Dire HIV numbers demand new responses

Uri Butler is a natural in front of the camera. His tall, lanky frame and soft features project confidence, love, happiness — all easily captured by a professional photographer.

Butler, 20, said he’s thought of being a model and quickly scans through his cell phone to show photos of him posing in other shoots. Right now, though, he is a junior majoring in biology at Fort Valley State University, located about 90 miles south of Atlanta, and dreams of becoming a nurse.

But on Aug. 13, Butler took a break from his studies to pose for the Evolution Project’s new media campaign, set to launch in September to reach out to black, gay young men about HIV prevention. The Evolution Center, a project of AID Atlanta located on Juniper Street, offers programming and resources as well as HIV testing specifically aimed at black gay men.

“I was diagnosed [with HIV] in February,” Butler said while watching his friends take their turns in front of the camera. “Normally I get tested every six months; I would get tested in August or September and then again in January of February. At the time I was with my partner. After six months together I showed him my status and he told me he didn’t know his status. It was right around that time I tested positive.”

New generation of gay men at risk

As a 20-year-old black gay man with HIV, Butler is now part of a demographic that has public health officials sounding the alarms. On Aug. 3, the Centers for Disease Control & Prevention released data showing that between 2006-2009, black men who have sex with men (MSM) ages 13-29 showed a 48 percent increase in new HIV infections.

The CDC numbers show that in 2006, there were 4,400 HIV infections among black gay and bisexual men ages 13-29. The numbers jumped to 6,500 infections in 2009 within the same age group. This subpopulation represents the only subpopulation in the U.S. to experience a statistically significant increase during these three years.

And while in the U.S. the rate of new HIV infections remains relatively stable at 50,000 new infections a year, gay and bisexual men still account for the highest numbers of new infections — they make up 2 percent of the nation’s population but accounted for 61 percent of all new HIV infections in 2009, according to the CDC.

“We are deeply concerned by the alarming rise in new HIV infections in young, black gay and bisexual men and the continued impact of HIV among young gay and bisexual men of all races,” said Jonathan Mermin, director of CDC’s Division of HIV/AIDS Prevention, in a statement.

“We cannot allow the health of a new generation of gay men to be lost to a preventable disease. It’s time to renew the focus on HIV among gay men and confront the homophobia and stigma that all too often accompany this disease,” Mermin added.

Fighting stigma with visibility

For Butler, participating in such a public campaign is a way to help others.

“This is my way of showing people who may have felt the same way I felt that you can be happy,” he said.

“My initial reaction was not to cry or panic, but to think, ‘What next?’” he said. “What do I need to do to ensure my longevity. My initial thought was that this photo shoot will help bring off the film, the stigma.”

Butler also said testing HIV positive relieved him of the burden of having to worry about contracting it at some later time.

“Finding out kind of liberated me because now I don’t have to worry about it,” Butler added. “That’s a part of the culture. It’s looming everywhere. My thoughts now are that I have something where my body is compromised and instead of running around having sex with everyone, I think that this person might have something that might harm me, like a cold. I feel like I have to focus on my health and being healthy.

“And when I meet people they look at me and say I’m handsome, I’m smart and I have everything going for me. When I disclose my status, they kind of back up a little,” he said. “Sometimes I want to be negative and give up. But in the past month my perception has changed. I think the Evolution Center rescued me.”

No easy answer to continuing epidemic

HIV is a preventable disease. And to many, it seems simple enough to not contract the virus  — just practice safer sex. Gay men have been told for 30 years to use condoms, to not do this, not do that, be careful with every single person you become intimate with. It’s enough to wear someone down and for many it becomes part of the background, like white noise.

There are no easy answers for why people, including gay and bisexual men, continue to contract HIV, said Steven Igarashi, gay men’s health coordinator for AID Atlanta.

“That’s the million dollar question — why? But I don’t think it’s one issue we can pinpoint. If we could we’d have a solution,” Igarashi said.

With the nation 30 years into the pandemic, there comes backlash such as condom fatigue, he added.

“And people just tired of hearing about it,” Igarashi said.

Abstinence-only sex education in schools contributes to young people being ignorant to the risks of sex, which can be deadly for young people who already believe they are invincible, Igarashi said.

“And in the gay community — and I don’t think this mindset is a blanket statement — there is a portion of our community that still looks at HIV as inevitable. They see it is a risk and think they will probably become positive anyway so why take precautions,” he said.

AID Atlanta and Positive Impact’s MISTER Project are also very conscious about providing programs and resources for gay men that do not force them to come sit in a sterile clinical environment to learn how to be safe or talk about issues they face.

MISTER provides yoga classes and book clubs while Igarashi organizes social outings at bars, coffee shops and restaurants.

“We want to meet men where they are and remove the barriers of them having to come to us as part of building community,” Igarashi said.

Researcher: CDC numbers not shocking

David Malebranche, a physician who has focused much of his public health research on black gay men and HIV, is an assistant professor at Emory University’s School of Medicine. He said looking for one “smoking gun” as to why HIV infections continue to increase is a fool’s mission. He also said the CDC’s most recent numbers on young, black gay men are not shocking at all.

“I’m frustrated and annoyed and this fucking emergency has been going on since 1998. It’s nothing new. I love the statistics, but they never tell us why. So they keep sounding the alarm — and I don’t see research that asks black gay men these questions, like why,” he said.

