Last week, City Council held hearings to discuss the ongoing, if little talked about, AIDS crises in Philadelphia, especially within black communities. The key statistics, from the Department of Public Health: 19,237 people in Philadelphia are living with HIV/AIDS, or 1.3 percent of the total population; 12,741 are black, of which 8,416 are men; the largest risk factor among blacks is heterosexual transmission, which accounts for about 40 percent of infections.
Speaking at the hearing was Dr. Lisa Bowleg, an associate professor in the Department of Community Health and Prevention at Drexel. She is completing a three-year study on HIV/AIDS risk factors among black heterosexual men in Philadelphia, which she presented at the 2010 International AIDS Conference in Vienna, Austria. PW caught up with Bowleg to discuss her findings.
What was your study about? Give us the abstract.
The goal of the study was to understand how structural factors such as unemployment, incarceration, poverty and factors such as masculine ideologies and black men’s ideas about what it means to be a black man are associated with sexual risk. All of this is informed by theoretical work and empirical work on men and HIV.
What was your methodology?
For the first phase of research we did interviews and focus groups. We really wanted to make sure we were getting culturally grounded understanding of men’s lives here in Philadelphia. Second phase we designed a computer survey and had teams of recorders go out into census blocks we randomly selected with 50 percent or more black people. We recruited men between ages of 18 and 44 who reported having sex with a woman in the last 6 months, and identify as heterosexual and live in Philadelphia. We collected data from 581 of them.
Did you test the men for HIV?
No, but we did ask if they’ve been tested. Many reported they had been, probably because they got tested in jail. Most of them said they didn’t know their status. Either they didn’t want to disclose it, or also a lot of people don’t return for the results of the test.
Why heterosexual black males?
The rate on HIV in black communities continues to be staggeringly high, especially as we get ready to enter three decades of this epidemic. There are so few studies of theory on interventions focused on heterosexual black men. Most of it focused on black men who have sex with men or [who are] IV drug users. I feel strongly that black heterosexual men are the missing link and forgotten group.
What did you learn?
The most important thing we’ve learned is how much stress these men are under. Most of them are unemployed. Most of them have histories of incarceration. Most are unstably housed. Most report incomes less than $5,000 a year. Most of them report having unprotected sex with multiple women. The other take-home message is the need for structurally based interventions. We can’t just throw condoms at them; we need to really take innovative goal steps in terms of employment for black men, address macro-level forces like poverty. Which is daunting. Even when I say it, part of me as a researcher says how the hell do we do that?
You spoke about how expectations of black men can lead to risky behavior.
That’s one of the things we asked men about. What are these expectations for black men? Many said that you’re supposed to have lots of sex partners. Not all the men endorsed this. But when you can’t get financial success and are unemployed, it’s pretty rough, and one of the ways to be respected in black communities is to have sex with many women. We have narratives where men are telling us that. And they say it’s just natural; that’s how it’s always been.
Have you received any backlash from people saying that you are perpetuating stereotypes?
Not yet, but it’s something that concerns me. It’s something I worry about because that’s the last thing I want to do. One of the things I do in research is really try to talk about the context of black men’s lives. It’s not about me pointing the finger at black men; there are some factors beyond the level of the individual that might shape this. Also, black men are not the only men with multiple partners. What makes it so dire is how concentrated HIV is in sexual networks.
[HIV/AIDS researcher] Dr. Amy Nunn mentioned a study that found number of partners, condom use and drug use rates to be similar among blacks and other races.
That’s exactly right. There’s an amazing study where they look across the races, and there were no major differences in condom use, or drug use, or number of sex partners. But for black folks, because HIV is so densely concentrated in the networks, it meant that a person having unprotected sex with one partner could get infected. Whereas people in white communities it won’t happen because HIV isn’t that concentrated in the network. That’s the take-home point. Chances are you’re having sex within your race and community, and prevalence is higher and so is the risk of infection.
At the hearing, Councilman Wilson Goode asked if the HIV rates had more to do with race, or poverty.