- The Whitman-Walker Clinic reaches out to D.C.'s positive
Last week, the Centers for Disease Control released new figures charting the spread of the HIV epidemic among gay and bisexual men of color: In cities like D.C., one in three black men who have sex with men is HIV-positive, and new infections among young black men are higher than in any other group. Justin Goforth, community health director for the Whitman-Walker Clinic, agreed to speak with me about patterns of infection among the District's black gay men—how the District can reach those at greatest risk of HIV.
For a sexual health provider like the Whitman-Walker clinic, getting HIV/AIDS prevention and treatment to black, gay men is particularly challenging. “In the black community, there has been a historic lack of access to healthcare, which leads to a lack of trust in the healthcare system," Goforth says. "Many black men who have sex with men also don't associate themselves with the gay community, because the stigma in the black community is much larger than it is in the white community.”
In order to provide care, the Whitman-Walker Clinic also must contend with the District's cycle of poverty, which manifests itself in patterns of infection. “In the black gay community, very young black men tend to have their first sexual experiences and relationships with older black MSM," Goforth says. "It’s a very resource-driven situation. For young black MSM from urban areas, their peers don’t have the resources that they need—a place to stay, food on the table, pay my cell phone bill." So when these young men come out, they risk losing the financial support of their families, and will "generally turn to older black men who have resources” for relationships, Goforth says.
And those relationships can create a power imbalance that denies these young men sexual agency. "Young, black MSM in this situation feel like they don’t have the power to say, ‘I want us to use condoms, I want to protect my body, I want to have safe sex,’” Goforth says. "It's this really bad repeating cycle of older black MSM infecting younger black men, who are then aging into the over-30 age range, and are being sought out by younger men. That scenario is very scary.”
In order to address these factors, the Whitman-Walker Clinic runs an east-of-the-river clinic that “specifically targets Ward 7 and Ward 8 for testing, counseling, and treatment." Its mobile testing unit frequents “any venues that we can get access to that specifically target MSM of color,” like Delta, Bachelor’s Mill, and Crew Club. Whitman-Walker also partners with organizations like Metro Teen AIDS, the Sexual Minority Youth Assistance League, Black Pride, and Youth Pride to reach local young men. And the clinic runs several support groups for HIV-positive black MSM, including "Healthy Relationships," a five-week working group, and "Plus One," a peer mentorship program for newly-infective positive men.
But the District population that's most at-risk for infection—young, black men who have sex with men—may be too young to even get onto WWC's radar. "So much of our successful outreach happens at clubs and bars and venues that bring the gay commnunity out," Goforth says. "But younger men are not involved in that, because they’re not old enough to get in."
According to Goforth, District schools must ramp up their sexual education efforts in order to fill the gap. “We really need to reach those kids before they’re of legal age, in high school and junior high, if not before,” Goforth says. “Who’s doing education about healthy intimate relationships and sexual health for 12-, 13-, and 14-year-olds? I doubt it’s the parents, and I doubt that our educational system is doing the appropriate education at those ages. But if we don’t do it at that age, then we have 16-, 17-, and 18-year-olds coming in testing positive. How else do you reach that person?"