How Power and Privilege Impact MSM Communities

How Power and Privilege Impacts Gay Men/Men who have Sex with Men (MSM)

The social and sexual lives of many gay men and other MSM have been impacted by at least three social oppressive forces—poverty, racism and homophobia—that together tend to produce heightened risk for HIV infection by increasing social isolation, alienation, and personal shame.1 Many men have responded to social oppression with resourcefulness, creativity, and personal agency. Others have been deeply troubled by financial hardship, family rejection, discriminatory practices, and stigma that create barriers to health promoting behaviors and prevent their fair and full participation in community life. As a whole, the dominant American culture gives preference to heterosexuals, manifested most outwardly through marriage rights and the ability publicly acknowledge one’s partner. Because of this overarching heterosexual privilege, everything that is not heterosexual receives less value and is often considered deviant. Furthermore, for young people, school-based HIV prevention curricula that address sexuality often reinforce heterosexual preference and privilege.Many widely used abstinence-only curricula address same-sex behavior within the context of promiscuity and disease. Not only do these models present incorrect information, but they also create a hostile learning environment for gay youth that negatively contribute to low self-esteem and enhance vulnerability to risky behaviors.

There are also reverberations of power and privilege within gay communities that crystallize as internalized homophobia. To effectively combat the impact of power and privilege, gay communities must also look inwardly and address the fact that ‘masculine’ gay men are often granted power and privilege over ‘effeminate’ gay men. When gay men support an already pervasive societal norm, internal homophobia in the gay community serves to further marginalize gay men. Internalized homophobia is associated with increased risk behavior among gay men. Additionally, the various intersections of sexual orientation, gender, class, race, and immigration status often do not operate as distinct realities and often serve to amplify the impact of power and privilege on risks for gay men, particularly gay men of color. For instance, many Latino gay men feel the impact of power and privilege through overlapping experiences of homophobia, poverty, and racism. As a result, they are often isolated from the communities that would normally provide them support and safety. Many Latino gay men often have to deal with rejection from family, exclusion from places of worship, discrimination at work, and sexual objectification in the gay community. In some ways, this can be viewed as double or triply stigmatizing. Adding HIV/AIDS stigma to this may serve to “feed upon, strengthen, and reproduce existing inequalities of class, race, gender, and sexuality.”2

In attempting to address some of these issues, local and state health departments have prioritized HIV prevention strategies targeting gay men. Health departments across the country are now specifically considering the contexts and situations within which individual risk behaviors take place. Prevention programs funded by health departments are seeking to address situational and structural factors that make safer sex difficult, including mental health, immigration status, substance use, and other lived experiences. The following story profiles Florida’s efforts to specifically address situational and structural factors impacting HIV risk among gay men.

As an extension of the Florida Department of Health, the Office of HIV/AIDS of the Miami-Dade County Health Department (MDCHD) has served as a leader in the county, state, and nation in its work to address the multi-layered impacts of power and privilege on gay men of color. With the implementation of a Statewide Minority AIDS Initiative that includes a Statewide Latino HIV/AIDS Coordinator, Statewide Black MSM Coordinator and nine Regional Minority AIDS Coordinators, MDCHD has been able to develop initiatives that address racial and ethnic health disparities among communities of color, particularly gay men of color.

MDCHD recently developed a participatory social marketing and community mobilization effort targeted at gay men (both HIV positive and negative) aimed at instigating resistance against HIV/AIDS-related stigma in relation to underlying social inequality, namely, homophobia. In developing their Anti-Homophobia and HIV Prevention campaign, Florida recognized that stigma continues to complicate HIV prevention efforts in Miami-Dade County by creating social disincentives to accessing important education, information, risk reduction counseling, and HIV testing. Their review of the research told them that a variety of social and demographic variables have been shown to correlate with HIV/AIDS related stigma. Older persons and those with lower incomes tend to manifest higher levels of stigma as well as people who do not personally know a person living with HIV/AIDS. Homophobic attitudes about gay people are highly correlated with HIV/AIDS stigma.3 Lastly, as a disease, HIV/AIDS manifests characteristics likely to evoke stigma. For example, stigma is more often attached to a disease if its causes are perceived to be the bearer’s responsibility.4 Stigma is also associated with conditions that disrupt social interaction or are perceived by others to be repellent, ugly, or upsetting.5,6

By dedicating resources and staff, MDCHD has been successful in developing and implementing this Anti-Homophobia campaign. Components of the campaign include outdoor and print media to raise questions about social inequality, stimulate public discourse about HIV/AIDS-related stigma, and trigger action among gay men living with HIV/AIDS in Miami-Dade County. A core focus group of 20 gay men (HIV postive and negative) worked with the health department to develop alternative images, messages, and publications designed to counter and critique homophobic, racist, and ageist media representations of gay men. MDCHD began its social marketing efforts by erecting a makeshift graffiti wall in a high-visibility gay neighborhood in the Miami-Dade area and inviting residents to write responses to a question/statement posted on the wall. The graffiti wall remained for approximately four days, serving as a spontaneous community forum about HIV/AIDS-related stigma. Responses to the question, as well as observed reactions to the wall, were recorded by project volunteers and core group members on a daily basis and added to the data the core group used to develop their messages. The graffiti wall served as a “teaser” for subsequent public art and marketing displays for the campaign.

MDCHD understands that stigma continues to complicate HIV prevention efforts in the gay community. With the department’s support, these and other initiatives are proving to be effective in increasing the perception of one’s own risk of contracting HIV, changing attitudes about HIV/AIDS, raising intentions to reduce risky behavior, deepening the knowledge about HIV transmission, and triggering community-wide discussion about prevention-related issues.

Florida’s program demonstrates that creative solutions to the structures of power and privilege that impact risk for gay men and other MSM are possible. Health departments and community-based organizations must continue to work in unison to challenge and tackle the ramifications of power and privilege across all populations.

NASTAD thanks Alberto Santana, Deputy Director of the Office of HIV/AIDS in the Miami-Dade County Health Department, for his assistance with this story.

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References
1. Diaz, R., Ayala, G. & Bein, E. The impact of homophobia, poverty and racism on the mental health of gay an bisexual Latino men: Findings from 3 US cities. American Journal of Public Health. June 2001, Vol.91, No.6.
2. Parker, R. & Aggleton, P. HIV and AIDS-related stigma and discrimination: a conceptual framework and implications for action. Social Sciences & Medicine, 57 (2003) 13-24.
3. Herek, G.M. AIDS and stigma. American Behavioral Scientist, Vol. 42, No.7, April 1999, 1106-1116.
4. Jones et al. Social stigma: the psychology of marked relationships. New York: Freeman. 1984.
5. Herek, G.M. & Capitanio, J.P. AIDS stigma and sexual prejudice. American Behavioral Scientist, 1999, 42(7), 1130-1147.
6. Klitzman, R. Being positive: the lives of men and women with HIV. Chicago: Ivan R. Dee. 1997.