Can President Obama’s Affirmation of Same Sex Marriage Save Lives?

By: Lisa Holbrook, JD, MBA

lholbrook@aya.yale.edu

In 2008, Barack Obama proved to young Black men that the color of their skin could not prevent them from achieving any dream, including becoming the President of the United States. This week, President Obama sent another message: gay Americans deserve dignity.

This message might save the lives of African Americans at risk of contracting HIV/AIDS. African Americans comprise 13% of the population, but they account for 49% of HIV/AIDS cases. (1)  Men who have sex with men (MSM) account for 50% of AIDS diagnosis and are the single largest group of individuals in the US who have become infected with HIV/AIDS. (2)  African American MSM are disproportionately affected with a 32% infection rate compared to a 7% infection rate in Caucasian MSM ages 23-29.(3)

We have proven that HIV/AIDS infection rates can be reduced with simple strategies such as 1) knowing your HIV status, 2) practicing safe sex and 3) engaging in harm reduction activities such clean needle exchange.  African American MSM have shown a dramatically low knowledge of infection rate with 67-91% of infected men unaware of their status. (4)  One possible explanation for the low knowledge rate regarding HIV status is gay stigma in African American communities.   Studies have shown that African American MSM have higher rates of internalized homophobia than other racial groups. (5)  African American MSM are more likely than Caucasian MSM to perceive that their friends and neighbors disapprove of homosexuality (6) and have greater rates of secrecy regarding their sexual orientation than other racial groups. (7)  By declaring that gay Americans are entitled to dignity and marriage, Barack Obama crushed the homophobic voice. In his statements this week, sitting in the Oval Office, the President of the United States made being gay okay.  This legitimization of gays and their relationships by our first African American President may free African American MSM from stigma and encourage them to be tested and know their HIV status.  This knowledge can save lives.

In 2008, Barack Obama inspired a nation to believe that no dream was too big, including the dream of a nation that would embrace all of its citizens regardless of the color of their skin.  This week, President Obama extended that embrace to include not just color, but sexual orientation as well.

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(1)Center for Disease Control and Prevention. “Cases of HIV Infection and Aids in the United States, by race/ethnicity 2000-2004.” Supp. Rep.2005.
(2) Kaiser Family Foundation, based on CDC, Presentation by Dr. Harold Jaffe, “HIV/AIDS in America Today,” National HIV Prevention Conference, 2003; CDC, HIV Surveillance Report, Vol. 22, 2012.
(3)HIV incidence among young men who have sex with men — seven US cities, 1994-2000.” (MMWR Morbidity and Mortality Weekly Report) 50 (2001): 440-444.
(4)Unrecognized HIV infection, risk behaviors, and perceptions of risk amoung young black men who have sex with men — six US citites, 1994-1998, (2002).
(5)Peterson, John L, and Kenneth T Jones. “HIV Prevention for Black Men Who Have Sex With Men in the United States.” (American Journal of Public Health) 99, no. 6 (June 2009).
(6)Peterson, John L, and Kenneth T Jones. “HIV Prevention for Black Men Who Have Sex With Men in the United States.” (American Journal of Public Health) 99, no. 6 (June 2009).
(7)Peterson, John L, and Kenneth T Jones. “HIV Prevention for Black Men Who Have Sex With Men in the United States.” (American Journal of Public Health) 99, no. 6 (June 2009).

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Yale Students Return from Ecuador

This summer, we, a team of five undergraduate and Public Health students, tested 1011 patients and spoke with over 3,000 Ecuadorians from 83 rural communities surrounding Manglaralto Hospital in the coastal province of Santa Elena. Furthermore, we undertook a collaborative public health research project, completing 512 surveys to determine HIV testing barriers.
Over seven weeks, we conducted daily educational talks and testing at Manglaralto Hospital, building and improving upon protocol tested during the Yale-Ecuador HIV Clinic Initiative’s March 2011 trip. In addition, we expanded these services to reach at-risk demographics at medical satellite clinics, high schools, nurseries, and brothels always in collaboration with Ecuadorian medical staff.

To address previously determined HIV/AIDS misconceptions we accompanied every testing session with a pre-test educational consultation. We created an informative, comedic 10 minute charla which focused on HIV transmission, the difference between HIV and AIDS, discrimination of HIV patients, and the importance of regular testing. At Manglaralto Hospital, we assisted patients through the testing procedure and followed up with a post-test consultation to review the concepts presented in the charlas and to provide the patient with their test results. In accordance with Manglaralto Hospital protocol, patients with reactive rapid test results were guided to trained hospital staff for a lengthy one-on-one post-test consultation and referred patients to Santa Elena or Salinas AIDS Clinic for confirmatory testing, ARV treatment and psychological support.

During the course of the summer, we noticed that the highest risk demographics—working men, teenagers and sex workers—were simply not present at Manglaralto Hospital. So, we launched an outreach program targeting these groups. In the afternoons, we packed up our supplies, hopped onto a hospital ambulance or local bus and conducted testing sessions in the rural towns. With the help of Ecuadorian medical professionals, we organized testing sessions at three satellite clinics, and even went door-to-door in San Antonio, a town we had identified with a significantly higher than average prevalence rate.

Besides the charlas presented to patients during HIV testing interventions, the YEHCI summer trip goals also included an educational component for local youth. Our summer team members sought to increase HIV/AIDS knowledge in the area by traveling to high schools in Manglaralto and Valdivia, twice independently and once with a professional team from Fundación VIHDA, to give presentations on HIV/AIDS which covered transmission methods, distinguished HIV from AIDs, emphasized the need to combat discrimination and stigma against HIV/AIDSpatients, and explained the importance utilizing prophylactic measures in preventing transmission of the virus. These presentations were given to youth from ages 11 to 20. Each school trip consisted of multiple visits to 4-5 classrooms of 30-40 students. In total, YEHCI was able to reach around 600 high school students through its summer educational outreach measures.

Equally important, our colleagues in Ecuador informed me that the YEHCI team created a comfortable and safe environment for HIV/AIDS education and conversation, improved quality-of-care, and connected professionally with previously unreached demographics such as sex workers and men who frequent brothels. Subcentro doctors took time out of their hectic schedules to help us conduct door-to-door HIV testing, publicized a testing session in a local community center over loud speaker to the entire town, and took us and our HIV tests to distant brothels in the fading hours of sunlight.

Each morning, Manglaralto families waved to us and young children gleefully greeted us with shouts of “Hola Ve-ee-ah-chay!” (HIV in Spanish) on the streets. The people we interacted with and tested truly welcomed and embraced us, making us feel like we had become a part of their cherished communities. As well, it appeared that the doctors had taken partial ownership of the project because we sought to work with them, not around their pre-existing schedules and preferences.

In the future, YEHCI will continue to send teams of students to Ecuador to build upon the successes of this past summer. There is much work left to be done in achieving widespread availability of HIV/AIDS education, testing, and treatment for all living in the rural, coastal Ecuadorian population. Future HIV testing interventions will seek to reach out to larger percentages of men, expand to those towns and communities with unusually high prevalence rates, and work with the Peace Corps to ensure year-round testing and educational services.

We thank all of our contributors, especially Fundación VIHDA and Manglaralto Hospital for their continued help and support of our Initiative!