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According to the latest report on the health of gay men in Chicago, 35 percent of gay black men have HIV. This is followed by 16.8 percent of gay white men, and 12.5 percent for gay Hispanic men.
Advocates battle surging HIV rates in Chicago
by Mattie Quinn
Mar 7, 2013
Jim Pickett, who has been HIV-positive since '95, is the director of advocacy at the AIDS Foundation of Chicago. He discusses some of the challenges advocates face today, and why it's important to stay positive.
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HIV Risk and Prevention Behaviors Among Men Who Have Sex with Men, Chicago, 2008 and 2011HIV in the United States: The Stages of CareLGBT health centers offer comfort
When the AIDS epidemic hit the United States in the 1980s, there were many unanswered questions about both the disease and the culture of being homosexual.
As a result, LGBT health clinics starting cropping up in big cities across the nation to aid those affected by both the disease and the stigma of being homosexual.
“LGBT specific health clinics historically did get their start because of the AIDS epidemic. That was a time of very little knowledge of the health issue and very little acceptance of homosexuals,” said Hector Vargas, executive director of the Gay and Lesbian Medical Association.
In Chicago there are several, including Howard Brown that opened before the AIDS epidemic started, and Center on Halsted, which opened in 2007.
Throughout the past couple of decades, these clinics have remained a comfort to the LGBT population even as more knowledge became available to the general public.
“The two things that many LGBTs seeking health care look for are a welcoming environment and a competent staff for their specific needs,” Vargas said. “An LGBT health clinic is just going to guarantee those two things will be addressed for them.”
Although LGBT culture has started to enter mainstream culture, with nine states legalizing gay marriage and Illinois trying to become the 10th, Vargas does not see the need for LGBT health clinics to go away any time in the near future.
“Nowadays, we need to make sure that all health providers have the training that is necessary to address LGBT health needs,” Vargas said.
“This doesn’t always happen, so for the foreseeable future I think the need for these specific health clinics will be there.”
But that’s the infection rate among gay black men in Chicago.
A report released in December 2012 by the Chicago Department of Public Health, paints a grim picture. The prevalence of HIV among gay men in Chicago is up 20 percent from 2008 to 2011.
“Black gay men continue to be our priority population. There is a real need to intervene, to champion policies that will reduce stigmas,” said Johnathon Briggs, chief officer of external relations for the AIDS Foundation of Chicago.
Break Down
The Chicago Department of Public Health report breaks down HIV rates among white, black and Hispanic men who have sex with men.
For gay white men, the rate of HIV infection is 16.8 percent. Among gay Hispanic men the rate is 12.5 percent. The rates among whites and blacks has risen since 2008, but it has held steady among Hispanics.
Poverty, incarceration, unemployment and severe social stigma all contribute to the high percentage of gay black men infected with HIV. Although nationwide, gay black men typically tend to have fewer partners than their white counterparts, according to a study released Wednesday by the Centers for Disease Control and Prevention.
“If you think of HIV as a pool on the South Side of Chicago, or any other urban area, and you’re a young black gay male just dipping your toe into that pool, you’re more likely to contract it because the risk factor is so high,” said Jim Pickett, director of advocacy for the AIDS Foundation.
For white homosexual men, the rise in HIV infection can be attributed to a younger generation that is more open and experimental, and as a result, this can mean more likely to engage in riskier behaviors, said Cynthia Tucker, director of prevention for the AIDS Foundation.
While the numbers for the Hispanic population stayed steady, this isn’t necessarily seen as good news for Hispanic community leaders.
“While the numbers are technically smaller, proportionally, we are second to blacks,” said Patricia Canessa, executive director of the Chicago Hispanic Health Coalition. “We have, historically, seen many of the same barriers they do in prevention and health care.”
One common theme among all races is the difficulty of getting HIV-positive men retained in care and prescribed “viral suppression” medicines.
Of all Americans living with HIV, only 20-30 percent are “virally suppressed,” which means receiving regular health care and taking medicines that drastically reduce the risk of passing of the virus.
“The public health points of intervention -- which are getting tested, getting diagnosed, getting into care, staying in care -- we see that people are really falling off along the way. It’s called the ‘cascade effect.’ As a whole in the country, we’re not doing a good job,” said Pickett.
