Capital Gains

During a speech earlier this year at the White House Conference on LGBT Health in Philadelphia, Secretary of Health and Human Services Kathleen Sebelius addressed what many in an auditorium filled with health care experts knew all too well: The game plan to fight HIV in America, she said, simply isn't working, particularly among populations most at risk for the disease. 'When this administration came into office, our domestic HIV/AIDS strategy was basically to keep doing what we were doing,' Sebelius said. 'We weren't adapting fast enough.' We had lost some of the urgency we had in the '90s. And yet 50,000 Americans continued to become infected with HIV each year'more than half of them were gay men. In some large cities, half of the African-American gay men were HIV-positive.' The infection rate among African-American men who have sex with men, which according to the Centers for Disease Control and Prevention jumped by nearly half between 2006 and 2009, has alarmed many in the movement. This is not only because prevention efforts appear to be stumbling, but also because of enduring stigma surrounding gay and bisexual black men (black women, meanwhile, have also recently shown rates of infection much higher than experts had previously expected). Risky behavior is not the reason for the difference in infection rates between white and black gay and bisexual men. The real answers behind the epidemic among African-Americans are far more complex. Advocates and researchers say that understanding how discrimination, incarceration rates, health care access, and poverty fuel new infections and premature death are far more vital than a narrow focus on individual behaviors. And although they have had an obvious campaign vibe to them, the White House's series of conferences throughout this winter and spring are illuminating both the Obama administration's commitment to a new direction in domestic policy and an appreciation for the nuance that experts have urged in understanding the issue. 'I think that this White House absolutely gets it,' says Aisha C. Moodie-Mills, an adviser for LGBT policy and racial justice at the Center for American Progress. 'When you read through the AIDS strategy, you see they understand the complexities of the issues at hand.' It's not simply a matter of throwing money at the problem, Moodie-Mills explains. From her perspective, the administration is actually working hard to first identify the underlying problems among African-Americans that lead to high rates of HIV/AIDS'then spending federal dollars accordingly. But Moodie-Mills cautions that the White House needs to feel external pressure from gay Americans in order to translate that understanding into further meaningful action. The national LGBT movement's focus on marriage equality over the past few years is well-meaning, though advocates warn of the consequences of leaving behind those who are simply trying to survive. 'In many communities, black gay men are in the same place where white gay men were 25 years ago,' Cornelius Baker, national policy adviser for the National Black Gay Men's Advocacy Coalition, says of the HIV epidemic. 'If they don't believe that the larger gay and lesbian movement is attentive to their lives, why should they invest in it? Why should they participate in it?'