Eliminating the stigmas of homosexuality in Buffalo’s black community would be the greatest step in finding a solution for the prevention of AIDS’ devastating effects among men. The greatest influence and support system among the black community is the Church. With stigma against homosexuality in the Church and the community the black men having sex with men (BMSM) find themselves living double lives engaging in heterosexual relationships. Studies have proven that discussion group interventions have made the greatest head way in behavioral treatment (1). I believe that intervention programs within the Church should be implemented to support the BMSM and provide them with counseling. The Church should make these steps forward because ignoring AIDS among BMSM will end in the deaths of many of their parishioners. In the programs there would be talk of safe sex, condom use and better community support. The group would also insure that the BMSM were well aware of the meaning of treatment because of the common misconception that it is safe to engage in sexual intercourse with one’s partners because there on HIV medication.
AIDS hits hardest in Buffalo, NY’s black communities with rates as high as 1770.89. The greatest rates are among black men, with most transmissions through 43.5% men having sex with men (MSM). Most BMSM fear being ousted from their societies and therefore take on an ultra masculine façade along with heterosexual relationships in order to appear straighter. They also do not identify themselves as gay but would prefer to be identified as bisexual. Some of the BMSM have children and consider the fact of being referred as “gay” to be very embarrassing. Other will state that the take the still have the male role in the relationship during the sexual encounters in that they do the penetrating (2).
It is important to catch the young BMSM early on because they have problems finding romantic partners because most men are hidden behind their veils of masculinity. Unfortunately these young men end up in risky situations looking for partners in sex clubs and the internet (3). In a Chicago case study which included 83% blacks, 68% percent of the young MSM went online to find relationship or sex partners, while 48% reported finding and actually having sex with someone they met on the internet. 53% of the 100% total young MSM used condoms when they had sex with partners they had met on the internet (4). The recklessness among these young MSM can be attributed to the great drug and alcohol abuse. Along with the abuse it is also important to acknowledge the lack of education due to the fact that most black males in Buffalo drop out of high school and never learn about safe sex or substance abuse.
Drug and alcohol abuse are becoming associated with the HIV status. This would probably be due tot the fact that these drugs are used during sexual encounters as aphrodisiac to heighten the sexual experience. The drugs of choice among blacks in order of most used are crack, heroine, and cocaine. There is also use of Viagra, which extends the sexual activity span and therefore increases the high risks. With half the drug users injecting the drugs, a new group of addicted MSM-IDU willing to trade sex for drugs developds (5). Drug using MSM usually find difficulties getting help with their addictions because they cannot find compatible groups. They fear homophobia in self help twelve step programs, which include Narcotic and Alcoholic anonymous, because of their spiritual connection (1). The sense of loss among the MSM-IDU in the community must be addressed in order for everyone to receive necessary aid. The substance abuse may be prompted by past sexual abuse, posttraumatic stress disorder and depression.
Recent studies haves shown sexual abuse histories (CSA) and posttraumatic stress disorder (PTSD) to prompt high risk sexual behavior. In this case study 54 % of the two hundred and ninety-eight men were African American, the ages ranged from eighteen to forty-nine. The mean number of lifetime partners was observed in order to show the highs and lows of risky sexual activities of moving from relationships to relationships. The highest mean of partner change under race was that of African Americans with 20.95. Among men that had many partners there was a presence CSA history and depression was likely present. On a perspective of education the greatest partners mean of 20.85 was found among those with less then 12th grade/ GED (6). This is frightening since it reveals that the young MSM who are predominantly black are engaging in risky behavior because they have not been well informed through proper education. The men with CSA histories that caused later PTSD, tried to imitate childhood CSA incidences. Alone the CSA and PTSD usually encompassed consecutive non personal relationships or speedy cycling of non personal relationship. The failure in the interactions is because of swift and numerous failures. Studies have observed that PTSD with depression ignited by traumatic flashbacks worsen the pattern of consecutive relationships.
The Church would be the best setting for the program because that’s where most of the black community’s trust lies. It is a support mechanism for the community with transportation, health care, shelter and food (7). Incidences as the Tuskegee Trials in which black men were infected with syphilis under false pretenses, have caused great mistrust in government health officials. These ideas are closely analyzed in The Deadly Deception, a film which chronicles the testing on black men that began in 1932 and lasted for forty years. The Tuskegee Trials have rendered BMSM from seeking help from health officials, this in effect impedes on research on the inclinations and practices of black men (3). Without trust in the health officials most of the weight in preventing the AIDS epidemic is placed in the hands of the Church. Though very influential, the black Churches in Buffalo fail to attempt to reach the HIV/AIDS in the pews because of stigma. The Churches of the black community have not accepted risk reduction efforts like condoms because they promote abstinence and chastity. They also do not support needle exchange programs that would help HIV/AIDS affected through IDUs, since they feel it would be a step that would encourage drug use. If cases of HIV/AIDS were so bad that they could not be ignored, programs would be implemented. An example of such a program in Buffalo is seen in an article, “New York: Pastor Bringing HIV Testing Into the Pews”. The story covers Rev. Darius G. Pridgen of Buffalo, who initiated an HIV/AIDS awareness program in True Bethel Baptist Church on the East Side of Buffalo. In the program the reverend told a bible story in which a character was ostracized for their illness to relate to the present day conflict. He then welcomed the congregation to get tested for HIV in the sanctuary of God (8).