“It’s obscene that only about 20 percent of people living with HIV have undetectable viral loads,” Pickett said, meaning they are actively taking HIV medicines and have a low risk of passing on the virus.
Education
For those whose everyday work is in HIV/AIDS, making sure people across the spectrum are receiving comprehensive care is the most important battle.
“There is awareness and then there is education. The issue was never really awareness. Gay men were always getting tested, but it was the frequency of testing that needed to be changed,” Briggs said.
Throughout Chicago, there have been more testing efforts at social venues, as well as “need to know” HIV campaigns.
“The recommendation is to get tested every six months, but now we are telling people with high-risk factors or multiple partners that it should probably be every three months,” Briggs said.
Compared with the rest of the country, Chicago has more prevention and education programs than most. Unfortunately, as times and treatment techniques change, the programs don’t always adapt.
“Research has found that testing has to be coupled with education, but there is a real lack of resources and much of our spending is getting cut,” Tucker said.
There has been some good news, though. The Bridge Project, which started in early 2011 as a collaborative effort among the AIDS Foundation, Chicago Department of Human Services and biopharmaceutical company Gilead Sciences, Inc., goes into high impact areas of the city and conducts free testing at various Department of Human Services offices in the city.
“We’ve tested a little over 7,000 people, and linked 70 percent of those people to care. We created the idea that it is the ‘red carpet to health services.’ You come in on Tuesday to get tested, and on Wednesday you are linked to a health care provider,” said Tucker.
Because federal money for free health services is being cut, advocates in Chicago often see people traveling from across the state traveling to get help, Tucker said.
“We are blessed in Chicago to have the resources that we have, but it’s just not enough,” said Tucker.
For such a complex disease that is still riddled with stigma, making sure people are looked at beyond just “the navel to the knee” is important to Pickett, who is HIV-positive.
“We have to address people’s lives as a whole. We have to look at their environment in which they live in, and the structural barriers that they live with. Prevention means you have to look at ‘bad’ people that sometimes have ‘bad’ behaviors,” Pickett said.
“Human beings are messy and complicated, after all.”
To have proper prevention, Briggs and Pickett urge “a buffet of options” that move beyond just handing out condoms.
“In the hardest hit areas of this city, we have to consider new technologies and deploy them. Human beings don’t tend to deal well with condoms, they don’t tend to use them regularly. Condoms are a tool, but we’ve deferred to them too often,” Pickett said.
“We’ve banged the propaganda drum on condoms exclusively for 30 years and made that the only way that safe sex is understandable, and that just isn’t so.”
In July of 2012, a new oral HIV drug, Truvada, was approved by the FDA. Originally prescribed to treat the virus, it has now been given the green light to be used as prevention. If taken every day, it has been proven in studies to reduce the risk of contracting HIV by 90 percent.
“It’s a brave new world out there. There is still controversy and unanswered questions regarding this new drug, but these prevention techniques are no longer science fiction. And we need to reach these hard hit areas,” Pickett said.
Cost remains an obstacle. Many drugs are expensive, and new ones tend to be among the most expensive. Complicating the cost issue, federal budget cuts under sequestration will push more than 7,000 people off the federal AIDS drug assistance program, Picket said.
Silver Linings
With increased acceptance of LGBT culture, including the hit TV show “The New Normal” about a homosexual male couple, things aren’t all doom and gloom for HIV stigma and advocacy.
Only 22 percent of homosexual men were unaware of their HIV infection, according to the Chicago public health report. This is a sharp decline from the 52 percent who were unaware in 2008.
The increase of awareness can be attributed to the increased testing opportunities, and HIV advocates throughout the city actively seeking out high-risk areas for treatment and education, according to both Briggs and Pickett.
“I’m confident and very glass-half-full about the progress being made. But we can’t get confident, we can’t get complacent, we can’t get cocky,” Pickett said.
While the roadblocks can be frustrating, Pickett calls HIV advocacy and prevention his life’s work.
“I was working as an editor for a LGBT zine back in the early ’90s before I tested positive in ’95. Then I felt that if I was going to be a real writer, I needed to move beyond interviewing B-list celebrities and writing satire,” Pickett said. “So that’s when I decided to face the scariest, most challenging, the realist thing in my life.”
“We must always acknowledge that there is work to be done. There are still mountains that need to be moved.”
