Fenton spoke at a March 20 community engagement session in Atlanta. Participants included Georgia HIV non-profit organizations such as AID Atlanta and AID Gwinnett, as well as the state Department of Public Health.
During the session, Fenton and the CDC focused on black gay and bisexual men because of the significant increases in new HIV infections. But gay men of all races are impacted heavily, CDC officials noted.
“When we look at how funds are distributed, we underfund MSM by a significant amount,” said Dr. Jonathan Mermin, director of the CDC’s HIV/AIDS Prevention Program.
Most of the CDC’s HIV prevention programs are administered by the Division of HIV/AIDS Prevention. In 2011, the division awarded funding totaling $621 million with 41 percent going toward men who have sex with men, according to the CDC.
More funding is going to research and prevention for gay and bisexual men because the CDC feels a responsibility to “match the epidemic.”
Fenton, who is openly gay, noted that homophobia and stigma likely play a role in the underfunding.
“Historically what we see across the U.S is it’s easier … for states and local jurisdictions sometimes not to put money where the epidemic actually is. In part because data aren’t there … and undercounts gay men,” Fenton said.
“But remember [for] many places across the country, especially in the ‘80s and ‘90s, it’s far easier to do work with women and children, with young people, with high risk heterosexuals, than it is to deal with gay men who having raw sex in bathrooms,” he added.
“Our own stigma, our own homophobia, cascades down in our funding and allocations intentionally or unintentionally resulting in underfunding of gay men’s work across the country,” Fenton said.
‘Spiritual dimension’ to sexual health?
The session in Atlanta is one of many slated to take place across the U.S. to try to find ways to deal with the epidemic that continues to hit gay and bisexual men the hardest.
As part of the session, Fenton discussed a definition of “What is sexual health?” that is currently being considered by the CDC and the federal Health Resources & Service Administration (HRSA), a division of the U.S. Department of Health & Human Services.
The proposed definition is as follows, with changes in bold:
• Sexual health is a state of wellbeing in relation to sexuality across the lifespan that involves physical, emotional, mental, social and spiritual dimensions.
• Sexual health is an intrinsic element of human health and is based on a positive, equitable, and respectful approach to sexuality, relationships, and reproduction, that is free of coercion, fear, discrimination, stigma, shame, and violence.
• It includes the ability to understand the benefits, risks, and responsibilities of sexual behavior; the prevention and care of disease and other adverse outcomes; and the possibility of fulfilling sexual relationships.
• Sexual health is impacted by socioeconomic and cultural contexts — including policies, practices, and services — that support healthy outcomes for individuals and their communities.
The approximately 50 people at the Atlanta session overwhelmingly approved of adding a “spiritual” aspect to the definition.
Pastor Dennis Meredith of Tabernacle Baptist Church, who identifies as bisexual and is currently in a gay relationship, praised the CDC’s inclusion of the “spiritual” in sexual health, saying that black churches tend to be among the larger purveyors of anti-gay messages.
“The black church in particular — we do not do due diligence with the Bible. We still do the hate messages. You cannot read homosexuality is a sin when you read the Bible. They put it there because of homophobia,” Meredith said.
“You’ve got to mess with the faith. It is the pastors who must be approached and not just the parishioners,” he added of efforts to combat HIV infection rates.
Fenton said adding “spiritual” is new to the CDC, but something that must be considered and part of the responsibility of recognizing “who we are as beings.”
All must address ‘crisis in our midst’
HIV activist Adolph Arromand brought up the issue of “raw sex” that gay and bisexual men tell their HIV counselors and testers that they prefer rather than using a condom.
“At end of day as providers of HIV testing, this is reality we deal with. There is a large number of people who interventions will not work on,” Arromand said.
While Fenton agreed there is a group of people who prefer raw sex, most men practice safer sex, he said.
“Most men practice safer sex and practice it consistently. Survey after survey proves this,” Fenton said. “It is wrong for us to think that is the norm in the community.”
Ways to engage this segment of the community include possibly creating spaces where it is safe to have raw sex, such as through serosorting, Fenton said. But there must also be continued support of men to have safer sex, he added.
Black gay men are not valued in many communities, from the nation in general to the LGBT community itself, said Craig Washington, a longtime Atlanta HIV activist.
Sophisticated approaches to ending the epidemic include the development of young black gay leaders, not just within HIV organizations but in research and advocacy, he said, where they can directly impact change.
“We need to exercise creative approaches,” Washington said.
Fenton said one of the most important issues he wanted all people and groups to consider is, “Who is responsible for ending the epidemic?”
“What can we do to empower and hold each other accountable? We can do what we can from the federal, state and CBO [community based organizations], but I wonder to what extent we need to have a new conversation of us as a community where we say this is enough?” Fenton asked.
“We have a crisis in our midst,” he added. “What more do we need to do to address the epidemic among gay men? It requires all of us to say this is an injustice and we need to do better.
“Let us not have the question, ‘What has the CDC done for me lately?’ We are all in this together,” he said. “We are going to have to have a new narrative of what we are going to do together.”
Top photo: At a March 20 community meeting, the CDC’s Dr. Kevin Fenton addressed many issues gay black men face when fighting against HIV.
(by Dyana Bagby)