The Impact of HIV on Elder Black Same Gender Loving Men (SGLM)

The quote below by Black Civil Rights and LGBTQ+ Activist Bayard Rustin (1947) provides a lens for this writing, in 1948 after returning from a trip to India, where the teachings of Mahatma Gandhi highly influenced him, Rustin proclaimed this powerful quote:

"In every community, we need a group of angelic troublemakers."

This quote has relevance for Black same-gender-loving men (SGLM), henceforth referred to in this writing as SGLM, a term coined by activist Cleo Manago in the early 90s (Business Equity, 2019). This represents an identity by Black gay and bisexual men that affirms their affection and love for each other, as opposed to more Eurocentric terms such as gay, queer, or bisexual. The purpose of this writing is to shed light on the HIV epidemic among elder Black SGLM, and the continuing oppression, racism, and stigma this underserved population continues to experience.

Despite these disparities and barriers, this population continues to thrive and live full, meaningful, and productive lives; their experience, strength, and hope have important implications for a new generation of HIV+ persons attempting to cope with their diagnosis. As a community, we can collectively become angelic troublemakers and catalysts for positive change in supporting this community and promoting impact that results in positive outcomes.

SGLM face multiple oppressions; they live at the nexus of race, gender, age, and sexual orientation. SGLM are the victims of discrimination through overzealous policing, are marginalized not only by other populations but those they belong to, and face tough health disparities through a convoluted and often inaccessible healthcare system (Bryant, 2008). Moreover, this population also experiences social stressors such as violence, homophobia, stigma, and substance use disorders (SUD) (American Psychological Association, 2018; Bryant, 2008); these oppressions have a cumulative effect among older SGLM persons (>55). Many in this population have faced these challenges their entire lives and continue to experience them in their elder years. The following trends help illustrate the continuing impact the HIV epidemic has on this community.

HIV Trends

According to the Centers for Disease Control, the HIV/AIDS epidemic in the US continues to rage in the Black community. Figure 1 shows that in 2022, there were a staggering 31,800 new cases of HIV in the US (CDC, 2024) This number reflects the incidence rate, which means that new cases are continuing to emerge. The HIV incidence is important because it indicates how efficacious our prevention efforts are and, more importantly, where intervention efforts would have a beneficial impact on populations. Of the 31,800 new cases of HIV, in 2022, 67% were among gay, bisexual, and other same gender identities. This number represents a significant overrepresentation of this population in terms of HIV/AIDS trends. In contrast, 22% of new cases were among heterosexual persons, while 7% were among injection drug users (CDC, 2024). These HIV/AIDS trends among Black SGLM are particularly alarming and warrant our undivided attention.

Figure 1

Black SGLM are at the epicenter of the HIV/AIDS epidemic in the US, as noted in figure 2 (CDC, 2024). In the early 1980s, when the epidemic began, it affected mostly White gay men; now, the face of the epidemic is Black and Brown. The social determinants of health (SDOH) help us better understand how social, political, and personal factors adversely impact this population. The stigma associated with healthcare providers is one example. The CDC (2021a) gives the following illustrations of discrimination against SGLM by healthcare professionals:

1. Refusing to provide quality care,
2. Refusing casual contact with HIV/AIDS patients,
3. Referring to HIV+ patients as HIVers or “Having the package.”
4. Provider bias
5. Provider lack of cultural sensitivity

Figure 2 below shows that in 2022, not only are Black SGLM disproportionately impacted by HIV/AIDS, but Hispanics were also adversely affected, with data showing 8,831 and 9,374, respectively, followed by White males and Heterosexual Black women (CDC, 2024). Moreover, in Georgia, AIDS is the leading cause of death for Black men between the ages of 35 and 44 (McKinzie, 2018). SGLM accounts for 63% of HIV and AIDS cases, even though they represent only 28% of the state’s population. Disparities are also seen in SGLM who have substance use disorders (SUD).

According to the Centers for Disease Control and Prevention, these data trends have more to do with SDOH factors, such as poverty, lack of insurance, and stigma, than with promiscuity (McKinzie, 2018). This is particularly relevant for Atlanta. According to Carlos del Rio, Hubert, Professor at Rollins School of Public Health, and co-director of the Emory Center for AIDS Research (CFAR), the HIV epidemic in Atlanta mirrors that of some African Cities. (McKinzie, 2018)

Figure 2

Elder Black SGLM

Some providers may be reluctant to recommend HIV testing to elderly persons because they may falsely assume that this population is not engaging in sexual activity, or they may not routinely take a comprehensive sexual history. According to (Lanier, et, al, 2014), less than 40% of providers have sexual histories, and many providers have not been formally trained on how to conduct appropriate sexual health histories. This has implications for older individuals and can lead to late HIV diagnosis, resulting in poorer prognosis; this oversite may prevent SGLM from receiving timely antiretroviral treatment (ART). and living longer, fulfilled lives. In addition to HIV, elderly persons may also be dealing with co-occurring age-related diseases such as diabetes, cardiac disease, liver disease, and cancers.

Figure 3

Action steps

In providing resources and support for elderly individuals who are HIV+, we can begin to incorporate evidence-based strategies, such as cultural humility, preferred language, promoting inclusive research, and engaging in practices that affirm and respect LGBTQ+ persons.

Cultural Humility

According to the University of Oregon (2015), cultural humility involves “…an ongoing process of self-exploration and self-critique, combined with a willingness to learn from others. It means entering a relationship with another person with the intention of honoring their beliefs, customs, and values. It means acknowledging differences and accepting that person for who they are” (UO, pg1)

Principles that guide cultural humility include 1) open-mindedness, 2) self-reflection, 3) lifelong learning, 4) empathy, and 5) acknowledging power imbalances (UO, 2015).

