Mapping Pathways is a multi-national project to develop and nurture a research-driven, community-led global understanding of the emerging evidence base around the adoption of antiretroviral-based prevention strategies to end the HIV/AIDS epidemic. The evidence base is more than results from clinical trials - it must include stakeholder and community perspectives as well.

25 July 2011

HIV Prevention and LGBT Communities: Syndemics, Resilience, and Real Change

How can justice be better served for the lesbian, gay, bisexual and/or transgender (LGBT) community? This remains one of the biggest questions in the US – the last few months have seen a country-wide discussion on this issue, sparked off by what is being called an “epidemic” of suicides by gay teenagers.[1] “People are talking about the important ways through which the US, in the coming generation, can begin to honor the rights of LGBT communities – I believe, in time, that would reduce the incidence of HIV infection,” says Julie Davids, Director of National Advocacy and Mobilization at the AIDS Foundation of Chicago and Coordinator at the HIV Prevention Justice Alliance.

There is strong data on the “syndemics” phenomenon[2] (synchronous epidemics) in the lives of gay men. Gay men often face violence, abuse, marginalization and rejection by parents, friends and peers – there is compelling data that these conditions make them far more vulnerable later in life to substance use and abuse, intimate partner violence, and contracting HIV. The syndemics discussion has also led to an increasing focus on the idea of resilience. Says Julie, “Although HIV is very widespread among gay men, the majority of gay men are not HIV positive – what helps them remain HIV negative? As someone who believes very strongly in the idea of gay and queer liberation, I believe that members of LGBT communities create resilience, have innovative ways of living and of structuring families and lives that can be extended to broader society for better health outcomes and happier lives.”

There is a concerted effort to steer prevention efforts away from an earlier reliance on fear tactics and a vocabulary based on vulnerability. The gay men’s health movement and their allies in the HIV/AIDS community are increasingly emphasizing resilience and trying to create a scale of measuring this quality in the lives of gay men – and hopefully extend this to other communities as well. “There are a number of programs – like Project CRYSP, Lifelube, the Gay Men’s Health Crisis, and the Gay Men's Health Summit – that confront the conditions that drive the syndemic among gay men and build resilience and resourcefulness in gay communities[3]. Other projects doing fantastic work in this field include the Gay City Health Project in Seattle, Magnet in San Francisco, and William Way in Philadelphia,” says Jim Pickett, Director of Prevention Advocacy and Gay Men's Health at the AIDS Foundation of Chicago, chair of IRMA, and a member of the Mapping Pathways team. In fact, Jim recently checked in with Dr. Ron Stall, an expert in gay men’s health, to get his views on syndemics and the HIV/AIDS epidemic among gay youth and adults, as well as the idea of resilience. You can read the eye-opening interview here.

The approach to HIV prevention could also benefit from elements of asset-based community development: focusing on the assets of a community, the skills and experiences that are available, can help illuminate the path forward and create sustainable solutions.

“We can’t do it all on our own though,” says Julie, “so it’s important to continue to push for government policies that honor the human rights of all people – specially now that there is a focus on the impact of bullying of LGBT people. We need to made sure doesn’t just end up contributing to mass imprisonment – another social driver of HIV in our country. Creating merely a punitive system doesn’t really solve the problem – it just results in more imprisonment, thus exacerbating health issues like HIV. Many people who are bullies have been bullied themselves. We need policies and mechanisms to increase parental acceptance of gay and gender variant children, strengthen communities to support all their LGBT members rather than rejecting them, and help people proactively stand up to bullying. Addressing the root causes will bring about real, long-term change.”

[1] To know more, take a look at The New York Times’ “Coming Out” project, which captures compelling first-person accounts by gay teenagers.
[2] Syndemics: A set of linked health problems involving two or more health conditions, interacting synergistically, and contributing to excess burden of disease in a population. Learn more about the syndemic among gay men that drive the HIV/AIDS epidemic by accessing Ron Stall’s presentation here.
[3] Take a look at Jim Pickett’s presentation on this here.

[Content that is linked from other sources is for informational purposes and should not construe a Mapping Pathways position.]

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