GMFA Why black gay men need PrEP Words by Philip Samba | @IdiosyncraticXL Black gay and bisexual men are far less likely than their white counterparts to take PrEP. Since the introduction of PrEP, HIV incidence in white gay and bisexual men has fallen greatly, but the fall in black men hasn’t been as big. We are also only enrolled on to PrEP trials around the world in tiny amounts. WHY WE NEED PrEP This is why that’s not good enough: HIV rates in England continue to be higher among black men compared with white British men. There’s also been a year-on-year increase in new UK HIV diagnoses among black African men for over a decade. Black Africans in the UK are also more likely to be diagnosed late with advanced HIV because they either don’t test regularly enough or at all, and this means that by the time they are diagnosed their immune systems are already badly damaged. In fact, a 2014 Public Health England report said that black British men who have sex with men (MSM) are 15 times more likely to be HIV-positive than the general population. There are many reasons that contribute to this, which include structural racism, homophobia, discrimination, cultural norms valuing masculinity, poverty, concerns about confidentiality during HIV testing or treatment and the lack of targeted HIV prevention campaigns. As a gay black man, I’ve experienced nearly all of these issues and I know that many others like me have had similar experiences. Let’s not forget mental health. In the UK, compared with the white British majority, black men are more likely to qualify as depressed and report suicidal thoughts. Poor mental health also leads to sexual risk taking. I can say from my own experiences that poor mental health leads to poor sexual health. There have been many times in the past where I have taken risks sexually as a result of feeling depressed and using sex as an unhealthy coping mechanism. A WORLDWIDE FAILURE Black men not having proper access to PrEP isn’t even a travesty that’s exclusive to England. It’s worldwide. The iPrEx study (which covers Peru, Ecuador, Brazil, South Africa, Thailand and the United States) was to determine whether PrEP could safely and effectively prevent HIV acquisition through sex in men who have sex with men and transgender women. It had 2499 participants. Only 10% were Black. The French IPERGAY study had 400 gay men participate and only 7.2% were black. Then there’s England. The Proud Study which measured the effectiveness of daily PrEP for MSM in England, recruited 545 gay men in their thirties who were predominantly white, university educated and employed. Only 3% of the participants were black. We are very lucky to have free healthcare in the UK, but what good is the NHS if it is only beneficial to those who are accessing sexual health services and not doing everything in its power to protect those can benefit from PrEP? What are we doing to reach and engage with those who are not? NHS England has an opportunity to make amends for their woeful history on PrEP and seize the opportunity to show leadership and set an example for other countries who aren’t as liberal. Currently, in the UK, NHS Scotland provides PrEP across Scotland, NHS Wales has started the PrEPared Wales project, and Health and Social Care in Northern Ireland has started offering PrEP through a pilot. Why can’t we step up too? THE TRIAL ON TRIAL Besides self-sourcing online (approximately 10,000 people do in the UK) PrEP is not available in England apart from the PrEP Impact Trial. The trial aims to find out how many people attending sexual health services need PrEP, how many of them would start taking it if offered and how long they will need to be on PrEP. This is ridiculous. We already know the demographics which are disproportionately affected by HIV. The ongoing trial is reaching capacity (around 8,000 of 10,000 spaces filled). A further 3,000 places were announced but there were no details of when or where they would be released. Within only eight months of this three-year trial, over 8,000 people have rushed to fill places, with many participating clinics closed to any further recruitment to men who have sex with men. As a result, most clinics have very long waiting lists and many people were turned away, some of them needlessly getting HIV as a result of not being able to access the drug. When this trial launched, I was initially turned down when I tried to enrol because I didn’t fit one part of the criteria even though I am gay, black and African – three categories that are all disproportionately affected by HIV. I hadn’t had condomless sex in the past three months although I had before and could have in the future. So, a friend gave me some advice: “Fuck ‘em, go back to that clinic and lie, and tell all your mates to lie too.” REPRESENTATION MATTERS An in-depth study called the LA PrEP Stories Project launched in January, designed to solicit stories from and interviews with black and Latino MSM who are or who are not on PrEP exploring how stigma affects participants’ perception of access to the drug. Omar Nieto, the study’s project director said “What we’re finding with non-PrEP users is that it really does affect them if they don’t know people who are on PrEP personally. You yourself can read and hear things about PrEP, but until you have the experience of talking to someone living on PrEP themselves, it’s really hard to have a good grasp of the specifics of PrEP and how it works.” Phill Wilson, founder and CEO of The Black AIDS Institute said: “When you offer PrEP to black people and the people who are offering the services are black, the people doing the outreach are black, and the messages that are being created are created by black people then black people are interested.” As I said, there’s a lack of HIV prevention campaigns specifically targeted at black men. In sexual health, a lot of the time the intersection of being both black and gay isn’t taken into consideration, we are a unique group that has very specific concerns and we need to be communicated with in our language. This is why co-developing and featuring in the Me.Him.Us. campaign was so important for me. The campaign was created by and for black gay and bisexual men. It wasn’t solely to target them and motivate them to get tested for HIV and STIs but to also honestly represent a wide range of black men, celebrating their differences and individual identities. As a black African gay man, I very rarely feel accurately represented in mainstream media. There are currently very few positive black male role models that steer away from stereotypes and there are even fewer that are gay. It’s improving now but when I was younger there was no one who I felt was anything like me and I didn’t meet anyone who was like me until I was 21. I never saw anyone on TV like me, I wasn’t listening to any music artists who were like me either and I definitely never saw myself in public health campaigns until now. WE NEED PrEP NOW We need to step up our advocacy and campaigning for HIV prevention tools including PrEP and treatment as prevention, especially within countries and within communities that are not only disproportionately affected by HIV, but also by stigma, lack of awareness and inadequate access to treatment for the condition. Should these people become HIV-positive they might struggle to find support that other people who are not like them could get easily. Having a strong support network is a privilege that not everyone has. There are many black gay men who might not be out to their families because they might not accept their sexuality, let alone a HIV-positive diagnosis. The potential for rejection and isolation for these people is significant. Within demographics that we work with that are disproportionately affected by stigma it’s especially important we provide all the tools and support we can across the board. We need to do as much as we can to step up prevention efforts to ensure that they don’t find themselves in this situation, because a positive status probably has more of a detrimental mental health impact and social implications in those communities than others. This is about equity not equality – it might take longer, it might be more difficult, it might even be more work to get more black men talking about PrEP, embracing PrEP, taking PrEP and telling their friends, but just because it takes extra work doesn’t mean that we shouldn’t do it. Find out more about PrEP here: www.gmfa.org.uk/prep Find out more information about PrEP at prepster.info Find out where to get PrEP at www.iwantprepnow.co.uk.