It is a global pandemic that has claimed the lives of more than 33 million men, women and children since 1981. It is an indiscriminate, insidious killer. But here in the States, AIDS is beginning to be looked at by a new generation of young adults as not so big a threat; and one subset, in particular, has taken a dramatic lead in new infection rates while experts remain uncertain how to reach them.
According to data recently released by the National Center for HIV/AIDS at the Centers for Disease Control, the rate of infection among African-American gay and bisexual men aged 18-29 increased 50 percent from 2006-2009. This group was the only segment of the population to experience a significant increase in new infections during that period and the numbers are shocking. In 2008, for example, 75 percent of all diagnosed HIV infections in youth ages 13-19 were among black youth, even though blacks represented only 17 percent of the population in that age group.
Locally, the trend is the same.
"The prevention messages that we're giving are not landing on deaf ears, but there are a lot of people who are of the mindset that, 'If I get HIV I can just take a pill and that's not so bad,'" said Royale Theus, program director for the Michigan AIDS Coalition. "They're not afraid."
Hank Millbourne, associate executive director and director of prevention services for AIDS Partnership Michigan, agreed that as the younger generation begins to view HIV/AIDS as a chronic disease and not a deadly one, they feel less compelled to protect themselves. They often fail to consider the challenges that come with taking antiviral medications over long-term periods, the risk of reinfection and varied strands of the disease and the fact that AIDS still claims the lives of 1.8 million people every year.
"I think that's a message that you have to keep telling young people over and over and in several different ways in several different types of settings," Millbourne said. "What I think the REC Boyz and Mpowerment Detroit has been trying to do is influence community norms around that. That takes time."
Time is not on the side of those trying to tackle this trend though. In October, the CDC failed to renew funding for REC Boyz, APM's highly acclaimed HIV prevention program for young men of color who have sex with men. With reduced funding in the face of rising numbers of infections among this group of young men comes a conundrum that few know just how to handle.
"It makes me think, is the work that we're doing beneficial?" questioned Theus. "Is that why they're taking all the money they were giving us and moving it down south? Because from the outside looking in, it would look like we're not really doing our job. They see all the money they're pouring into prevention and education and they're not seeing a change, so why would they give us money? But it's not that we're not doing the work, it's that the consumer has the right to do what they want to do. They still have to make that choice to wear a condom or not wear a condom."
Theus said feedback from counseling sessions even prompted APM to change the type of condoms they distribute.
"I've heard that the condom is being used but the condom is being taken off because of the feeling," he explained. "The regular condoms aren't working. So we looked at giving them the thin condoms because they want something that feels like it's not there. So we've been trying to change the behavior from that end."
Key to changing the behavior, of course, is understanding the cause of it. The reasons, it seems, are many. CDC materials on the topic list individuals lack of knowledge of their status, complacency about transmitting the virus, alcohol and drug use and the failure of regular prevention messages to reach this population as possible causes. But the real root of this problem goes even deeper.
"I get annoyed with people who dismiss this phenomenon as, quote, the natural recklessness of youth," said longtime AIDS activist Cleve Jones, Equality Michigan's 2011 Catalyst Award winner for Lifetime Achievement. "There's this kind of dismissive way of looking at it, particularly with young gay men of color. I think this is a consequence of despair and fatalism that comes from lack of opportunity and the continual marginalization of these populations."
DeJuan LeBlanc was just looking for a little affection. His search resulted in him testing positive at 17.
"It was an emotional thing," said LeBlanc, now 19. "I craved attention because I didn't get it as a child. That's how I got into this situation. Me wanting to please everybody first before I pleased myself. "
In a situation that's not rare among young, black men who sleep with men in Detroit, LeBlanc was raised by a single parent. And in his case, his parent suffered from substance abuse issues that only compounded his problems.
"It isn't like I didn't know about the safe sex thing," he said. "I knew everything about safe sex. I knew to use a condom. I knew to get tested. It's just an emotional thing. When somebody gives you attention or says that they love you, holds you or something … well, you get sidetracked."
While still in operation, the staff running the REC Boyz program heard stories such as LeBlanc's all the time.
"We conducted a pretty robust evaluation and part of that looked at self-esteem," Millbourne said. "What was surprising to us is that on self-esteem measures, our young men measured very high. But when we looked at self-worth – what they thought they were worth to themselves and their communities – those measures were very low. If you tease out the difference between what you think about yourself and what you think your worth is to the world or the community, those are really two different types of things."
Adding yet another layer to this quagmire is a recent marketing trend that promotes unsafe sexual practices – barebacking – as sexy, stimulating and the new norm. By the late 80s, all mainstream porn companies had begun using condoms in their videos. But in recent years there's been a bumper crop of internet start-ups specifically promoting sex without condoms. Sites such as RawRods and Breed It Raw are multiplying daily. These sites are often advertised in and cross-promoted with events at clubs that cater to black MSMs.
One such local company, ThugSeduction, announced in September that raw porn was not for them. The site had long had a partnership with Mpowerment Detroit that provided them with condoms.
"Someone this morning told me 'don't lose my integrity 'cause that's all you have,'" said site owner Andre Perkins on his FaceBook page. "That's the motivation I needed to continue to do condom porn."
Within weeks, though, Perkins had changed his tune.
"People rather see raw porn than condom porn," Perkins posted. "If I don't throw my morals out the window I will go out of business."
Millbourne said this trend is a definite cause for concern.
"We're seeing a proliferation of raw and bareback porn nationally," he said. "It's disturbing. It's counter to the message we're trying to put out there for people. I can't say how much that influences behavior, but I do think it does have some influence. "
Millbourne is not alone in believing this.
"If that's what they're watching, they're gonna mimic that behavior," said Theus. "They see it's so seemingly enjoyable when there's no barrier being used, and they think, 'I should be able to do the same thing.' This is the mindset of someone who hasn't even matured mentally. These are teenagers who are trying to figure out what sex is, let alone how to do it properly."
While experts agree there is no surefire way to curb the trend of rising infections numbers in this community, there are strategies.
"We now know that people who are being treated successfully are not capable of transmitting the virus," said Jones. "So I think a new slogan for years to come is that 'treatment equals prevention.' We need to turn the complacency into a real desire for people to learn their status and get treatment.
"I think it's also important to remember that we do know some things that work," Jones continued. "We know that prevention education campaigns – when they are targeted, when they're explicit and when they're prevalent – are effective. They are hampered by a lack of funding and by censorship, but when we pay attention to these populations with appropriate messages and involve the community in creating these messages, it does make a difference. "
AIDS Partnership Michgan has been trying to develop such messages.
"In the last two years we've implemented three strategies that just target young MSMs," said Millbourne. "We have a social networking strategy, we have a text messaging type program that we run and then the Status Sexy campaign. They see those efforts and get tested."
To develop such messages effectively and stop these risky behaviors, Millbourne said we have to realize why young, black MSMs are engaging in them.
"We need to look at the contextual and environmental conditions in which behaviors happen," he said. "I don't think we can downplay how the economic situation that we are in now disproportionately impacts young people and their ability to live independently. It impacts their choices, in terms of whether or not they may participate in a riskier behavior for survival. We don't often look at that but I think it has an impact in behavior in ways that are detrimental to our youth."
But maybe the biggest cause of this problem is that these young, black men aren't being looked at all by the LGBT community at large. And maybe the solution lies, at least in part, in giving them the attention they crave.
Jones summed it up succinctly.
"We need to tell them that their lives matter and we value them greatly and that we want them to live and grow."
