "Men who believe a relationship is serious mistakenly think they don't need to protect themselves."

Mustanski is the lead author of a new paper on the risk presented by the idea that being in a committed relationship means there's no need for safer sex. The paper was published by the American Psychological Association journal Health Psychology, the article said.

"We need to do greater outreach to young male couples," Mustanski said. "This is one population that has really been left behind. We should be focusing on serious relationships."

The research indicated that gay men in relationships were nearly eight times more likely to engage in unprotected sex.

But many men who have sex with men do not enter into serious relationships with others of the same gender. Rather, they self-identify as heterosexual, and that, too, can be a source of misinformation and a risk factor. Many believe that AIDS is a "gay" disease, and they won't get it if they are straight. The problem with that is the virus does not discriminate between those who say they are straight and those who acknowledge that they are bisexual or gay. The virus simply infects those who are exposed to it.

Sorting through issues of love, sex, and romance is hard enough even when a young man does not face the social, political, and religious stigma of being gay. Being HIV positive makes things all the harder.

Ramirez and Greene's Q Spot seeks to ease some of that burden, allowing HIV positive men a place to meet and to talk -- as one Q Spot per counselor put it, "to meet other HIV-positive men and talk about what we're going through." Added the young man, "You need people you can relate to."