Read any report on HIV in black America, attend any HIV conference or look up at an HIV prevention billboard and it's clear who is most impacted by this epidemic in the U.S.: black men who have sex with men (MSM) and black heterosexual women. Perhaps that heavy focus, along with homophobia in the black community, is what led to the belief in the down-low phenomenon, according to which duplicitous and sinister bisexual men are sleeping with men and also having unprotected sex with women.
And while so many in the African-American community buy into this myth, science demonstrates that that just isn't so. The down low is not fueling the HIV epidemic among black women. So, if it's not about men on the down low and the main source of HIV transmission among black women is heterosexual contact, at what point are we going to address the elephant in the room?
Heterosexual men do have HIV, and they are falling through the cracks.
In order to fully address this epidemic head on, we have to include heterosexual African-American men. But how do we go about doing this given the stigma and homophobia in the black community? What work is being done now that is making an impact among this demographic? And where are the heterosexual men living with HIV who will speak out?
Participating in this discussion on the subject are Ingrid Floyd, the executive director of Iris House in New York City, and Larry Bryant, the national field organizer for Housing Works in Washington, D.C. Bryant has been living with HIV since 1986.
This is part two of the discussion; you can read part one here.
Kellee Terrell: The more I see how prevention gets framed, the more I see that the bulk of the responsibility for condom use is placed on women. I hear so much of this "Women, save yourselves, love yourselves," and while it's empowering, because we do need to love ourselves, this approach suffers from tunnel vision. Because it's really counterproductive to leave heterosexual men out of these types of conversations, especially given who is really controlling when condoms get used.
Ingrid Floyd: What we've seen in our work with women -- and this is how we've come to start to do programs for heterosexual men -- is that women aren't the ones who make the final decision about whether a condom is going to be worn or not.
Most of our programs focus on: How do we teach women how to negotiate? How do we teach women how to use a condom? And I agree that women need to have these skills and to know what to do in those situations, but in a lot of cases what we find is that at home and in the bedroom, a lot is being led by the male in the relationship. And that's due to the gender norms that we have in our society.
So men have to be as willing to use a condom. Men have to be as willing to know their status, and as willing to seek care and treatment if they know that they're positive. And it can't be the pressure of the woman to make that decision for him.
Larry Bryant: It works both ways, too. There are some women who see the idea of using a condom with their man as a challenge of trust. And there are women who may not be educated on prevention or protection, but for whatever reason believe that condomless sex is what is truly sexual, in the purest sense.
I have received those kinds of pressures from women even among the ones who knew my status from the beginning. So I think that in more "equal" and ideal situations -- definitely not counting in situations that involve sexual violence, rape or control -- we all need to have some accountability.
Ingrid Floyd: Larry brings up a good point. People feel that there's a lack of intimacy when condoms are used. So how do we make sure that, in those cases, people are educated enough to know each other's status? We often tell people that it's great to know your status, but if you don't know your partner's status, and you don't want to use a condom, then it doesn't benefit you. So, in those cases where people feel that condom use prevents intimacy, how do we make sure that both parties are educated and are aware of their status and have shared that information? How do they get to a place where they can at least have that kind of dialogue or communication?
Kellee Terrell: That's a great question, Ingrid. So, looking at the work that you both do around addressing heterosexual black men, what is working and what's not?
Ingrid Floyd: Iris House has a new program called Listen-Up. And we just recently launched our "Love Your Life -- Keep It 100" campaign, which we are really excited about. "Love Your Life -- Keep It 100" is all about trying to make condom use a social norm in black heterosexual circles and communities. We really want to get across the messages that it's OK to use condoms in your relationship and that it's OK to know your HIV status or come in and get tested.
The campaign itself launched in October. Under this new program, Listen-Up, we've been providing services to young heterosexual men through an intervention called "Nia." We do this in collaboration with barbershops, colleges, fitness centers, rec centers and other places to encourage and recruit young men to get tested and participate in the intervention. Kind of learn more with the goal of making them leaders in their own circles.
We're excited because we just recently received funding to expand "Love Your Life -- Keep It 100," and so we're going to be launching the campaign in Irvington, N.J., at the end of [March]. That allows for us to enter into another community that's heavily impacted by HIV and STIs [sexually transmitted infections] and further the message that these programs and these resources are available for people to access.
