Friday, June 22, 2012

Let’s do the black talk – HIV and black gay men in Europe

Just as I return from Stockholm where I attended the first European conference “The Future of Prevention for MSM in Europe” (FEMP) specifically addressing prevention issues affecting men who have sex with other men (MSM), I am surprised, as much as you should be, that this was the first European conference of its kind since the outbreak of the epidemic 30 years ago.

The US and South Africa have been exemplary in leading the way with innovative approaches to HIV prevention, treatment and advocacy.
As a black gay man of African origin living in the United Kingdom, the challenges I face in my everyday life are in no way different from those faced by black gay, bisexual and other MSM in America.
However, whilst there is a history of over 200 years of black civil rights movement in America, there is little that can be said about similar black organisations in Europe.
But the problem has deeper roots. Most amazingly, the results of the recent HIV prevalence survey conducted by the European Centre for Disease Control (ECDC) do not differentiate the HIV epidemic in Europe according to ethnic origin mostly because the French and the Germans do not allow for identifying and recording racial background.
The hypocrisy of the French “equality” motto is that by denying the existence of epidemiologic differences related to racial background it further oppresses ethnic minorities, mostly black, by denying them the rights to tailored healthcare.
In the UK the Health Protection Agency (HPA) estimates that 86,500 people are living with HIV in 2010.
An estimated 4% of Black Africans living in England have been diagnosed with HIV, compared with 0.1% of the white population. The disease disproportionately affects MSM who represents nearly half of those newly infected with a consistently higher proportion of black MSM.
The latest HIV diagnosis data for 2001-10 from the HPA shows a steady increase in the number of new diagnosis in the black MSM population (Black Caribbean, Black African and Black other) from 100 in 2000 to 112 in 2010.
If these data can be translated to the European scale, the choice of the French and German government to ignore race is raising serious questions about the real HIV prevalence in the black/African community in Europe.
With an incomplete picture and missing data, how can we advocate for black gay, bi and MSM driven and led HIV prevention and treatment?
Unlike the French and the German agencies, the UK Health Protection Agency has one of the most comprehensive datasets on HIV prevalence, taking into account race and ethnicity in the whole of Europe.
This may explain why many UK black gay advocates attended FEMP and why they have been at the forefront of the battle for similar data collecting system in other European countries.
However, these data should not hide structural and cultural issues affecting Black MSM and suggesting that number of infection remains underestimated.
The impact of institutional racism and community discrimination on the self-confidence of young black gay/bisexual men and MSM to access healthcare in the UK was investigated by the Monya project, funded by Newham Primary care trust in London and carried out by Naz Project London.
Surveys showed that more than 60% of MSM of African origin agreed that they did not fit into the mainstream, predominantly white, gay setting.
As many as 45% criticised the healthcare professionals for being heteronormative and almost 70% said the counselling they received at the sexual health clinics did not meet their needs for full sexual happiness and fulfilment.
Whilst the ECDC agreed that there is a need for concrete intervention for HIV prevention for heterosexual migrants from high epidemic countries, there was nothing said about the need for tailored HIV prevalence for MSM from the same region.
We cannot blame the ECDC for being limited by red tape and national policies, but I was shocked that despite 5 plenary and more than 15 breakout sessions, there was not one single session talking about black gay, bisexual men and MSM at the FEMP conference.
The one session on migration was flawed by an ambiguous EMIS definition of migration and data collected on migration that do not distinguish between internal and external migration. Further, the panel consisting of two Spanish researchers could not provide convincing answers about the epidemic of black gay/bi sexual and MSM from high epidemic areas like Africa.
While I strongly believe that there is a need for a European MSM conference, I think that this conference failed in acknowledging and accepting that there is a need to put black and African MSM men on the agenda.
Even the number of black and African gay men at the event was nothing to be proud of, with fewer than 10
of them amongst 200 participants. The HIV Epidemic in the community is a time bomb waiting to explode and we are turning our back to it.
I went to this meeting to assess and investigate the need to establish a European-wide MSM HIV prevention and treatment advocacy, but whilst the conference raised good points, I returned to London having failed to achieve my aim, as there was no platform for black gay men to meet and discuss the issues that matters to
As we plan for the next FEMP conference, it is important we start talking about the hidden and mostly ignored HIV epidemic in the black MSM community and what roles social factors like religion, culture, self confidence and racism are playing in the increasing epidemic in the black community in Europe.
We, the black MSM community in Europe, should be demanding for research-driven prevention policies from health care authorities and our governments. We have a lot to learn from our brothers from America and we need them to help us in organizing and lobbying. We do not want to wait for another five years and then to become the agenda of the “HIV do-gooders” trying to save the endangered species.

Representation: The undefined Job Description

Since the discussion around Pre- Exposure Prophylaxis-PrEP, (the anti HIV drugs to be taken by HIV negative people to prevent them from getting HIV even if they come in contact with virus). I have listened, spoke, argued and even made cases for the cautious implement of the policy so that the people that will be taking the pills know what really they are getting themselves into and be able to make an informed choice about their life, their health and their future.

However, there is been a particular group of people that have been missing in this very important discussion, the people that will be taking the drug. The issue of representation in this case has been taken over by the HIV positive old horses that think that they can speak for everyone. Just like the pope and the Catholics criticizing condoms and contraceptives for women when they are not one that will use it.

This scenario of self appointed speaker/ representative is not limited to the HIV field. I have seen many people speaking on behalf of other people with such authority (mind you I am not excluding myself) and with the use of the word "Community" that you asked yourself when was the election conducted? Who are the opposition party? On which political platform that person stood? These questions brought about the argument of the notable academia Anne-Marie Slaughter when she talked about "Representation and Democratic deficit". 

Just recently I was drag into a twitter argument over racism and representation again. When on BBC Sunday Morning live, a panel discussing racism has no black person on it. The argument was in 21st century, do we really need to have a black person talk about black issues? Do we only need a gay person to voice the concerns of gay people? And since we have no HIV negative community, do we really then have to look for someone to speak for them?

Do we really need to desperately look for someone to speak for a group of people? As an African Gay man living with HIV living in London, I constantly find myself having to speak or represent that community and on many occasion I have asked myself that do I really know what deep down the issues are? Does having those boxes to tick makes me the best person to speak for this group of people?

As much as I asked myself these questions, I have never been able to find an answer to it nor will I ever be able to find an answer to it. However, what makes my case different is that I have to certain degree the support of the group of people I represent. This is clearly different from White people representing Black issues, or an HIV positive man talking about what is best for HIV negative man with such authority.

We all know that there is a difference between taking a pill to stay alive and taking a pill because it is an option not to catch something. Both are different and the level of tolerating the risk differs as well.

I wish we can take the PrEP conversation away from the ball room of HIV positive people to the dinner room of HIV negative people and allow them to take centre stage on the discussion as much as taking the conversation of racism away from the sympathetic white middle class to the reality of black people on the street of the UK.