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How HIV prevention is failing queer black British men

Black men who have sex with men contract the virus at 15x the rate of their white peers. It's time they received the information and support they need.

Discussion of the intersection of race and sexuality for queer British black men is woefully lacking. Where there’s been opportunity to discuss our sexual and political experience, the conversation has been dominantly focused on either representation (see hashtags like #gaymediasowhite), or whether or not it’s racist if white men don’t want to fuck us. In fact, the single episode to focus on race in BBC Three’s Queer Britain series, which aired earlier this year, was dominated by boring, reductive and humiliating conversations on Grindr racism. It’s not that these issues don’t matter – I’m a fierce advocate for diversifying LGBTQ media, but discussion around the specific concerns of black British MSM (men who have sex with men) must begin to address the arena of public health and more complicated, structural inequalities.

Public health and HIV prevention arenas consistently fail to address the specific needs of black MSM. Higher HIV prevalence amongst black gay, bisexual and other MSM is a global issue in the African diaspora. Recent survey evidence from academic research published found that “among GBM in England, HIV prevalence continues to be higher among black men” as compared to white British men. In 2014, Public Health England reported that black British MSM are 15x more likely to be HIV positive than the general population. The most basic analysis suggests it’s the same old factors – structural racism, poverty, homophobia – that contribute to this. It’s a pattern for black MSM that is mirrored in the U.S. and around the world.

But specific awareness and discussion of black British MSM issues is lacking. This is because research, documentation and archiving of black British LGBTQ people in general is underdeveloped. Either that, or existing research flattens black LGBTQ people into ‘black’ or ‘LGBTQ’ categories, not taking us at our intersection as a unique group with specific concerns and interests.

“Black British MSM are 15x more likely to be HIV positive than the general population. And on the most basic analysis it’s the same old factors – structural racism, poverty, homophobia – which contribute to this”

What’s worrying to me is that the PrEP Impact trial began recruiting in October 2017, and yet I’m not hearing much about it from mainstream gay media. PrEP, Pre-Exposure Prophylaxis, a HIV-prevention medical technology, is being rolled out to 10,000 people. The height of the PrEP discussion in public consciousness was before the trial started, when the right-wing press sensationalised the proposed institutionalisation of PrEP, with outlandish claims that money for cataract surgery was being cut to fund a wonder drug allowing gay men to bareback all the way to oblivion. “What a skewed sense of values,” wrote the Daily Mail. But since this, even though the trial has the potential to revolutionise sexual health for gay men living in the shadow of the Aids crisis, publicity has been seriously lacking. Most of my friends, particularly my black gay friends, still don’t know a thing about PrEP or the impact trial, and don’t know where to get information on it either.

To complicate this, whilst sexual health information may be delivered in mainstream LGBTQ scenes and publications, the routine exclusion of black LGBTQ people from these spaces means we’re less likely to access this information. PrEP advertisements also dominantly feature stock images of white gay couples or interracial couples, where the black male partner is typically lighter skinned. A 2010 study found that black men have sex with black men and more frequently contract HIV from other black men. So if HIV for black British MSM is dominantly transmitted through black sexual networks, why do a lot of PrEP advertisements fail to show same-race coupling? Are PrEP advertisements simply ‘colour blind’ and dodging this matter? This is clearly another area where the inclusion and input of black LGBTQ people in LGBTQ and other health organisations is crucial.

“Black people are generally often blamed for our own inequalities in sexual health through a long history of stereotyping us as hypersexual”

Risk-taking behaviour doesn’t explain the higher rate of HIV amongst black MSM, as reported levels of ‘bareback’ anal sex are equal across racial groups. Yet black people are generally often blamed for our own inequalities in sexual health through a long history of stereotyping us as hypersexual. This was an assumption that contributed to a lack of support and access to medical help for black MSM at the height of the Aids crisis. It is striking how much the present situation for our community is connected to a long history of sexual stigma around black queer men – often better documented in the U.S. For example, the concerns voiced by the poet Essex Hemphill in Marlon Riggs’s landmark film Tongues Untied, released almost 30 years ago in 1989, seem as urgent as ever. Hemphill’s work powerfully documents how a racist and homophobic society constructed perceptions of black MSM as oversexed, risk-taking agents of our own destruction. This kind of dehumanisation persists, and it functions as yet another social and institutional barrier to the appropriate conversations and medical treatment around sexual health.

