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.

Sources:

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.

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