One of CBAM’s areas of focus is HIV prevention, especially in the context of addiction and communities with health disparities. We sat down with CBAM staff member Chris Blades to get an in-depth perspective on our prevention work with MSM (men who have sex with men) of color. In this 3 part series, we’ll delve into the challenges and experiences of working with the LA community to prevent the spread of HIV.
Part 2: “I think it’s just about meeting them where they are.”
Why is HIV such a common problem among minority MSM in particular?
I just think that the sexual pool is smaller. I think that’s one of the main factors why African American young men in particular have the highest new transmission rates. I think it’s because their sexual networks and the guys they are having sex with are the same guys. For example, I’ve been doing a lot of work with the Gay and Lesbian Center (the Highland Center, specifically) and one of the case managers there says it’s the same story. Every cycle they see young guys come in, and 9 times out of 10 they are getting infected by the same guys that were diagnosed at their center.
So when you come into contact with people who don’t think that HIV is a big deal or a priority, how do you counsel them to think about it differently?
I think it’s just about meeting them where they are. A lot of the guys, especially the young guys, go to different agencies where they’re constantly being given info on HIV transmission and prevention. I think the focus should be on new approaches. If they have any concerns/questions, then we try to give them the proper guidance. If guys are more resistant and feel like, “I’m a top…I don’t use protection, but I’m never going to get HIV,” we say, “It’s fine that you feel that way, however these are the facts. We know that if you have unprotected sex you will always be at risk, not just for HIV but for other STIs as well.” And then we ask them, “How would you feel if you were HIV positive? What would your life look like then? How would you handle that situation?” So we’re not really trying to change their thinking, but rather encouraging them to be more open to receiving information.
Recently we saw a young guy who had a long history of high sexual risk (having unprotected sex with men that are positive, injecting drugs, sharing needles with men who are positive for 3 or 4 years) but who has never tested positive. You would think that based on this information alone that he would have tested positive by now. But in his mind, he felt he was immune to it. He thought that he had been exposed so often that his body had developed immunity to it. Having a conversation about HIV prevention with someone who feels like they are never going to become infected with HIV is difficult. He was given a preliminary positive result at his screening visit. Once his results were released to him his response was, “Oh wow, so I can get it.”
How do people generally react to a diagnosis of HIV?
Sometimes we have guys who have put off testing for so long because they felt like they were either already HIV positive, or knew they were doing things that exposed them to HIV, so when we tell them their results are preliminary positive, sometimes guys are shocked and sometimes guys say, “Well, I had a feeling.” But it varies on the individual. For me, when I’m doing my counseling session, I try to paint a picture for them, not to scare them about being infected with HIV, but letting them know that in the case that they do get infected with HIV that there are many options for them. We let them know that HIV is not a death sentence and we try to provide education on what HIV means and what it looks like.
In some cases, I think getting that kind of diagnosis might be correlated with some more risky behavior as a response—like, ok, I already have it, so now I can do whatever I want.
We’ve seen that too. We’ve seen guys who were given the HIV diagnosis and who say, “Well someone gave me this unknowingly and now I need to go do the same.” That’s a hard thing to hear and see. But then again, it’s out of our hands at that point. So they really need to take care of themselves.
Stay tuned for part 3 of this discussion, and make sure to visit cbam.ucla.edu for more information on our HIV prevention efforts.