Importantly, cultural humility requires that we confront our own biases and make a personal commitment to understanding the culture of others. For example, exploring the historical context of SGLMs journey through racism, discrimination, homophobia, ageism, and HIV/AIDS can provide greater insight into the stressors this population must deal with from an intersectional perspective. Understanding and practicing the principles associated with cultural humility can result in better health outcomes (Elevance Health, 2022)

Language Matters:

Language continues to be problematic when interacting with SGLM. For example, language that further stigmatizes a person can be hurtful and drive a wedge between provider and client. The movement toward language that is destigmatizing and that is evidence-based is reflected in Figure 4

Figure 4

The above chart reflects a contrast between stigmatized language and preferred language. Central to this strategy is person-centered language, which focuses on the individual and their lived experiences as opposed to a disease or condition. For example, instead of referring to our clients as addicts, the preferred term is a person with a substance use disorder. (Gladd, ND)

Research

As a dissertation chair and mentor at Capella University, I had the privilege of chairing a student dissertation entitled “Long-Term Survival Strategies for SGL Men.” The purpose of this research was to illuminate attributes and strategies SGLM utilizes in living long-term with HIV. This qualitative research explored the lived experiences of elderly people between the ages of 45-75 y/o and has implications for a younger generation of newly diagnosed HIV+ persons, as well as those < than 45. I will illuminate a few recommendations:

• Family support - has been associated with protective factors for SGLM.
• Education – Knowledgeable of HIV disease and treatment
• Medication adherence – the importance of taking medications as prescribed
• Positive provider/client relationship - acknowledged the importance of having a culturally responsive healthcare provider.
• Faith – participants acknowledged that spirituality was an important part of their lives and contentment

Most participants in this formative study reinforced the critical role the above strategies play in promoting longevity and sustainability. Many participants illuminated the fact that having a cheerful outlook also plays a vital role in helping maintain their mental health and well-being (Abernathy et al., 2021).

Conclusion

As an elder SGLM, living with HIV for 27 years and in long-term recovery for 33 years, my goal is to share my lifelong lessons and lived experiences with a new generation of young persons who may be struggling with issues such as identity, discrimination, racism, healthcare access, SUD, HIV/AIDS, mental health, as well as navigating a world that is not always supportive. This blog highlights some of these issues and provides a lens to engage with SGLM more empathetically and compassionately. My commitment to being an angelic troublemaker is unwavering, unlimited, and unabated. Given the alarming HIV/AIDS data represented here, we must galvanize all available resources in realizing the CDC goal of decreasing the estimated number of HIV infections to 9,300 by 2025, and 3000 by 2030 (figure 1).

While these goals are ambitious, our efforts must concentrate on providing efficacious evidence-based strategies and interventions that result in positive outcomes. I will end with this powerful quote from the great Maya Angelou:

Namaste!    

References

Abernathy, S., Bryant, L., (2021). Long-term Survival Strategies for Same Gender Loving African American Males Living with HIV. Unpublished Doctoral Dissertation. Capella University

American Psychological Association (2018). Health Disparities in Racial/Ethnic and Sexual Minority Boys and Men. (Retrieved March 20, 2021 from: https://www.apa.org/pi/health-disparities/resources/race-sexuality-men

Business Equality. (2019). Cleo Manago. Business Equality Magazine, June 10, 2019. (Retrieved December 20, 2020 from https://businessequalitymagazine.com/50_above_50/cleo-manago/

Bryant, L.O. (2008). How black men who have sex with men learn to cope with homophobia and racism. Doctoral Dissertation. University of Georgia. Retrieved 11/20/2024 from: https://getd.libs.uga.edu/pdfs/bryant_lawrence_o_200808_phd.pdf)

CDC (2024, May 20). Fast Facts HIV in the United States. Retrieved November 20, 2024, from https://www.cdc.gov/hiv/data-research/facts-stats/index.html

Centers for Disease Control and Prevention. (2021a). HIV Stigma and Discrimination. Retrieved June 21, 2021 from: https://www.cdc.gov/hiv/basics/hiv-stigma/index.html

Centers for Disease Control (2024) Fast facts, HIV, Gay and Bisexual Men, Retrieved 11/04/2024 From: https://www.cdc.gov/hiv/data-research/facts-stats/gay-bisexual-men.html#:~:text=In%20recent%20years%2C%20estimated%20HIV,and%20bisexual%20men%20(20%25).&text=Among%20people%20aged%2013%20and%20older.

Elevance Health (2022, May 20). Cultural Humility in Healthcare. Retrieved November 20, 2024, from https://www.elevancehealth.com/our-approach-to-health/health-equity/cultural-humility-in-healthcare

GLAAD (n.d.). Glossary of Terms LGBTQ+. GLAAD Media Reference Guide. Retrieved November 20, 2024, from https://glaad.org/reference/terms/

Lanier, Y., Castellanos, T., Barrow, R. Y., Jordan, W. C., Caine, V., & Sutton, M. Y. (2014). Brief sexual histories and routine HIV/STD testing by medical providers. AIDS patient care and STDs, 28(3), 113–120. https://doi.org/10.1089/apc.2013.0328

McKenzie, M. (2018). HIV/AIDS in Atlanta. Emory Health Digest, Spring, 2018. (Retrieved December 24, 2020 from: https://news.emory.edu/features/2018/05/aids-atl/index.html)

Watchfire Media (2024), Bayard Rustin. Retrieved November 3, 2024, From https://www.holytroublemakers.com/bayard

University of Oregon (2015), What is cultural humility? The basics. Retrieved 11/20/2024, from file:///C:/Users/olive/Dropbox/PC/Downloads/JTranscultNurs-2016-Foronda-210-7.pdf