Unfortunately these programs are not ubiquitous because some churches blame a lack of financial support and minister’s inexperience with presenting the subject of AIDS/HIV in the Church. The Churches acknowledged that there is a problem and give the socially desirable answers of financial issues because they did not want to acknowledge the presence of MSM and IDU in the Church (9). Buffalo black Catholics support the exclusion of condoms and needle exchange systems because they do not conform to the ideas of abstinence and chastity. In order to slow the spread of AIDS into the black community youths would be targeted to implement the Church’s ideas in various programs (10). In a survey for parishioners about the church 77.8% disagreed that the Church provided health education and prevention. 88.9% agreed that the Church did not provide HIV/ AIDS related services that 83.3% agree were needed.
Outreach attempts to change the minds of conservative clergymen have been researched by nurses in aims to initiate HIV prevention in the black community. These nurses used Pernessa Seele, a pioneer of the process of working with HIV/AIDS and the black clergy, as a reference (7). These nurses focused on education by dealing with the various terms, self esteem along mode of transmission. Not only did they educate the parishioners but also wanted to gather church leaders, head cleric and mentors in order to discuss the uncomfortable sexual connotations like anal, oral and vaginal sex that related to the various risk factors. The nurse would also set up programs in which everyone would be encouraged to engage in discussions and also given the freedom to leave if they felt uncomfortable. The groups would also be informed of the alarming AIDS statistics that often goes unmentioned.
Buffalo’s outreach program is MOCHA, which aims to educate the at risk youths whose ages range from 14 to mid twenties. The MOCHA Project is the Men of Color Health Awareness, which goes into case management along with community enlargement for men that identify themselves and MSA, gay or bi (11). The program was initiated by Gary English who felt that the issues of homophobia, sexism, racism and those regarding church and family being faced by BMSM needed to be addressed. With applications for grants of the health department he was able to fund his program, which would provide support groups, case management and direct service. MOCHA’s values are Responsibility and Respect in each other, Effective and Efficient in delivery of service, Accountability to the mission, Communication and Highest Quality . In this program that that prides itself in its confidential quick HIV Testing they provide different methods to stay HIV negative (12).
As the public official I feel that ideals and visions of MOCHA should be implemented into the Buffalo black Church’s programs. Most of the BMSM and BMSM-IDU reside in the Church squelched by the stigmas. I would make it a priority to notify the minister and make sure they are aware of HIV/AIDS devastating effect their community. For those who are truly unaware about the disease I would make sure they became well informed so they could teach the community.
I would not limit the group members to those that simple attend mass, but I would also go further to reach BMSM on the internet and Buffalo sex clubs. In my advertisement I would call those that considered themselves gay, bi sexual, MSM or even question in order to reach the broader public. Simply calling out BMSM or gay does not call attention black men who do not want to classify themselves in those groups. In advertising my program I would emphasize that it contained group discussions and not seem aggressive in intervention methods to convert these men from their alternative lifestyles.
In the programs I would offer HIV tests so to those that arrived so they would be aware of their status in complete confidentiality. It is imperative that HIV tests are taken because when most black males take the test they get the twofold diagnosis of HIV and AIDS (13).Those with negative test results would be informed on how to maintain their status. For those positive we would be informed about the treatment options. Both groups would be instructed in safe sex and the meaning of being on treatment. It is important to inform the group that being on HIV medication did not mean that the spread of HIV was minor or impossible (14). In this program I would make sure set up self help twelve step program for the BMSM-IDU to work through their addiction problems. I would implement contingency management, a behavior therapy that would use the incentives of money and food to bring people and give them a reason to return in order to keep correspondence (1). If people are content with the conditions then they would come back for a second part that consisted of counseling. In counseling we could find and try to treat those with CSA histories or PTSD.
In all AIDS is an epidemic, which is taking the lives of BMSM at a frightening rate in Buffalo, NY, but it can be prevented with steps forward to get rid of stigma and implementing education in the public. We can work as Gary English to get grants from the health department. To meet the demands I feel as though 50,000 dollars would be sufficient in insuring my program’s success. This money would be used towards advertisement, printing informative pamphlets and incentives for the contingency management. This program greatly relies on the support of the Church to bring the community together because it is truly trusted by those greatly affected by AIDS. Maybe among these gatherings maybe the BMSM could find partners at a lower risk. AIDS prevention is something we can take apart in tolerance and care for one another.