The Centers for Disease Control and Prevention (CDC) estimates that HIV will infect half of all black/African-American men who have sex with men (MSM) in their lifetime if nothing changes. But interventions that focus on Black history, culture, and resilience can help reverse these trends.

If black/African-American MSM were a country, they would have the highest rate of HIV in the world—by far.

As it is, they are the hardest-hit population in the United States. They made up 26 per cent of the 37,832 new HIV diagnoses in the country in 2018. They represented 37 per cent of the new HIV diagnoses among all MSM, who altogether account for 70 per cent of all HIV cases in the country.

New HIV infections are either down or “stable”—apparently meaning a level the public will tolerate without panic—among almost every population except 25- to 34-year-old MSM, particularly black/African-American gay and bisexual men. They have had 42 per cent more new HIV infections.

These numbers make it all the more puzzling as to why even HIV prevention researchers admit that so few studies have focused on the connection between black history/resilience and black/African-American MSM’s choices to practice safer sexual behaviours—when the few studies that have been done point firmly toward a strong correlation between high resilience and lower risk behaviour.

One of the first studies, if not the first, to assess the direct relationships between resilience and HIV risk among black/African-American MSM in the Deep South (Alabama, Georgia, Louisiana, South Carolina, and Mississippi)—the country’s hardest-hit region—found that higher resilience was associated with less condomless anal sex (the highest-risk activity), fewer partners, and lower sexually transmitted infections. Those with lower resilience had more STIs and were more likely to participate in sex parties/orgies.

Using Black History and lessons of resilience as a guide

Black History and Black African-American gay/bi men interventions that work
Interventions rooted in Black History, family, and community cultures are the only ones that work for black gay and bisexual men.

The researchers concluded that “future prevention efforts should address building resilience, self-efficacy traits, and educational opportunities to address post-traumatic stress-related disorders associated with incarceration and homelessness”—traumatic experiences disproportionately affecting men of colour, including gay and bisexual men. They said their findings imply that black/African-American MSM need culturally appropriate trauma treatment—cognitive-behavioural therapies that help lessen the impact and reprocess the effects of trauma—and behavioural interventions.

Black and other MSM of colour have long understood that the only thing that would work for them were interventions rooted in their family and community cultures and histories. The programs that gay men of colour created to serve their brothers in the early years of AIDS were the very model of “cultural appropriateness” as they reached deep into their shared culture and history, and claimed for themselves the bravery and resilience of the heroic men and women who came before them.

H. Alexander Satorie-Robinson’s was president of The National Task Force on AIDS Prevention when the nation’s first prevention program targeting gay men of colour was created in 1985. Lacking a full embrace in the mostly white gay community—and the AIDS service organizations it created—and not very welcome in the black, Latino, and Asian communities that reared the men it served, the Task Force “was a place of comfort,” said Satorie-Robinson in an interview for my book Stonewall Strong.

“Just from an instinctual part of it, whatever culture or community we’re from, or faith or religious belief we have, we often in times of trouble move back toward those places because they bring comfort and some sort of continuity.”

Of course, not all gay men of colour have had positive experiences in their home communities or with religion even before AIDS, so the group took what spoke to them and left the rest. “While we were going back to the black community,” said Satorie-Robinson, “or the Latino or Christian culture, we weren’t literally going back to our places of origin; we were recreating those places in our gay and bisexual image.”

Even without empirical data, Satorie-Robinson said the gay men who created the Task Force drew on their own cultural and survival instincts. “To the extent there was healing and healthy behaviours that were part of those cultures,” he said, “we looked at what works, what doesn’t work, and what’s adaptable for us as gay men.”

Learning from the recent past

Considering the number of gay and bisexual men living with and still becoming infected by HIV today, Satorie-Robinson said, “The number of young gay men, in particular, becoming infected is disturbing. The number of black men becoming infected is disturbing.”

He sees it as an unfortunate side effect of successful HIV treatment. “It’s kind of like ‘we survived,’ but now what’s been the impact of the survival? What’s the impact of being resilient? There is post-traumatic stress that goes along with that capacity to survive. There is that lack of urgency that comes with feeling like you made it through.

I look at our culture, the number of places I see where there is acceptance of bare-backing [condomless anal sex], places where people can say ‘I’m negative so therefore I can have certain behaviours put me at risk.’ The urgency has been taken away because the impact seems not as critical.”

Looking back three decades to his experience with the Task Force and all that’s happened since, Satorie-Robinson said, “We’ve got to remember what happened, how we responded and what the response was about, and we’ve got to keep it alive. That goes to resilience. To the extent that you can draw upon your history, your religious or cultural values, and apply those lessons to new and emerging threats, your ability to survive seems likely to be increased.” On an unsettling note, he added, “When I talk to many out gay youth, they are so unaware of the history.”

Of course, it’s up to gay male elders to transmit our history to the younger generations, just as it’s up to those younger people to be receptive to learning about it. This is, after all, how history, knowledge, lore, and wisdom are passed down in every community.

The National Task Force on AIDS Prevention showed us three decades ago that to be effective, HIV prevention has to begin by building upon people’s resilience. Providing continuity in the present, while helping them to connect in a healthy way to the past—to claim its heroes and lessons for themselves—builds resilience as it fuels hope for the future, hope that can literally save lives.

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