Phill Wilson speaks at the XIX International AIDS Conference Monday. Alvin Tran.
WASHINGTON, D.C. -- Black AIDS Institute Director Phill Wilson spoke before a crowd of more than 1,000 people about how HIV/AIDS affects communities across the U.S. at the XIX International AIDS Conference Monday morning.
Wilson, who’s openly gay and been living with HIV for more than 30 years, said that despite recent successes in HIV treatment and prevention, “for some of us, the system is terribly broken.” The HIV epidemic, he said, is 43 percent black and 19 percent Latino.
He encouraged everyone living with HIV to come out, to live “openly and proudly with HIV…as compelling reminders” to the community about the importance of getting tested. He understands, however, it’s too dangerous for some because of stigma and persecution.
Despite the challenges, Wilson reminded the crowd that “this is our time. This is our deciding moment. Together we are greater than AIDS.”
He spoke with the Star Tribune about how HIV/AIDS is affecting young black gay and bisexual men, a high-risk group in Minnesota and throughout the country. The conversation has been edited for clarity.
Star Tribune: What are the chances black gay and bisexual men will get HIV?
Phil Wilson: [They] are at elevated risk throughout their lifetimes. There is 1 in 12 chance of HIV infection. What is shocking is that by 25, one in four of them are already HIV-positive. In addition, we see an alarming rate of new infections. We see a 46 percent increase among young black men who have sex with men. We have high prevalence and we see rapid growth in this population. By 40, they have a 60 percent chance. It doesn’t let up as we get older. It does sound an alarm.
ST: Why do young black gay and bisexual men have a higher risk than their peers?
PW: It’s a population that has been neglected in the HIV conversation until recently. There’s also a lack of access to health care and education, unemployment, and a school system that’s hostile to gay men. They feel alienated and ostracized, and they drop out. They’re not prepared to live in a world with HIV.
ST: There have been reports of higher rates of HIV co-infections with syphilis, chlamydia, gonorrhea. Is this a problem among young black gay and bisexual men?
PW: Certainly. It’s a huge influence on HIV acquisition. We see rising STI cases among young gay and bisexual men, particularly for young men in the South. We’re not making the kinds of investments in public health we need to address this issue. In the southern part of the county, there’s also elevated levels of stigma.
ST: What’s the effect of stigma?
PW: Stigma shuts down the opportunity for communication. It hammers away at self-esteem. How folks are treated when they enter in the health care system also has an effect. If people have a negative experience, they will be more reluctant to go to the doctor. Stigma negatively impacts treatment.
ST: Are there unique barriers to care among young black gay and bisexual men?
PW: Not sure if the barriers are unique, but we see an accumulation of barriers. One is homophobia and sexual orientation-based stigma. We shouldn’t under how strong that is. Among young black men in general, there is high rate of unemployment, a high rate of dropping out of school, homelessness, and drug addiction.
What’s really important about this is that probably the chief driver of elevated HIV risk for young black men who have sex with men is the background prevalence in the networks in which they are intimate. It debunks the myth they’re engaging in higher levels of risky behaviors.
Young people are coming to grips with their sex orientation at younger age, at 15, 16, 17. Young black men who have sex with men are not afforded support. When a young black [gay or bisexual] man has his sexual debut [first sexual experience] he usually has it with someone who is slightly older. Because of stigma or fear, he’s less willing to come out in his high school, among his peers. This 15-, 16-, 17-year old is having sex with someone who’s 19 or 20. The difference in those few years can make all the difference in the world [because] the older young man has already been part of that sexual world.
ST: What are the biggest misconceptions about HIV/AIDS in the black community, especially among the young?
PW: As a result of a decline in education and conversation about HIV, young black [gay or bisexual] man are not as acquainted with the facts. They make decisions that are dangerous. They think you can tell someone has HIV by the way they look. “They didn’t look like they were sick,” [the say], so they see that as a form of protection. Or “they didn’t seem like they were the kind of person to have HIV.” They’re using the stigmatizing language as a double risk: They buy into stigmatizing language, providing them with rational to not protect themselves.
ST: What are the biggest changes with regards to HIV/AIDS in the black community over the last decade?
PW: The bad news is the infected population has grown. The good news is the tools at our disposal. The prevention tools will be critically important to reach an AIDS-free generation. For black gay men who are at high risk of HIV, Truvada for PrEP [pre-exposure prophylaxis] can be extremely important. It couldn’t have come sooner. By going on that treatment, and actually adhering to it, it can provide protection against infection.
ST: Why are transgendered communities at higher risk?
PW: For many of the same social determinants as young black men who have sex with men. [They] also suffer the additional stigma of being transgendered and people not even knowing what that means. On top of that, you have an elevated level of unemployment in the black transgendered community and that leads to other social [problems].
ST: How has the Internet changed the way young black gay and bisexual men interact?
PW: The way young black men, and all people, build our social networks is changing. That creates a changing dynamic on what kinds of involvement they have with each other and how vulnerable they’re willing to be with each other.
There is lots of stigmatizing language online, like people “looking for clean men,” as if having HIV makes you dirty. In addition to just being hurtful, [that language makes] people emotionally shut down and eliminates avenues where you can go for help.
ST: What is the role of the church?
PW: The church can be a very important institution for many young black men who have sex with men. A great many of us were baptized in the church in our formative years. It was a place we spent a lot of time. People who discover they are gay or bisexual and discover their church is not welcoming place—that can be devastating.
There are a number of churches that have a positive message, that realize we have to be responsive to everyone in our family. Those churches are providing an important leadership role. Fortunately, more and more churches are taking that stance.
-- DANIELA HERNANDEZ