A Brief Reflection on the Intersections between Race, HIV, Sexual Orientation, and Gender Identity

As a Black and gay male, I understand the urgency of addressing the HIV epidemic that affects me and others within our community. National Black HIV/AIDS Awareness Day, February 7, is a time set aside for us within the Black community to increase HIV education, testing, community involvement, and treatment in an effort to end the HIV epidemic. It is also important to take time to acknowledge distinct barriers to prevention and care that impede efforts ending the HIV epidemic. One such barrier is the unique experience of LGBTQ people in regard to the intersection of HIV/AIDS and domestic abuse.

Power and control wheel

“LGBTQ Relationship Violence” From the National Domestic Violence Hotline

In his article, Just*in Time: HIV & LGBTQ Domestic Violence, Justin B. Terry-Smith voices the struggles of the intersection of HIV/AIDS and domestic abuse. He details a few tactics of abusers: using HIV guilt as a weapon, taking away or controlling access to HIV medication – this control over medication can be for PrEP, nPEP[1], or antiretroviral HIV medications – controlling access to money and other resources, using social media to manipulate and threaten, and creating or magnifying stress and trauma. All of these tactics can make a person’s HIV diagnosis more dangerous for their health. An abuser’s ability to victim-blame, isolate and control by using social media, and regulating HIV medication is amplified for LGBTQ Blacks and African Americans, who at the same time are experiencing racial disparities within the healthcare and domestic violence services systems. Additionally, resources for LGBTQ people are already limited, and an abuser isolating an LGBTQ partner can be especially detrimental for health outcomes.

According to the United States Census Bureau, we lack equity in economics, insurance coverage, and health.

  • Economics: In 2017, the Census Bureau reported the average Black median household income to be $40,165 in comparison to $65,845 for white households. Also in 2017, the Census Bureau reported that 22.9 percent of Blacks in comparison to 9.6 percent of whites were living at the poverty level. Further, in 2017, the unemployment rate for Blacks was found to be twice that of non-Hispanic whites, 9.5 percent and 4.2 percent, respectively.
  • Insurance Coverage: In 2017, the Census Bureau reported 55.5 percent of Blacks in comparison to 75.4 percent of whites used private health insurance. Also in 2017, 43.9 percent of Blacks in comparison to 33.7 percent of whites relied on Medicaid or public health insurance. Lastly, 9.9 percent of Blacks in comparison to 5.9 percent of whites were uninsured.
  • Health: According to Census Bureau projections, the 2015 life expectancies at birth for Blacks is 76.1 years, with 78.9 years for women, and 72.9 years for men. For whites the projected life expectancies is 79.8 years, with 82.0 years for women, and 77.5 years for men. The death rate for African Americans is generally higher than whites for the following: heart diseases, stroke, cancer, asthma, influenza and pneumonia, diabetes, HIV/AIDS, and homicide.

“never reported, contracted HIV.” — Gay male, 29, Charlottesville*

The National Domestic Violence Hotline goes even further into the unique mental and physical tactics LGBTQ abusers use to gain power and control, detailing that LGBTQ tactics to gain control are all rooted in homophobia, biphobia, heterosexism, and transphobia. Threatening to “out” a survivor’s sexual orientation or gender identity, denying the survivor’s sexual orientation or gender identity, suggesting the abuse is “deserved” because of the survivor’s sexual orientation or gender identity, and explaining away abuse by upholding the abuse as masculine or some other desirable trait. These mental tactics all serve to isolate the survivor from the LGBTQ community. This is especially damaging for LGBTQ people since there are fewer specific resources for LGBTQ people. Similarly, these tactics can be combined with racism to compound the isolation and damage experienced by the person being abused.

It was a friend. The first gay person I ever knew. I really was reaching out for the first time trying to find a mentor. He was older and I wanted to learn what it was like to be gay in my rural community … but then this [violence] happened.” — Gay queer male, 23, Richmond*

As Black and African American LGBTQ people, we are tasked with managing our health, regardless of HIV status, finding ways to navigate institutions that were not designed with us in mind, stigma that is associated with HIV/AIDS and domestic abuse, and various other societal pressures without much structural or institutional support.

“I didn’t think it was a big deal; it felt normal or not what I thought “domestic violence” was;” –Bisexual female, 20, Richmond*

It is also important to acknowledge and understand the power we have as individuals and as a community to combat stigma accompanying HIV/AIDS and domestic abuse and bring change to existing institutions. Reducing stigma by acknowledging anyone – regardless of gender – can be in an abusive relationship, and that domestic abuse is more than physical abuse; domestic abuse can also be mental abuse and emotional abuse. Stigma reduction also helps in disregarding victim-blaming narratives linked with HIV/AIDS and domestic abuse, respectively. Educating ourselves to understand the circumstances that would lead to a HIV diagnosis or to someone being with an abuser, likewise, helps reduce victim-blaming. For example, understanding that prevention measures such as nPEP and PrEP may not be available due to lack of accessible healthcare options, or unable to access because a person’s abuser is controlling their lives, are two examples of how reducing stigma also reduces victim-blaming.