We also offer a rapid HIV testing program throughout the community, not just on-site, while partnering with other community organizations who don't have testing programs, as a way to engage young men, including heterosexual men, in general, to come in for services.
Kellee Terrell: What has the response been?
Ingrid Floyd: Really positive. We did an evaluation of the campaign and what we've found is that, in people who have seen the campaign, 47 percent reported an increase in communications around HIV, as well as a change in behaviors, whether those behaviors are sexual behaviors, or whether those behaviors have to do with personal relationships and how they communicate in those relationships.
So we've gotten a really positive response. We've gotten really good media attention for the campaign, which is also good because it helps us to take it to other audiences who may not be in New York City, or who may not have seen it when it was up in the bus shelters, or through the posters or palm cards that we've been distributing.
Kellee Terrell: Can you talk to me about the language that your campaign uses? How does it engage heterosexual black men?
Ingrid Floyd: In order to create the campaign, we involved heterosexual black men in the framing of it. We would talk to them about imagery -- what they wanted to see and what would be attractive to them. One of the things that we found through our focus groups and surveys is that they didn't want dire straits messages or negative connotations, such as "This is going to happen to you if you get HIV."
And so here's how we came up with "Love Your Life." Because one of the things that we know is important for young black men is to teach them: How do you love your life? How do you value yourselves? Not just the woman you're with, but valuing you as a person? Hence, the "Love Your Life" part.
The "Keep It 100": Keeping 100 means keeping it real, keeping it honest. That tagline really captures people's attention, because most young black men know what it means. It creates a dialogue and creates an opportunity for them to talk about what "Keep It 100" means.
We also made sure that it was attractive to not just heterosexual men, but men who sleep with men and women. We have one image that's of a single guy. This guy could be a young guy in college; he could be a young guy just hanging out on the corner; or he could be a young gay guy. So we looked at images that could attract the attention of several audiences -- people who are heterosexual; men who may be sleeping with men and women; and young gay black guys.
We have three different images: one of a couple; one of three guys together; and one of a single male. We ran all the images by [our heterosexual black male focus group]. We got their feedback and we made changes as they saw fit. But I think for us it worked because they were involved in creating it.
The other unique part is that we're using QR codes. As far as we know, we're the only social marketing campaign that is incorporating QR codes. It allows people to use a smartphone, click the QR code, and go right to our "Keep It 100" New York website to see other images from the campaign and to get information on where they can get free condoms and where they can go to get tested.
Kellee Terrell: Larry, talk to me about some of the work that you do addressing this issue. What's been working, and what hasn't been working? I was on a panel with you at USCA [United States Conference on AIDS] in Chicago and there was a working group of advocates working on addressing this issue.
Larry Bryant: Some of the things that have been working are from that panel. The heterosexual men of color group was a coalition of men who identify as heterosexual -- both people living with HIV and people who work the front lines, and some are researchers and medical professionals. All kinds of people are building that coalition nationally to help increase the dialogue and involvement of straight men in prevention, care, education and services.
It's not enough to just have straight men be a part of the conversation. It's not enough to have heterosexual men be visible, or be in the room. How can straight men take the lead on some of these discussions, which then leads to some of the measureable outcomes that are expected in, say, the national HIV and AIDS strategy? So it's about developing and supporting that leadership and visibility among straight black men and men of color in the AIDS community, and then bridging out to the larger communities -- the non-HIV and AIDS communities -- that we all live in where it's hard to have those conversations out of our comfort zones, even if you're working in the field. So that group has been growing.
And we're pushing to have, hopefully, a panel, discussion, or some kind of program at the International AIDS Conference that focuses on heterosexual populations, led by men but including women and community members, as well.
Kellee Terrell: That's great.
Larry Bryant: Also, a lot of my work leading up to the International AIDS Conference is focusing on the We Can End AIDS mobilization, which consists of a very large march and a series of rallies that are happening on the Tuesday of the conference -- that is July 24 -- and it centers on basically the elements and the factors that contribute to the epidemic. And when we're talking about the black community, particularly black men, it's really important that we understand the factors that contribute to the epidemic. We spoke about these before: economic disparities, education disparities, lack of job skills and health insurance, health disparities, etc. And so focusing on things like housing, syringe exchange, mental health, so forth and so on. And being involved with that mobilization that helps to push the national dialogue and identify solutions to these things that address the black community largely, but specifically, black men.