These experiences have also impacted black men I know who’ve sought sexual health treatment under the NHS. PEP, Post-Exposure Prophylaxis, a course of anti-HIV medication taken after potential exposure to HIV, is available under the NHS. Jamie Barton, a black gay man living in Lewisham, spoke to me about the reception and his peers got when trying to access PEP and HIV diagnosis: “We were largely seen as promiscuous and engaging in activities like chemsex when this was far from the case,” he says. Sure, not everyone is experiencing dehumanisation which is this explicit, but this experience is still important – how can we inspire positive conversations around sexual health for black MSM if we are still experiencing racism and homophobia from medical institutions?

The problem is even deeper. Jamie describes attempting to access PEP from Lewisham Hospital following an assault:

“I found myself being strongly advised to take PEP, with only the wisdom that this was a ‘very powerful’ 28 day course of drugs that needed to be taken consistently in order to be effective. All else was a mystery, to the point where follow-up appointments with GPs would break from their medical gaze and ask me information on PEP. This fundamental lack of knowledge about PEP became intertwined with the shock and confusion I was experiencing from the assault. Each time I swallowed the drugs, each time I thought, ‘why do I have to take these?’, I was haunted by the memory of the assault.”

What does it say for the future of PrEP if there’s still a culture of ignorance around medical technologies that have already been institutionalised? Jamie’s experience points to the need for sensitivity and cultural understanding when administering HIV prevention technologies to men of colour. It’s not enough to just roll out prevention technologies – these have to be accompanied by specific intervention programmes and strategies. It should be recognised that the daily ritual of taking PrEP or PEP might be more of a psychological stress, than something bringing peace of mind. Victims of sexual trauma may have more trouble taking such medication. Shame is important too. Shame around homosexual activity, particularly “down low” activity, is rife within black communities, and racism intensifies the ‘truvada whore’ labelling that MSM who take PrEP are subjected to.

There are already organisations committing to tackling sexual health inequalities. The Naz Project specialises in advocating for positive sexual health engagement within BME communities, and provides the vital mental health and community support needed alongside such projects. Marc Thompson is one activist leading the conversation on HIV prevention for black British MSM. Through blackOut UK and PrEPster, he educates young black British MSM on HIV prevention. Marc believes that HIV rates are higher amongst black British MSM because of “cultural factors”, we are “less likely to discuss our sex lives”. Marc also speaks of how we have “lower education regarding PrEP” and that black communities are far less willing to engage with the impact trial because the language of ‘trial’ is complicated and off-putting: “black communities have a mistrust of ‘trials’, and don’t understand that a ‘trial’ doesn’t mean they’re testing whether or not PrEP works, but whether or not people will actually use it.” But why would black British MSM use PrEP if not properly informed? Why would we be willing to lend our bodies to medicine, or trust medical innovations, considering histories of scientific racism? But it’s on the healthcare system to win us over, as Marc is adamant that if the trial doesn’t engage enough black MSM, then it will have failed.

We’ve come far in HIV prevention. Recent reports from Public Health England celebrate a 21 per cent decline in new cases of HIV between 2015 and 2016, for the first time since the epidemic was detected in the early 1980s. But if we’re looking to a future where PrEP is institutionalised under the NHS, then the healthcare system must answer to black British MSM and the sexual health inequalities we experience. The gap between Black British communities and our medical systems must be bridged. Black MSM, if and when they begin accessing PrEP, need to know that they are not being erased from British medicine, but being supported properly along the way.