"HIV has never been just a question of behavior. It forces usto look at science in a critical way and examine behavioral and social factors."
In the second of thisthree-part series, Charles Stephens of AIDS United, a Mapping Pathways partner organisation, speaks about the socialdrivers of HIV and its impact on vulnerable communities. Click here for partone. MP: According to theCenters for Disease Control and Prevention (CDC) figures, men who havesex with men (MSM) accounted for 61% of all new HIV infections in the U.S.2009. There was also a 48% increase in HIV incidence figures among young blackgay men (aged 13-29). Why has the HIV epidemic seemed to havedisproportionately affected this demographic?
CS: I think thereare a number of researchers right now investigating that question. I feel weare still at the stage of trying to figure out what questions we should beasking. For example, a number of researchers have done work that suggests thatblack gay men don’t necessarily engage in any higher sexual risks or drug-takingrisks than white gay men. However, there is a higher incidence of HIV amongblack gay men – so why is that?
One argument is that there is a higher prevalence of HIVwithin existing black, gay male sexual networks, which leads to higherincidence numbers. There is also some thought about ways that poverty, stigmaand other social factors can play a role in driving the HIV epidemic amongblack gay men.
HIV has never been just a question of behavior. It forces usto look at science in a critical way and examine behavioral and social factors.One of most exciting conversations I’ve witnessed in the research and advocacyrealm is ‘What are the social drivers of HIV and how do those social driversdisproportionately impact some communities over others?’
I think researchers should be looking at lot of areas. Butmore importantly, considering the impact of HIV among young black gay men inparticular, I think its important that researchers, policymakers and communitymembers all come together in grappling with this really severe epidemic.
MP: Can you elaborateon some of the social drivers you talked about?
CS: Some of thequestions we have to ask are: What is the role of housing or joblessness? Whatare the roles of social class, stigma and homophobia? These questions force usto think about HIV in a very intersectional way. By intersectional, I mean thechallenge and issue of HIV is also connected to these other larger socialissues.
An intersectional approach forces us not to operate insilos. It forces us to be very innovative in how we think about grappling withHIV. It’s impossible to think about HIV without some analyses of social issuesbecause very often those social issues reinforce the impact of HIV,particularly in vulnerable communities.
Ultimately, it is important to look at communities that aremost vulnerable. But what we seem to find is that communities vulnerable to HIVare also vulnerable to a number of other social issues, which means that wehave to think very critically about the role that these other social drivers ofHIV play – particularly in the lives of young black gay men.
MP: What are some ofthese challenges and issues that young black gay men seem to face in particular?What makes them so vulnerable?
CS: I think that,again, is a research question. There needs to be a research agenda around youngblack gay men, particularly in the context of HIV, that asks those veryquestions. Some of the questions to be asked are: How do we understand thevulnerability of this population? What are some of the forces that contributeto this vulnerability?
The research agenda should bring together researchers frommultiple disciplines and approaches. This research agenda requires diversemethodologies, skillsets and worldviews. In effect, this would not just be aresearch agenda but a research and advocacy agenda, with the research helpingdrive the advocacy.
Current vulnerabilities include, but are not limited to,joblessness, poverty and stigma. We talk about stigma, in particular, as abarrier to someone accessing prevention or care services. Someone might beunwilling to get an HIV test because they don’t want to be seen going to an AIDSservice organisation because of the stigma associated with HIV. Someonediagnosed with HIV might not tell people and thus fail to build a supportsystem around them. Lack of healthcare access is another vulnerability in thispopulation. Communities that are marginalised because of race, class or gendersometimes don’t have access to the best healthcare resources, which contributesto negative health outcomes.
A number of steps have been taken to make HIV testing asaccessible as possible. There are efforts to bring HIV testing to communitiesand one sees HIV testing events at community centers and mobile testing.
Stay tuned to the blog as we bring you part three of ourconversation with Charles, where he speaks about some of the challenges facedby people living with HIV in rural areas and shares his thoughts on the goodwork being done in the HIV prevention landscape.
[Content that is linked from other sources is for informational purposes and should not construe a Mapping Pathways position. Please look for us on Facebook here www.facebook.com/MappingPathways and you can follow us on Twitter @mappingpathways as well.]
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