Journalist Linda Villarosa’s sobering and comprehensive New York Times profile on “America’s hidden HIV epidemic” among gay and bisexual black men, particularly those living in Southern states, is one of the most important pieces you will read this year. Although life-saving medications and services have pulled gay and bi men in major cities like San Francisco and New York back from the brink of death, for gay and bi black men “the idea that an AIDS-free generation could be within reach” can feel like a largely white one:
Last year, the Centers for Disease Control and Prevention, using the first comprehensive national estimates of lifetime risk of H.I.V. for several key populations, predicted that if current rates continue, one in two African-American gay and bisexual men will be infected with the virus. That compares with a lifetime risk of one in 99 for all Americans and one in 11 for white gay and bisexual men. To offer more perspective: Swaziland, a tiny African nation, has the world’s highest rate of H.I.V., at 28.8 percent of the population. If gay and bisexual African-American men made up a country, its rate would surpass that of this impoverished African nation — and all other nations.
Southern states are home to 37 percent of the population but account for more than one-half of all new HIV diagnoses, writes Villarosa, with Mississippi having the highest percentage of gay and bi men living with the virus, at 40 percent. In Jackson, population 170,000, six black gay or bi men find out they are HIV positive every month. “An unconscionable number of them are dying,” writes Villarosa. “Among black men in this region, the H.I.V.-related death rate was seven times as high as that of the United States population at large.”
While the George W. Bush-era federal government launched groundbreaking and lifesaving programs like Pepfar to expand HIV prevention, treatment, and care overseas, black America “never got a Pepfar.” Indeed, “while buckets of money went overseas, domestic funding for H.I.V./AIDS remained flat, and efforts to fight the disease here were reduced to a poorly coordinated patchwork affair.”
Villarosa followed the footsteps of Cedric Sturdevant, a Mississippian who has stepped in where the federal government hasn’t and fought in the trenches to save the lives of young black men and trans women in his community. Sturdevant, who has racked up 300,000 miles “in his improvised role of visiting nurse, motivational coach and father figure,” is a project coordinator for a local non-profit and helps his clients “get to the doctor’s appointments, pharmacies, food banks and counseling sessions that can make the difference between life and death”:
Negotiating a maze of unpaved roads in Jackson in the company car, a 13-year-old Ford Expedition with cracked seats and chipped paint, he stopped to drop off H.I.V. medication at a couple’s home. One of the men was H.I.V.-positive, the other negative; they lived in the neighborhood locals call the Bottom, where every fifth or sixth home is abandoned, with broken windows, doors hanging off hinges, downed limbs and dry leaves blanketing front yards. Sturdevant banged on the door of a small house, its yard overgrown with weeds; he knew not to leave the package on the doorstep, where it could be stolen. After a while a young man emerged, shirtless, shrugging off sleep. He had just gotten out of jail. Sturdevant handed him the package, shook his hand and told him to “stay out of trouble.”
Sturdevant drove on another 15 minutes to pick up Marq (a shortened version of his name to protect his privacy), a teenager who was still reeling from the H.I.V. diagnosis he received the previous spring. As they headed to and from a doctor’s appointment and a meeting with a counselor, Sturdevant, slow-talking and patient, with eyes that disappear into his cheekbones when he smiles and a snowy beard, gently grilled him, reminding him to stay on his meds. The teenager slumped in the back seat, half listening, half checking his texts. He looked up briefly when Sturdevant told him, “You’ve come a long way. I’m proud of you.” But Marq barely said goodbye as he jumped out of the car in front of a convenience store on an avenue scattered with a pawnshop, a liquor store and several Baptist churches, and he all but admitted he was planning to spend the afternoon smoking weed and looking at Instagram. “Knucklehead,” Sturdevant whispered, as the teenager slammed the door. Pulling off his favorite Dallas Cowboys baseball cap and running a hand over his bald head, Sturdevant added softly, “Breaks my heart.”
“Black gay and bisexual men and the organizations and activists that support them have come to the painful realization that the nation and society have failed them and that they must take care of themselves and one another,” writes Villarosa in the must-read profile. While it’s so important to remember that advances by President Barack Obama helped expand HIV/AIDS care for gay and bi communities, the new administration’s proposed cuts to Pepfar, cuts to Medicaid, and repeated attempts to repeal Obamacare and pass Trumpcare stand to devastate this already vulnerable population. It’s dangerous new reality for a community when much too much has been lost already.