I believe we as a nation will reach equity in regard to race, gender identity and expression, and sexuality. True equity would mean no one would be able to determine a person’s health outcomes based on their race, gender identity and expression, and/or sexuality. We can and do have the power to combat HIV/AIDS and domestic abuse in all of our communities, across race, LGBTQ identities, and other dimensions.

“I really believe that LGBTQ hate crimes, domestic violence, discrimination and bias are still quite a problem in our time. Since I was involved in a support group for LGBTQ folks (Dignity/Integrity Richmond, now defunct, from the mid-1980s to the mid-1990s) I became aware of these issues, particularly LGBTQ domestic violence. All of these issues were occurring then and I am quite sure they continue to occur today. For the most part I think LGBTQ folks are aware of these issues but for the most part I think LGBTQ folks, for whatever their reasons, don’t report them or try to deal with them on their own. This is the reason, I think for surveys like this one and I think it’s a good thing.” — Gay male, 51, Henrico*

You can reach the Virginia Disease Prevention Hotline (Monday-Friday, 8am-5pm) at 1-800-533-4148, where counselors answer questions and provide crisis intervention, referrals, and written educational materials regarding Sexually Transmitted Diseases (STDs), HIV/AIDS, and Viral Hepatitis. 

If you or someone you know needs help or resources, contact the LGBTQ partner abuse and sexual assault helpline 24 hours a day, 7 days a week, at 1-866-356-6998. Or, text 804-793-9999 or chat: www.vadata.org/chat

*The quotes in this post come from the Virginia Anti-Violence Project 2008 Survey.


The State of Violence in Lesbian, Gay, Bisexual, Transgender, and Queer Communities of Virginia: A Report of the Equality Virginia Education Fund Anti-Violence Project

National Black HIV/AIDS Awareness Day

Just*in Time: HIV & LGBTQ Domestic Violence

Income and Poverty in the United States: 2017

The Black Population: 2010

Health Insurance Coverage in the United States: 2017

Census Bureau, 2018. 2017 American Community Survey 1-Year Estimates

The National Domestic Violence Hotline page on LGBT abuse

[1] Pre-exposure prophylaxis (PrEP) and non-occupational post-exposure prophylaxis (nPEP) are HIV prevention strategies.  They are medical interventions and public health approaches used to prevent infection. (Learn more about PrEP and nPEP.)

Christian Carr is a Ryland Roane Fellow for the Virginia Department of Health and is currently working alongside Minority Health Consortium to help empower the Richmond, Virginia community.

Healthy Boundaries and Consensual Non-Monogamy

Preliminary definitions (from morethantwo.com): 

RESPONSIBLE (or CONSENSEUAL or ETHICAL) NON-MONOGAMY: Any relationship that is not sexually and/or emotionally exclusive by the explicit agreement and with the full knowledge of all the parties involved. 

POLYAMORY: (Literally, poly” meaning many + amor” meaning love) The state or practice of maintaining multiple sexual and/or romantic relationships simultaneously, with the full knowledge and consent of all the people involved. 

SWINGING: The practice of having multiple sexual partners outside of an existing romantic relationship, most often with the understanding that the focus of those relationships is primarily sexual rather than romantic or emotionally intimate. 

MONOGAMY: (Literally, mono” meaning one + gamos” meaning marriage) Formally, the state or practice of having only one wedded spouse. Informally, the state or practice of having only one wedded spouse at a time, or more generally, having only one sexual partner or only one romantic relationship at a time. 

Everyone has expectations of the people in their lives. Sometimes those expectations are hard and fast with no wiggle room (ie. I have an expectation of safety and bodily autonomy. Therefore, if you are physically violent with me, I will leave.) Other times, the expectations may be of high importance but there’s an understanding that there’s room for potential error (ie. I have an expectation of honesty but recognize that being transparent can be difficult. I will hold you accountable when you are dishonest.) Whether they’re called rules, boundaries, expectations, understandings, or something entirely different, it’s reasonable and common for people to assert them and expect others to respect them. 

As advocates, it’s easy for us to wrap our minds around this concept in monogamous relationships. We understand that people have lots of different rules and agreements made with their partner: fidelity, consultation about major financial decisions, expectations of home maintenance. However, sometimes relationship rules can assert an unfair level of control. Where that line is drawn is different for everyone Some people might find a rule of “If you’re going to spend over $100, we need to have a conversation about it first” extremely inhibiting. Others might not care. Some people might be totally okay with a rule of “No sexual or romantic relationships with anyone beyond the two of us.” Others might feel limited by this. 

