World AIDS Day Special Issue

Homophobia causes AIDS

Study fingers anti-gay sentiment as a major factor in HIV�s spread among black men

by Eric Resnick

Washington, D.C.--The verdict is in, again. Homophobia is a major cause of AIDS among black men.

�Homophobia evidenced through stigma, discrimination and violence . . . creates vulnerability to behaviors and conditions associated with risk for HIV infection among black men who have sex with men,� says the National Minority AIDS Council in a paper released on World AIDS Day.

The report is arguably the loudest alarm to date on the role of anti-gay sentiment in the spread of HIV among black men.

�Investing in research to produce interventions that will work for a diverse population of black MSM [men who have sex with men] is essential to a national prevention effort that will reverse the course of the epidemic in this population,� wrote the report�s author, Robert E. Fullilove, an associate dean of sociomedical sciences at Columbia University.

Black Americans become infected with and die from HIV and AIDS far more than any other racial or ethnic group, and Fullilove wanted to examine why.

The report says, �African Americans comprised only 13 percent of the U.S. population but accounted for half of all new HIV/AIDS diagnoses. The disease strikes subgroups of African Americans, especially young women and gay, bisexual, or same-gender loving men.�

Fullilove also noted that �African Americans with HIV/AIDS are more likely than other racial groups to postpone medical care and become hospitalized, with the result that they are more likely to die from HIV-related causes.�

Advances in retroviral medications have reduced AIDS related deaths among whites by 19 percent, but only seven percent among blacks, from 2000 to 2004.

�HIV�s racial divide is not new,� wrote Fullilove. �Each year we ask the same question: Why is AIDS hitting black Americans hardest?�

Fullilove goes on to answer that question saying, �The HIV/AIDS epidemic in African-American communities results from a complex set of social, individual and environmental factors.�

One of those factors, according to Fullilove, is �community and religious beliefs often stigmatize homosexuality as both immoral, but also as anti-black.�

Fullilove�s study of the scientific literature indicates that because of that stigma, black men who have sex with men are less likely to identify as gay or disclose their sexual behavior to others.

�The considerable stigma and homophobia experienced by many black MSM can also have an impact on their self-esteem and behaviors,� wrote Fullilove.

�One study found a reduction in self-esteem among black MSM who attended churches that fostered homophobia,� Fullilove continued. �For some black MSM, this loss of self-esteem undermined the individual�s ability to practice safe sex, seek medical care in a timely fashion, or follow other health practices essential to well being.�

�Rebuilding self-esteem is an important task for those involved with AIDS treatment and prevention,� Fullilove concluded.

The report highlights five other factors, including economic disparity and lack of access to health care that is also credited with higher rates and lower treatment among blacks compared to whites in other diseases such as cancer, diabetes, and cardiovascular disease.

Fullilove also pays a lot of attention to incarcerated men, where the rate of infection is three times higher than in the general population.

�Ensuring access to condoms in prisons would not only protect prisoners, but also the health and the lives of the people in the communities to which they will return,� Fullilove wrote.

�Prisons increasingly hold members of poor communities who are both under-educated and unemployable,� wrote Fullilove, also advocating voluntary, routine HIV testing to prisoners on entry and release.

In 2004, African-American males were seven times more likely than whites and three times more likely than Hispanic males to be imprisoned, according to the Department of Justice. The federal government�s �War on Drugs� is a major contributor to this disparity.

Approximately one quarter of people living with HIV, known or unknown, are believed to pass through correctional facilities.

Fullilove describes prisons themselves as �independent risk factors for HIV infection because prisoners engage in unsafe sex and drug injection practices while �on the inside.� � He condemns public officials who are keeping condoms out of correctional facilities, presumably also due to homophobia.

Ohio�s HIV cases resemble the national figures, with the exception of the Hispanic population, according to Ohio Department of Health data from 2004, the most recent available.

Fullilove studied the Hispanic population, but to a much lesser degree than African-Americans. There, he also found disproportionately high infection and morbidity rates compared to whites, and for some of the same socioeconomic reasons.

Forty eight percent of Ohio�s 2004 infections were among whites and 41 percent among blacks, despite Ohio�s total population being 86 percent white. Infection among Ohio�s Hispanic community was five percent.

Men who have sex with men lead Ohio�s infections, too, at 39 percent of new infections in 2004, most between the ages of 30 and 39.

�This report has made clear that policy and legislative reforms need to focus on structural interventions that will address the root causes of the overrepresentation of African-Americans in the HIV/AIDS epidemic,� Fullilove concluded. �Such reforms will not only improve efforts to prevent HIV, they will improve the chances of survival for those African Americans already living with HIV/AIDS.�

�The development of interventions capable of creating tolerance, acceptance and compassion represents a significant and vital challenge for behavioral intervention specialists.