Re-imagining HIV prevention with young adult Black same-gender-loving men

Current HIV prevention efforts have and continue to fail Black same-gender-loving (SGL)[1] men. But with meaningful reflection and changes to service delivery, this can change.

Whether it be from personal experiences, accounts from those close to you, or existing literature, we know the ways in which anti-Black racism – linked with homophobia and heterosexism – limits Black SGL men’s access to the tools and resources that promote and sustain our optimal sexual health. The available Canadian surveillance data also reflects this, as Black SGL men are disproportionately represented among new HIV diagnoses.

Despite this knowledge, major players within Ontario’s HIV sector have taken up the narrative of potentially reaching an “endgame” in our efforts to eliminate HIV. We’ve also seen public health researchers and HIV advocates set the ambitious target of ending the HIV epidemic in Canada by 2025 in a piece published by the Canadian Foundation for AIDS Research (CANFAR).

If we know HIV still disproportionately impacts Black SGL men (along with other Black and Indigenous communities), it begs the question: for whom are we reaching an HIV endgame or ending the epidemic?

Before we can even begin to start making such claims or embark on completing these ambitious goals, we must first start to better understand and respond to the HIV prevention needs of Black SGL men.

As a young Black SGL man looking to rectify the current state of HIV prevention work within Black SGL communities, I worked with members of our community to consult, amplify voices and highlight the necessary changes needed to ensure HIV prevention efforts are relevant and useful to young Black SGL men.

Through our focus groups with young Black SGL men in Toronto and Ottawa, this community-driven initiative outlined the following recommendations for service providers and organizations on how to develop and improve HIV prevention strategies and programming in a way that honours the fullness of our true selves.

1. Address institutional racism and its role in service delivery

AIDS service organizations (ASOs) and others working with young Black SGL men must intentionally address the systemic racism and structural forces embedded within their organizations. Left untouched, these forces undermine our well-being, thus increasing HIV vulnerability among young Black SGL men.

While many organizations and service providers have the language to speak to anti-Black racism and the importance of equity and inclusion, many do not truly integrate these concepts into their work and/or how they operate. Often we see this language co-opted, while whiteness continues to be constructed and embedded as the dominant organization culture and norm. Such environments are hostile, intimidating or offensive to young Black SGL men and those who can’t perform whiteness. Organizational change is needed at all levels to identify and remove these barriers embedded within the culture of so many organizations meant to provide services to us.

Simply listing anti-racism as part of organizational culture or values, without truly integrating these concepts into practice, is not enough. Organizational change is long term, constant and ongoing. As such, it is important to consider the following when engaging in this work:

• How are we engaging, recruiting and working with diverse groups of young black SGL men?
• How are we amplifying Black SGL voices and leveraging cultural knowledge in our work?
• How are we confirming our work is culturally relevant and appropriate to Black SGL men?
• How are we ensuring Black SGL clients and employees are feeling safe within our organization?
• How are we guaranteeing non-Black staff are not displacing lateral violence towards Black staff?
• What supports and learning opportunities are in place to stimulate anti-racist and anti-oppression learning, discussion, and reflection that can be shared with coworkers?
• What accountability practices are in place to ensure staff and the organization are committed to anti-racist and anti-oppression learnings?
• What sustainability measures are in place to ensure and support long-term changes in the organizational identity culture and values?
• How are we engaging, recruiting and working with diverse groups of young black SGL men?

2. Improve the accessibility of programming for young Black SGL men

For HIV prevention efforts to be more relevant and accessible to young Black SGL men, ASOs and service providers must develop relationships and collaborate with other community-based organizations that address issues related to us. Recognizing the diversity within our communities, collaborations of this nature offer a more effective context for HIV prevention efforts to a wider range of folks. Additionally, we need to bring HIV programming and prevention efforts into pre-established community programming and venues that young Black SGL men attend. Linking these approaches to pre-established community programming in an effort to meet folks where they are, where their Blackness and queerness are affirmed, will be a more effective context for the delivery of HIV prevention efforts.

3. Leverage social media and online platforms to create safe spaces for young Black SGL men.

The novel coronavirus disease (COVID-19) has disrupted and shifted the vast majority of our work into the digital realm. As we’re forced to re-shape our work for the current environment, we must keep the same energy and begin to re-imagine how we can leverage this digital transformation in our HIV prevention efforts. Now is the time to reconsider how to best utilize online spaces for resource sharing, community building and programming more broadly. As mentioned previously, meeting young Black SGL men where we are, even digitally, allows for greater reach to disseminate information and programming to our social networks.

Admittedly, there is no one-size-fits-all approach to working with young Black SGL men. However, if we truly wish to reach this HIV endgame or goal of ending the epidemic many speak of, the recommendations above are a good starting point.

David Absalom, MPH, is a Black SGL man invested in improving and sustaining the health and well-being of Black SGL men. He’s worked across the health system in AIDS service organizations, research institutions and municipal government.

[1] The term “same-gender-loving (SGL)” was coined by Dr. Cleo Manago to describe Black men with same-gender attractions and sexual behaviors.