Those of us in the fields of sexual and domestic violence have learned to identify how rules can be used as tools of power and control in monogamous relationships. It’s not uncommon to see relationships where one person controls their partner’s behavior by isolating themtelling them who they can and cannot talk to, and limiting when/how they communicate with othersWe know what red flags look like in monogamy, and how to talk to empower people to make changes that honor their needs, but can we recognize these red flags in consensual non-monogamy? 

As people begin exploring consensual non-monogamy, they can experience a medley of emotions; liberation, trepidation, excitement, insecurity, growth, discomfort. When navigating something new and scary, people often take precautions to prepare ourselves. Even if someone is absolutely stoked to sky-dive out of a plane, they still create a mental and physical safety net for themselvesSo it’s not uncommon for people to establish rules or boundaries when they dive into consensual non-monogamy. In the swinging community, folks might start out with rules of “we only swing together” or “we do not have penetrative sex with other partners”. These boundaries can be to protect the sexual health of all involved, people’s own emotional well-being, or both. Someone beginning to explore polyamory may have an expectation that their partners don’t engage sexually or romantically with their friends, or only with people that they don’t share a social circle withAll of these expectations limit their partner’s behavior or engagement with others. But how do we recognize, and then empower others to identify, whether or not these expectations are healthy? 

All relationships have a level of give-and-take compromise. Sometimes that’s as small as not eating at your restaurant of choice for dinner, but often, it’s bigger. One thing we can be mindful of in determining whether or not a rule in a relationship is healthy is the mindsets of all involved parties. If someone is enforcing a rule or boundary, they should be mindful of where it stems from. Are they feeling insecure, anxious, threatened, jealous? If so, that’s okay. Those are all entirely valid feelings, even in consensual non-monogamy. Awareness of those feelings is an important step, as is taking accountability for the fact that those feelings are theirs to own and are not “caused by” their partner’s actions. A big red flag in non-monogamy, just like in monogamy, is if someone is blaming their partner for their negative emotions.  

infinity heart

We should look at whether or not people asking for their partners to restrict their behaviors are considerate of how long rules need to be in place. Using metaphorical training wheels makes a lot of sense, but is it fair of someone to impose restrictions on their partners forever? Saying “I know it’s important to you, but I do not want to hear about your relationships with your other partners,” is different from “I feel insecure when you talk about your other partners, but I know it’s important to you. For now, can we limit that talk to light topics, and as I adjust to this, maybe we can begin to discuss things a little more in-depth?” Another red flag is the unwillingness to compromise. There’s a difference in the assertion of control between someone who has an unyielding rule about being Facebook official with their polyamorous partner who is dating three people and someone who says “Visibility is really important to me. If being Facebook official isn’t something you can do, how else can you show people that we’re together?” 

One of the other ways we can keep an eye out for red flags is to examine how the person being asked to implement the rule is feeling. Do they feel like they have room to ask for compromise? Is this rule compromising an important value of theirs? Do they fear for their safety or well-being if they say no? Are there power dynamics at play that need to be explored? For example, someone who has been practicing polyamory for over a decade might want their brand-new-to-poly girlfriend to meet all their other partners. If their approach is “Look, I’ve been doing this a long time, and if you really want to be polyamorous, you have to just get over your fears and learn to get along with all the other people I’m dating,” that leaves a lot less room for compromise than “I understand why this makes you uncomfortable, and also it’s really important to me. Is meeting my partners something you’re interested in doing, and if so, how can we make that process go smoothly for you?” 

As advocates, we should be wary of making assumptions when it comes to consensual non-monogamy. Non-monogamous relationships are not inherently unhealthy. People are not automatically victims because their partner is interested in developing or has multiple relationships. Similarly, consensually non-monogamous folks are not immune to engaging in abusive and controlling behaviors. The same power dynamics we see in monogamous relationships can rear their heads in any other relationship structures. In consensual non-monogamy, unfair restrictions and control can be asserted both by people who don’t struggle with jealousy and those who use rules to manage their insecurity. Every relationship deserves an empathetic, unbiased, and nuanced conversation when it comes to determining whether people feel their boundaries are being violated. That’s one step we take to committing to end intimate partner violence for everyone. 

Laurel Winsor is the Events Coordinator at the Virginia Sexual and Domestic Violence Action Alliance and has her BA in Justice Studies from James Madison University. She is a black belt in martial arts, real-life social justice warrior, baker, climber, sister, and professional hype-man.