And I think it's extremely important for us to talk about developing different prevention and education strategies, particularly getting men tested and taking control and accountability for their own health care, and how and when they interact with others -- particularly black women. But I think it's as important to address the factors that contribute to those infection rates.
When we're talking about the economic disparities, and other health disparities, and other social justice issues that are prevalent in the black community, we need to target those equally as we do infection rates, and make sure that people know their status. We can find a cure. We can find the vaccine. And we can get people to know their status. But we're just going to keep counting new infections.
And even if we got rid of all the new infections, even if we found a cure or vaccine to eliminate those infections, if we don't address those social issues in black communities and in communities of color that lead to the perpetual cycle of poverty and homelessness and addiction and homophobia and sexual violence and those things, again, that black men play a very, very visible role in, then we're just waiting for the next epidemic. And we're not healing within our communities. We're going to begin breeding the next generation of apathetic, disconnected young men who are going to be fighting even harder against that support.
Kellee Terrell: Well said, Larry. What is your personal advice for heterosexual black men in terms of getting tested for HIV and STDs [sexually transmitted diseases]? Ingrid?
Ingrid Floyd: My personal advice would be to get educated; get the information. Don't think that you're invincible and that this does not impact you. Also, just make yourself a priority. When I talk to my nephews and to other young heterosexual men in my life, oftentimes they are not taught to value themselves. And they are not taught to value their bodies and to understand the importance of being healthy and maintaining their health beyond their high school and adolescent years. We have to continue to have those dialogues and encourage them to understand their bodies.
We had a presentation with Dr. David Bell of the Columbia University Young Men's Clinic. I learned more about men's health in that one-hour talk than anything else. He talked about how he uses this talk with the young men who come into the clinic. And his clinic is one of the few that I know nationally that focuses on young men's health and helps young men understand their reproductive organs and how they work and just how to value themselves, value their bodies. And in that, that means you need to know your HIV status. That means you need to get regular physicals. That means you need to stay connected to medical care as you continue to get older so that you don't wait until you're in your 40s and somebody says, "You need to go have a colonoscopy."
Kellee Terrell: Larry?
Larry Bryant: Wow. I don't know how to follow that. [Laughs.]
It's having the idea of ownership. The young black man is the most imitated, duplicated and mimicked in terms of style and personality, and yet somehow black men seem to be least connected to that. When we talk about the target age of people who make up the fastest growing number of people being infected -- you know, black women and men, ages between 16 and 28 or so -- this is who we're talking about.
How do we own our accountability in this process? I think we all have to acknowledge our level of ownership in how we address this epidemic and begin to have open discussions with ourselves and each other. We also have to move from discussions to strategies or solutions that not only lower infection rates, but heal our communities' physical, economic and spiritual health. We also have to know how to work together as a black community -- as a black man working with our youth, black women, gay black men and the transgender community. None of us live in a silo or live in a bubble by ourselves. We all survive because we all work together to survive.
In the end, my advice would be to just acknowledge ownership and claim your life. Claim our lives.
Kellee Terrell: Final thoughts?
Ingrid Floyd: Other than I'm happy that we are having this conversation, I think that service providers have to start to asking, "How can we start dispelling some of the gender norms that have been socialized in our communities?"
Gender "norms" play a big role in how heterosexual men view themselves and view relationships and I think that's an important aspect that oftentimes we miss in our discussions with women, as well as in our discussions with young men.
Larry Bryant: Just to piggyback on that, when we're talking about comprehensive sex or sexuality education in all school-age settings, I think that young black men aren't receiving messages about sexuality. Who are we in that relationship? Who are we, as young black heterosexual men? How do we define our sexuality in a healthy, creative, passionate way without putting ourselves and others at risk?
I have a 22-year-old son, and a 4-year-old grandson. And I hope that we begin to move toward an accepted level of conversation that allows them to speak to their loved ones, to speak to their partners, to speak to their girlfriends, as open and honest as I never was able to do at that age. We have to move to a place where we all feel safe and secure with doing so, without fear of retribution, or fear of stigma, or the element of ignorance that seems to always exist not too far from where we are. And any way that I can help support that, move the discussion toward action and further in that direction, that's where I'll be.
Kellee Terrell: And with that, this roundtable will come to a close. Thank you both for taking part in this amazing and eye-opening discussion.
This transcript has been lightly edited for clarity.
Follow Kellee on Twitter: @kelleent.