Of course, there is no single answer to “why” black gay men continue to be disproportionately affected by HIV. But Malebranche, who is openly gay, said it is structural  — poverty, barriers to access to healthcare, homelessness.

“What’s interesting at this point is that the CDC is pushing testing. It’s like they are testing every black MSM, which I think is counterproductive at this point,” he added.

“When people who are not black gay or bisexual men see the numbers impacting black MSMs, they think, ‘I’m fine. I’m not part of that risk group’ and keep having unprotected sex,” Malebranche said.

And for black gay and bisexual men who are bombarded with these numbers, Malebranche says it becomes a “self-fulfilling prophecy.”

“You keep overcasting a population. You keep testing more and more black MSMs and you are going to get more and more positive tests. There is an overemphasis on testing and just testing black MSMs. There is no end in sight and it looks like a huge racial disparity,” he said.

One thing is certain — black gay and bisexual men do not have more unprotected sex than other demographics. But new CDC studies do show that black MSMs tend to have more STDs, such as syphilis, which makes it easier for the HIV virus to spread.

“It’s never been about behavior,” Malebranche said.

And if he could have three wishes that he believes would drive down HIV infections among black gay and bisexual men?

“Universal healthcare, proper mentorship and role models for young black gay men, and for religion or spirituality to be more embracing in this country and accept all sexual orientations,” he answered.

Chase Andrews, 25, the recruitment and retention specialist for the Evolution Project, disagrees with Malebranche on the CDC’s numbers being counterproductive.

“I wasn’t shocked, but to see it in black and white was sobering,” he said. “People need to know … so they know this is still an issue.”

And why are HIV infections still on the rise?

“That’s the question. Our community isn’t really monolithic,” Andrews said. “I do this work because I fell in love with my community, I love working with them, coming up with unique ways to reach them and talking about how to save each other.

“Saving each other goes beyond HIV prevention … it goes to how we form relationships.”

‘Infecting with information’

Chris Barker, 26, a graphic designer who came up with the concept for the Evolution Project’s new campaign, spent hours directing Butler and a dozen other young gay black men at the Aug. 13 photo shoot. He is well aware of the CDC numbers that show the staggering increase in new HIV infections within his demographic.

“We are trying to be as aggressive as the numbers,” Barker, who is HIV negative, said about the campaign.

“We want to infect with information. This is our community. There is no one place you can go for this demographic. You have black, you have gay, you have local. We are trying to bring all this together to a very techno savvy group and be cohesive so people get the idea of branding. Many think it won’t happen to me, but it does. Every day,” he said.

Barker said he knew he wanted to stay HIV negative after his friend found out he was HIV positive after first becoming very ill.

“I thought it would be literally overnight that he would disappear. Then I would talk to him and ask what he was doing and he would say he was sitting in line at the IDP [Grady Infectious Disease Program] now. He also had to deal with social and class issues, go through all these avenues just to stay alive,” Barker said.

“People are living a lot longer but they don’t realize the hindrances. Especially for a young person who is used to always being on the go to now have to stop and wait in line. I know that’s not the way I wanted to live,” he said.

Barker’s passion for the Evolution Project’s campaign is easy to see. He knows exactly the look he is going for, how it must be implemented on the web, on social networking sites, on mobile phones, with QR codes.

“We want our demographic inundated with the best, positive messages. HIV is still a taboo subject,” he said.

“This campaign is us, literally our friends, neighbors, people we see in the park, the club, walking down 10th Street. Typically when people see our demographic it’s after the fact. We are doing more positive stances, postures, than seen in the past — to most effectively reach them you have to be amongst them,” he added.

Sex, mind and soul

Nicholas Robinson, 25, who is also a model in the Evolution Project campaign, was raised in a homophobic environment in Columbus, Ga. He said becoming educated about sex was a top priority when he began college at Georgia State University as part of his desire to be a healthy young man. He remains HIV negative.

“In high school there were so many people getting pregnant or engaging in unsafe sex and you would hear these people had STDs and STIs. I wanted to know about condoms, risky behaviors, different positions,” he said.

The high number of infections among black gay men shows that the black community is one that is in need, he added.

“It’s not just about sexual health but about emotional health,” Robinson said. “The need for love becomes so strong and if you lack education you end up with a population that doesn’t know how to go about navigating sex, you don’t know your own self worth — people need to know they deserve a healthy life and not just what comes along.”

Changing the tide of HIV infections in the black gay community — and in all communities — must focus not just on sex but also on the mind and soul, Robinson said. Leaving behind the homophobia of where he was raised planted the seed that he was worthy of having a happy and healthy life.

“I didn’t think I would live past the age of 18. But when I started college I got the smallest inkling that I was worthy. It took years for that to become concrete. Gay people deal with a lot of hate, a lot of misinformation is given to us. I didn’t know what it was to be valued,” he explained.

But over time, Robinson said he developed friendships and relationships that proved to him he is worthy of being alive. That’s a message he would like other young black gay men to know.

“If you can find people who will encourage you and support you, that you are not this piece of shit others tell you, find them and keep them around you to move on and forward. If your environment is bad — as soon as you can, get out, go to college. Take the reins and move toward happiness,” he said.


Top photo: Gay Atlanta men are part of a new HIV prevention campaign for the Evolution Project. (by Carlton Mackey)