The effectiveness of US Federal HIV/AIDS policy on black men who have sex with men
By the age of 35, Black Men who have Sex with Men (MSM’s) have a one in two chance of HIV infection. Black MSM’s, which represent less than one percent of the US population, is home to nearly a quarter of existing HIV cases, AIDS deaths as well as new HIV diagnosis. As early as 1987 studies were published revealing a paradoxical reality, that although Black MSM’s had no significant difference in risk behavior, there is a much larger HIV Prevalence among this group as nearly one in three Black MSM’s are HIV positive. Consistently and repeatedly, studies have shown Black MSM’s have fewer sexual partners than their White counterparts, and fewer occurrences of unprotected anal intercourse, yet significantly higher rates of HIV Incidence. The theoretical basis for this analysis is the concept Intersectionality, originated by Kimberlé Crenshaw, which states that cohorts comprised of multiple statuses of historic discrimination are qualitatively different from individual cohorts of component status. This qualitative difference requires the analysis of the composite cohort as an independent and unique entity as opposed to only looking at the components that it is made of. Therefore, Black MSM’s are a unique group and cannot be fully understood by looking at Black Men or MSM separately. This is particularly applicable for Black MSM’s because of the: history of oppression as Black Men, history of marginalization as MSM, isolation of Blacks within MSM community, isolation of MSM within the Black community and the history of HIV among Black MSM’s which dates back at least to 1969 (predating the publicly acknowledged epidemic in the White MSM community by 12 years). This traditional policy analysis evaluated the 2010 National HIV/AIDS Strategy for its effectiveness in addressing HIV/AIDS among Black MSM’s. To accomplish this, a convergence of evidence approach was implemented, utilizing a key document review, qualitative interviews with key stakeholders, as well as quantitative surveys of 300 Black MSM’s. These methods were then applied to each of the four stages of Policy Analysis: agenda setting, formulation, implementation and evaluation. This analysis revealed a landmark policy that has comprehensively improved the Federal response to HIV in the US. Innovations developed and instituted because of this policy included the Community Listening Sessions of the formulation stage, and even more importantly the new metrics that better equip agencies to understand the nature of the epidemic. Further, the results of this study were compared with the August 2014 Kaiser Family Foundation study, which produced a nationally representative survey of Gay and Bisexual men (sampling error ±7%). The findings of this study paralleled and/or magnified those of Kaiser in several key areas. Kaiser found that Men of Color were more likely to know someone with HIV/AIDS and those that do are more likely to say it is a significant personal issue. The results of this study of Black MSM’s expose a sample where 97% knew someone who has/had HIV/AIDS and almost all considered this to be a significant personal issue. Both studies also confirmed the continuing presence of stigma and perceived discrimination by the general public. In both studies, evidence also indicates the opportunity for increasing frequency of HIV testing and the widespread lack of knowledge of PrEP (Pre-Exposure Prophylaxis). Several key recommendations should also be taken from this analysis to improve the policy moving forward. The first is that Black MSM’s should be an independent category for policy targeting. The next is that as Black MSM’s are the only group that is at high risk of infection and also makes up a large portion of the disease, Black MSM’s are a significant hotspot that should be a primary focus of the intervention. Finally, the greatest advances in fighting HIV have come through biomedical progress. Therefore, educating and implementing biomedical innovations such as PrEP should compliment behavioral change as intervention objectives.