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.

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“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.

Recognizing Non-Verbal Consent: It’s Not That Hard

Let’s play a little game:

I’ve got some pictures here of nonverbal cues and actions. You look at them and categorize them under “Is open to having a conversation right now” or “Is closed to having a conversation right now.”

I think it’s fitting to say that none of these people want to have a conversation. The signs in the first image that they don’t want to talk include the furrowed brow, bitten lip, and the fact that they’re looking away from the person taking the photo. The second is someone whose arms are crossed with their head turned down. The third shows someone turned away and actually putting their hand out to push away or stop someone.

Let’s do this exercise again: categorize these images under “enjoys what they’re doing” or “doesn’t enjoy what they’re doing.”

Again, I think it’s safe to say that none of those people were enjoying what they were doing. The first image shows a person who disliked whatever they were drinking, made clear by their scrunched eyes and pursed lips. The second shows someone physically in pain, as indicated by being hunched over and grasping at their chest. The third shows people clearly disinterested and tired, as indicated by their hanging heads.

We’re expected to, and capable of, picking up on nonverbal indicators every day. A presenter is expected to survey a room to determine if the audience is engaged, and if they are not, the presenter is expected to modify their presentation. When our significant others come home and slump onto the couch with a haggard expression, we get the sense that they’ve had a long and hard day. We can usually identify physical signs of intoxication, like slurred speech and stumbling, without having seen someone consume alcohol.

Of course, we cannot be sure without asking. Someone may look angry and we might assume it is directed towards us for something we did but upon further conversation, we may come to understand that they were actually feeling frightened or defensive. Or they may be angry, but with somebody else. Or they may be angry with us, but for a reason we knew nothing about. There tends to be more than meets the eye, so asking questions and having an open dialogue with someone is critical to getting a complete picture of how they’re thinking and feeling.

Last month the world was briefly abuzz on the heels of Babe.net’s story about Aziz Ansari. I won’t be doing a full summary now, but here are some basics: Babe.net approached the anonymous Grace about a night she had with Aziz Ansari and Grace recounted their date and subsequent sexual interactions. Grace detailed the many times she expressed her lack of consent through non-verbal means; removing her hand from his groin after he repeatedly moved it there, pulling away, and ceasing movement altogether, including not moving her lips when being kissed. She also talked about the numerous ways she showed her lack of consent verbally: asking him to slow down and chill, responding with “next time” when asked repeatedly “how do you want me to f**k you”, and flat out saying “I said I don’t want to feel forced because then I’ll hate you, and I’d rather not hate you.”

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Grace eventually left, feeling hurt and violated, and informed Ansari via text that he made her feel extremely uncomfortable and ignored her verbal and non-verbal indications. Ansari apologized via text, saying he “clearly misread things in the moment” and was “truly sorry”.

In a public statement, he said:

“In September of last year, I met a woman at a party. We exchanged numbers. We texted back and forth and eventually went on a date. We went out to dinner, and afterwards we ended up engaging in sexual activity, which by all indications was completely consensual.

The next day, I got a text from her saying that although ‘it may have seemed okay,’ upon further reflection, she felt uncomfortable. It was true that everything did seem okay to me, so when I heard that it was not the case for her, I was surprised and concerned. I took her words to heart and responded privately after taking the time to process what she had said.

I continue to support the movement that is happening in our culture. It is necessary and long overdue.”

With this article came a flood of commentary, from news stories to op-ed pieces to Facebook posts. But I remember the first response I saw. It was an opinion piece from the New York Times titled “Aziz Ansari is Guilty. Of Not Being a Mind Reader.”

As the title alludes, the author believes that because Grace didn’t explicitly say “no”, Aziz could not have been expected to know that she didn’t want to engage in any sexual activities. The author goes on to say the simple fact that she was naked with him in his apartment was enough to assume that Ansari was going to try and have sex with her. It is arduous, problematic work, on par with mind-reading, for Ansari (or people in general) to figure out what these complex gestures and expressions mean. And a lot of people seemed to agree with the author’s assertion.

Let’s revisit our first three photos: viewing these images, I want you to contemplate a different question: Does it look like any of the people in these images want to engage in sexual activity?

How about this second set of photos: if the surroundings of these images had been changed to intimate settings, would it seem like any of these people were enjoying the sexual interactions they were having?

While these are stock Google images, the point remains: the same nonverbal cues we recognize in everyday situations are present in sexual situations.

If I go in to kiss someone and they physically respond like this:

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I know I shouldn’t continue trying to kiss them.

If I’m having sexual intercourse with someone and they make this face:

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I can safely assume they’re uncomfortable or hurting and I should stop.

The next step after recognizing these cues and ceasing activity is to ask your partner if they are okay. We need to take steps to determine what those nonverbal cues mean. Are they in pain? Are they uncomfortable? Do they feel pressured? Do they need to take a break? Do you need to stop altogether?

Equally important to asking is not demanding an answer that makes you happy. Just because you want to continue does not mean your partner wants to, and they should not feel pressured to put their feelings aside because you’re going to be upset if you stop.

Here’s the thing: I would love to live in a world where people express all their thoughts and feelings directly. I want to empower people to say when they’re comfortable and when they’re not, whether that’s in the workplace, at home, or in sexual situations. But it’s not a one-sided job. We need to ask our partners what they want and how they are. We need to recognize that there’s more than one way to say “no” and express discomfort.  We need to listen to our partners’ wants and needs and respect when they need things to change.

And to begin fostering a culture of affirmative consent and sexual pleasure, we need to stop thinking of sexual encounters as silent movies where things just work out without anyone talking about it. Ongoing, enthusiastic consent requires you to ask, listen, and respect.

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Laurel Winsor is the Events Coordinator at the Virginia Sexual and Domestic Violence Action Alliance. She received her Bachelor of Arts in Social Justice at James Madison University in December, 2016.