Disclaimer: I realize that I am speaking as a white man. My thoughts and feelings on this issue are not meant to degrade or denigrate black men or take away from the incredibly uphill battle that black gay and bisexual men have been fighting for decades. I realize that I have no idea what it is like to be black and I also realize and acknowledge that people of color are experts when it comes to their own experiences and needs. However, the fact that I am white does not mean that I cannot raise thoughts, opinions, and suggestions when it comes to the fight against HIV/AIDS in other communities.

In Focus: HIV/AIDS in Black Gay/Bisexual Communities

As a long time HIV/AIDS activist in the Central Massachusetts GLBT community, there is no question in my mind that we are in the midst of a crisis when it comes to gay and bisexual men and HIV/AIDS. From 2001 to 2006, HIV prevalence and infection rates have dropped significantly in every high-risk category - EXCEPT for men who have sex with men (MSM), which grew by 11% on average. In many ways I feel that in 2008, the gay/bi men’s community is now picking up where we left off in 1995 when the anti-HIV cocktail treatment first became available. Unfortunately, in the 13 years since that miraculous development, general community support has fallen off and HIV infection rates have grown with every passing year for MSM.

During these past 13 years, the health needs of black gay/bi men were doubly ignored. The mainstream gay community wanted to stop caring about HIV/AIDS and they sure as hell weren’t interested in the fact that black gay/bi men were facing extreme hardships, particularly the looming threat of increasing HIV infection rates. Meanwhile, mainstream black leaders were still paying little to no mind of the fact that black gay/bi men were bearing the brunt of HIV/AIDS in the black community—silence was the norm, and silence still equaled death for black gay men. In fact, when many black leaders and celebrities mentioned gay/bi men and HIV it was to demonize black men for “being on the down low” and “spreading it to women”.

Where Is the Money Going?

It wasn’t until 2005 that advocates on the federal level finally hit the panic button. That’s because in the summer of 2005 the Centers for Disease Control released an emergency report, revealing that during rapid HIV testing pilot trials in gay communities across 5 different US cities, researchers discovered that 46% of the black gay/bi MSM they tested were HIV positive! Of those black men who tested positive, only 2/3 had any clue they were at risk. For the next 2 years, officials and leaders sat back and shook their heads, wondering why. The answer for most people on the ground is obvious—no one has given much of a damn about the lives of black gay/bi men since the start of this epidemic.

In the wake of this ongoing tragedy, key advocates are finally beginning to try and do the right thing. State and federal HIV/AIDS advocates and agencies now prioritize prevention efforts towards black MSM, and millions of dollars in grant money has been made available to fight HIV infection rates in black gay communities.

But my question is, where is that money going? Will these new efforts be effective at preventing new HIV infections in black gay/bisexual communities, or will they merely reinvent the wheel or encounter similar problems that have arisen for HIV prevention efforts in the mainstream/white gay community? More bluntly, will this money bring down infection rates nationwide or merely serve as paychecks for members of elite, gay urban cliques?

Since the summer of 2005, we seem to have gained some ground. A cursory Google search will bring up the names and web pages of hundreds of community and AIDS service organizations that specialize in preventing HIV infection among gay black men. It seems that everyone is sporting shiny new web pages and posters featuring half-naked, muscular black men, new witty political blogs about being black and gay, and kente cloth AIDS ribbons. On the surface it seems that we are headed in the right direction.

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But are we really? How much of this money is actually going to services and support for the average black gay man? Or is it going to the self-promotion of a select handful of organizations that can write grants exceptionally well?

Take for example the much-touted “Many Men, Many Voices (3MV)” HIV prevention program that was recently developed and is the new Cadillac of evidence-based HIV prevention interventions. If you Google ‘DEBI’* and go to the site and read about this program, it seems awesome, and it probably is. The problem is that your average community and AIDS service program can’t afford it. I know this because many smaller-scale local community organizations have wanted to train their staff for this intervention since it was developed. However, in order to “do” this shiny new program you have to invest thousands of dollars in training—usually weeks of training—at specific locations (usually only in New York City, San Francisco, and Chicago) in order to be qualified to offer it to clients. Do black youth have the months and years to wait for community organizations to get trained in order to get funding to provide them with life-saving community programs?

No, they don’t. But DEBI programs such as 3MV are a staple requirement for organizations seeking federal HIV/AIDS prevention money. Of the curricula approved for federally funded organizations, less than a handful address the needs of gay and bisexual men. Of those, only one (3MV) addresses needs and issues relevant to black gay and bi men. Furthermore, these programs are incredibly difficult for small organizations with limited staff to replicate. These DEBI programs were developed by well-funded, university-based research organizations that were able to literally pay participants money for showing up.

Such an arrangement is a far cry for the average under-funded AIDS service organization. In fact, I’ve seen organizations staffed and run by people of color lose federal and state-based funding because they were unable to replicate the unrealistic goals of many of these DEBIs. What was originally intended as an effective helping tool has instead turned into a barrier for struggling organizations seeking to serve people of color.

The Broken Machinery of HIV/AIDS Funding

The reality is that our HIV/AIDS funding machinery is broken. Whenever we hit a major crisis point, leaders hit the panic button and grant money becomes available, through federal and state-based institutions. But then, that money gets sucked up by bloated bureaucracies and ineffective programming that rarely reaches those who need it most.

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A prime example is the recent flurry of money being thrown at “black, gay” programming. While the increase in available funding is well and good, the reality is that the money is suspiciously being concentrated in urban areas such as NYC and Chicago. Last time I checked, the areas with the highest rates of HIV infection and AIDS deaths were in rural communities and the South.

Unfortunately for black gay youth in Alabama, the only place they can go for HIV/AIDS information are faith and church-based programs. Most of these are not particularly GLBT-affirming.

To me, all this points again to the need for a national HIV/AIDS strategy. We can no longer rely on these ineffective funding streams – all of which have been underfunded since 1999 when President Clinton left office.
As of now, there is no official plan coming from the government at any level as to how to fix this broken funding machinery. On top of that, there is no public discussion table on HIV/AIDS that community members can come to in order to dialogue and problem solve with federal and state leaders. With a national AIDS strategy in place, we would be able to more effectively focus on this crisis and work to produce tangible results. Until then community groups and programs will continue to flounder while grasping for straws in the continually shrinking pot of funding for HIV/AIDS.

* Diffusion of Effective Behavioral Interventions: http://www.effectiveinterventions.org/