Dr. Leandro Mena. All images courtesy of Tonic
There is a HIV epidemic happening in the United States among African Americans. Although we are 12 percent of the population, we made up more than 44 percent of all HIV diagnoses in 2014. While diagnoses among black women are higher than women of other races, the virus is raging particularly among gay black men. According to a study released by the Centers for Disease Control this year, half of all the gay black men in America will contract HIV.
In the age of treatment as-prevention and pre-exposure prophylaxis, when the risk of getting a positive HIV diagnoses has fallen for all US citizens over the past ten years from 1 in 78 to 1 in 99, why is the situation so dire for black guys who like to have sex with other black guys? Some people have attributed this disparity to the myth of the "down low," the idea that the HIV virus is spreading at an extreme pace among blacks because they're having secret sex with one another while remaining closeted and having sex with women. The truth is, numerous experts have gone at great lengths to dispel this myth, including the CDC, which found in 2009 that less than 2 percent of black men are bisexually active. Another idea is that it is the backwards black Christian church that is to blame because of its intense homophobia, which encourages gay black men to hide in the shadows and not get treatment. Of course, one only needs to look at a Westboro Baptists Church protest or watch Pat Robertson on the 700 Club to know that white Christians are intensely homophobic, too—but white gay men have a 9 percent diagnoses risk, versus the 50 percent risk facing gay black men.
The true cause of the racial disparity in the nationwide fight against HIV comes down to limited access to treatment and a lack of sex education. Nowhere is this more obvious than Jackson, Mississippi. The city is nearly 80 percent black and has America's highest rate of HIV diagnoses—four out of ten gay or bisexual men have the disease. Due to Mississippi state law, schools in Jackson are forbidden to discuss or demonstrate condom use, so many young people simply don't know how to protect themselves against HIV. Thirty-three percent of the black people in Jackson live in poverty. Many of them can't get access to treatment because they lack the means to pay for it and the transportation to get to a doctor. And often, when they finally do get treatment, their HIV virus has already caused them to get AIDS.
VICE's health website Tonic recently visited Jackson to get a sense for how bad things are down there. The one glimmer of light they found was the Open Arms Healthcare Center, which fights the HIV crises in Jackson by treating 165 people a day. This is the only federally funded clinic in the state focused exclusively on providing access to HIV treatment and education, leaving an undeniable impact on the community. To get a better idea of what Open Arms is doing right now and how that can be replicated in poor black communities across the nation, I called up the center's Medical Director, Dr. Leandro Mena. He gave me a lot to think about.
The Jackson skyline
VICE: Tell me about your work.
Leandro Mena: For about 14 years, my work has been focused on HIV and STD prevention and trying to understand the dynamics of HIV transmission among minorities in the South. We want to develop and improve healthcare systems to be able to deliver HIV/STD services to these communities.
HIV is a crisis, especially in Jackson. Our healthcare system, our community, and our public health officers have been slow to respond to this crisis and that has been disproportionately bad for our young black gays—and they are our most vulnerable population.
How do you reach out to this population?
We have to work in collaboration with the health department and the community. In 2007, when we recognized the great number of HIV cases among black men who have sex with men. We tried to understand the factors that lead to this. During that investigation, one of the things that came up was the issue of access to healthcare. We found that the people who had a primary care provider were about four times less likely to be infected than those who had no primary care provider.
It was obvious to me that we needed to create access to health services, and that access had to be something people were wiling to use. At the same time, they needed to be cared for by healthcare providers who were competent.
At Open Arms, we provide health services that include screening for HIV, primary care, and we offer prophylactics in a setting that patients can feel comfortable. We don't want people to feel stigmatized or singled out because of their sexual orientation or race.
When it comes to the HIV crises in the black community, we still hear about the "down low." As someone who is in the trenches, fighting HIV, what do you think about that concept?
I think there is a sensationalism about it that is not entirely relevant when we are talking about HIV transmission. You might say the down-low man is not entirely open about his sexuality. But very often, these are men who identify as gay and do not have sex with women. They just don't want anyone to share with other people that they are gay.
On the other side, there is this idea that the down-low guys are spreading the disease by infecting women. While I've seen some young gay people who will have sex with a woman very early on in their life because they are still exploring their sexuality, we know from our studies that these men are more likely to use condoms both with their male and female partners. They do not play a significant role in the transmission of HIV.
What is the story with black women in Jackson in terms of this HIV crises?
Certainly, it is not similar. HIV mostly affects men who have sex with men. Gay men represent only 2 percent of the population in this country and they represent more than half of the diagnosis of HIV. But African American women are very frequent victims of HIV. The lifetime reach of HIV for a black woman is 1 in 48. The lifetime reach of HIV for a white women is 1 in 880. There is a huge disparity there. It is almost 90 times higher. So in Mississippi, where almost 80 percent of my patients are men, I try to remind people that one in five happen among a woman and most of the time that woman is a black woman.
How do you think the work you do will change under the Trump administration?
The clinic is funded through federal funds. Every time we have a change in government, there is always an opportunity to have a change in funding. But with Mississippi, we are such a poor state and we receive so little funding, I can't imagine that we will get any less than we already do. We have a lot of creativity extending the dollars that we receive to try to do the best we can.
How will Trump's potential repeal of Obamacare impact the HIV health crises in Jackson?
Nationwide, Obamacare has provided health insurance to over 30 million people. I think Mississippi has the highest rate of individuals who are uninsured. If you think about black men who have sex with men, they are one of the most uninsured populations. This is bad because people with health insurance are less likely to become HIV infected.
What do you need more of to service your community?
To me, the biggest impact isn't always made by more funding. I think if we found a better way to administer the stuff we have and implement better policies, it would take us a long way.
Sexual heath education for adolescents is ineffective here. Mississippi only allows abstinence and abstinence-plus education. We need comprehensive sexual education that allows children to have a conversation about condoms. Think about how crazy it is that by law you are not allowed to do condom demonstrations in class. Just those issues represent an incredible challenge to address the education and sexual health needs of these young adults in places where we have the highest rates of teen pregnancy, gonorrhea, and chlamydia. And we have the second highest rate of HIV infection among men 18 to 24. So we have significant health problems that could be improved by having better sex education.
What do you recommend to others fighting this battle across the South?
When I used to think about the problems that we have like racism and homophobia and poverty and a lack of education, I would feel overwhelmed. How could you change things so big? Then one day, a friend of mine challenged me. He said, "None of these problems is going to go away. But what can you do in spite of them?" For me, that moment was transformative. It was almost like I saw the breaking down of a wall I had created in my mind.
Very often, the mentality in some of our communities is resistant to change, but we should think about all the opportunity there is to make a difference. We should challenge ourselves and continue to challenge each other from an individual level to an institutional level. We have to start looking at these things in a new way. For many years, we've been doing things the same. But now, we have the tools in our hands to really reach the end of the HIV epidemic.
We know that treatment is prevention. The challenge that we have is to create health systems that can bring those tools to the population. If we don't do that, I can tell you in a few years the disparities that we have now will get even bigger between the people who have access and the people who don't.
To learn more about theOpen Arms Healthcare Center, visit its website.
Follow Wilbert L. Cooper on Twitter.
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