Original content from our Mapping Pathways blog team
"HIV has never been just a question of behavior. It forces us to look at science in a critical way and examine behavioral and social factors."
In the second of this
three-part series, Charles Stephens of AIDS United, a Mapping Pathways partner organisation, speaks about the social
drivers of HIV and its impact on vulnerable communities. Click here for part
one.
MP: According to the
Centers for Disease Control and Prevention (CDC) figures, men who have
sex 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 black
gay men (aged 13-29). Why has the HIV epidemic seemed to have
disproportionately affected this demographic?
CS: I think there
are a number of researchers right now investigating that question. I feel we
are still at the stage of trying to figure out what questions we should be
asking. For example, a number of researchers have done work that suggests that
black gay men don’t necessarily engage in any higher sexual risks or drug-taking
risks than white gay men. However, there is a higher incidence of HIV among
black gay men – so why is that?
One argument is that there is a higher prevalence of HIV
within existing black, gay male sexual networks, which leads to higher
incidence numbers. There is also some thought about ways that poverty, stigma
and other social factors can play a role in driving the HIV epidemic among
black gay men.
HIV has never been just a question of behavior. It forces us
to 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 advocacy
realm is ‘What are the social drivers of HIV and how do those social drivers
disproportionately impact some communities over others?’
I think researchers should be looking at lot of areas. But
more importantly, considering the impact of HIV among young black gay men in
particular, I think its important that researchers, policymakers and community
members all come together in grappling with this really severe epidemic.
MP: Can you elaborate
on some of the social drivers you talked about?
CS: Some of the
questions we have to ask are: What is the role of housing or joblessness? What
are the roles of social class, stigma and homophobia? These questions force us
to think about HIV in a very intersectional way. By intersectional, I mean the
challenge and issue of HIV is also connected to these other larger social
issues.
An intersectional approach forces us not to operate in
silos. It forces us to be very innovative in how we think about grappling with
HIV. It’s impossible to think about HIV without some analyses of social issues
because very often those social issues reinforce the impact of HIV,
particularly in vulnerable communities.
Ultimately, it is important to look at communities that are
most vulnerable. But what we seem to find is that communities vulnerable to HIV
are also vulnerable to a number of other social issues, which means that we
have to think very critically about the role that these other social drivers of
HIV play – particularly in the lives of young black gay men.
MP: What are some of
these 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 young
black gay men, particularly in the context of HIV, that asks those very
questions. Some of the questions to be asked are: How do we understand the
vulnerability of this population? What are some of the forces that contribute
to this vulnerability?
The research agenda should bring together researchers from
multiple disciplines and approaches. This research agenda requires diverse
methodologies, skillsets and worldviews. In effect, this would not just be a
research agenda but a research and advocacy agenda, with the research helping
drive the advocacy.
Current vulnerabilities include, but are not limited to,
joblessness, poverty and stigma. We talk about stigma, in particular, as a
barrier to someone accessing prevention or care services. Someone might be
unwilling to get an HIV test because they don’t want to be seen going to an AIDS
service organisation because of the stigma associated with HIV. Someone
diagnosed with HIV might not tell people and thus fail to build a support
system around them.
Lack of healthcare access is another vulnerability in this
population. Communities that are marginalised because of race, class or gender
sometimes don’t have access to the best healthcare resources, which contributes
to negative health outcomes.
A number of steps have been taken to make HIV testing as
accessible as possible. There are efforts to bring HIV testing to communities
and one sees HIV testing events at community centers and mobile testing.
Stay tuned to the blog as we bring you part three of our
conversation with Charles, where he speaks about some of the challenges faced
by people living with HIV in rural areas and shares his thoughts on the good
work being done in the HIV prevention landscape.
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