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
them.

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.

Dont call me "Non-White" its just racism

Human beings with any sense of intellectual prowess are known to be full of rhetorics. These rhetorics are most times their ways of either exercising their wealth of intelligence or simply showing how they can be more stupid than the rest of of us. And if it is the latter, then they find themselves in a situation where they are boxed to the corner and fighting for survival.

David Starkey on Newsnight.

One of such is Prof David Starkey the notable Historian (well many will question my use of "notable" for this honourable gentleman, but you will have to forgive me for that) behaviour during the London riot when he in his almighty stupidity argued on BBC newsnight (you can watch the video here)  that "white has become black" and that is the reason for white kids involvement in the right. 

The fury that followed was one that hell could not contain and this Professor will end up covering his head in shame. Not that it really matters when it comes to David Starkey, he was the same man that made controversial statement about gay people on BBC question time. And for clarification purpose, David himself is gay.

Now this blog is not about David in anyway and I am not sure I want to write about David. This blog is about two presentations at the just conclude British HIV Association (BHIVA) conference held in Birmingham United Kingdom. The two controversial presentations where those from Dr Anthony Mills from Los Angeles and Dr Chloe Orkin from Bart and the London NHS. 

It will be important to note that it was not the content of the presentation that made some people uncomfortable and that includes me but the ethic classification in the presentation. During his presentation on the "non- inferior efficacy and favourable safety of Quad compared to efavirenz/emtricitabine/tenofovir DF in treatment naive HIV-1 infected subjects" He classify the race as "white and non-white". I almost jumped on my seat. My immediate reaction is what really is racially non white? Black, Indians, Chinese, Hispanic or any other race that is not white? 

Also in considering metabolic assumption of HIV drugs in HIV positive people, racial classification is very important because of genetic make up. Saying white and non- white gives no explanation to what is happening to "African American" as they account for the emerging epidemic in America and likely to be on treatment and possibly react to the drugs in a different way compared to their white counterpart.

As if that was not enough insult for one day, Dr Chloe came on and made a presentation on "Efficacy, safety and pharmacokinetic results of an ongoing international phase 3 study comparing Quad with ritonavir-boosted atazanavir plus emtricitabine/tenofovir DF in treatment naive HIV-1 infected subjects at 48 weeks". In the same fashion talked about white and non white.

Angered by this blatantly act of intentional or unintentional racism, I went on twitter and vent my anger about the attitude of clinicians/researchers on not just race classification but recruitment of Black and Hispanic people into HIV trials. The reactions on twitter was nothing but that of anger and disgust. However, I did not stop there, I stood up and went to the microphone to challenged the notion of the concept of "White and non-white". 

I was not doing this to be a hero or become controversial, but to put the record straight that knowing how people are doing differently will help in designing and development of care and support service for HIV positive people from different ethnic background.

To my utter dismay, I was shocked at the way my concern was ignored not just by the researchers but by the chair of the session.

As if ignoring my concerns was not enough, afterwards, I was challenged by many clinician and researchers accusing me of raising a non issue to distract many people from the main issue of the conference.

I left Birmingham not angry, but determined to put this right once and for all. As an African living in the UK already given the Black identity I did not asked for, being tagged "non-white" in 2012 is nothing but blatant act of racism and bigoted insult.