CDC Studies Homegrown HIV Prevention

African-American men who engage in unsafe sex with men ranks as the leading way HIV is transmitted among blacks. That is according to the Centers for Disease Control, which is trying to foster homegrown, out-of-the-box intervention techniques to curb the trend. Phill Wilson, head of the Black AIDS Institute, and Cleo Manago, founder of bmxny.org, an online forum focused on same sex issues that particularly affect black men, discuss the challenges of reaching and educating black men about safer sex. Manago has developed an innovative approach to HIV prevention that the CDC plans to study.

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TONY COX, host:

I'm Tony Cox. This is TELL ME MORE, from NPR News. Michel Martin is away.

In a few minutes, food for thought and thoughts on food from a couple of chefs who set the tone for a variety of taste buds in some of America's casinos. Yes, casinos.

But first, the risky behavior among some black men who engage in sex with other men - unprotected sex. The Centers for Disease Control says that male-to-male sex is the single major contributor to HIV infection among African-Americans. And when you consider that blacks account for about half of all Americans living with HIV and AIDS, making certain that black men engage in safe sex is of major importance to the CDC.

So it's open to new, outside-the-box thinking on interventions. The CDC is now funding studies on what might be called homegrown intervention ideas for African-American men who have sex with men.

To talk about the apparent need to think differently, I'm joined now by Phill Wilson, the head of the Black AIDS Institute, who joins me from Southern California, and by Cleo Manago, who developed what he calls the Critical Thinking and Cultural Affirmation HIV risk behavior intervention. He runs the AmASSI Centers for Wellness and Culture in Harlem, Baltimore, L.A., Chicago, Atlanta, the Oakland East Bay area and Johannesburg, South Africa. Both of you, welcome to the show.

Mr. PHILL WILSON (Founder, Black AIDS Institute): Thank you very much.

Mr. CLEO MANAGO (Director, AmASSI Centers for Wellness and Culture): Thank you, Tony.

COX: Phill, I'm going to begin with you. Why is it that so many black men apparently understand that HIV is a huge risk when they engage in unprotected sex with other men, and yet they do it, anyway?

Mr. WILSON: Well, Tony, I think that it's important to note that while certainly, black men engage in unprotected sex, as does white men, black men don't engage in unprotected sex at a higher level than other racial ethnic groups. I think that's important to put out there.

COX: Why is that important?

Mr. WILSON: It's important because it puts the issue into a context. And the context is this: We have a high prevalence of HIV in black communities today because black communities have been neglected over the long haul of the AIDS epidemic. As a result, the bar for prevention is much higher in black communities than it is in other communities. We have to have a higher degree of behavioral change. And that's why the kinds of interventions that Cleo's designing and that the CDC has committed to support are critically important.

COX: Well, let's talk about that intervention that you have designed, Cleo, what is that method, and what was it that attracted the CDC to it?

Mr. MANAGO: Well, as Phil mentioned, the word context is very important. We found out as early as the early '90s that a lot of the men who were entering agencies for services knew how HIV was transmitted - through, you know, body fluids, particularly semen and blood. That was not a mystery to them. Though they were intellectually clear about HIV was transmitted, they behaviorally and emotionally had some conflicts that would short circuit their capacity to use what they know in terms of what they do.

So knowing that, we developed programs at the center that actually address these issues with the intention of figuring out what to do to change this epidemic.

COX: Well, give us a brief description of what some of those specifics are.

Mr. MANAGO: Well, some of the specifics are based on that some of these men, the fact that they know that HIV exists, but that they have confusion around their self-concept. They have some confusion around their manhood. They have a lot of displaced emotional issues that they're working or not working on, which creates a certain level of disorientation. And...

COX: Well, let me ask you this, Cleo, because we did not use the term gay with regard to men having sex with men. And from your perspective, as I understand it, that's a critical distinction to be made. Why?

Mr. MANAGO: It's a very critical distinction. One of the problems with this disease is that it's been framed in a gay identity agenda context. And the gay identity, in terms of affirming that, has been the entree into which the community, including the black community, has often had to deal with this issue.

MSM, which means men who have sex with men, is a very diverse group of men. These men include men who have been in prison, men who identify as gay, homosexual men who don't identify with or as gay, bisexual men, men who have been involved in sex with other men for survival purposes around drug abuse or financially. And it's a very vast group that, unfortunately, over time, has been thrown under the rubric of gay, despite the term MSM, and they've been typically alienated from services - including in the black community - because of the frame of reference in terms of identity.

COX: Phill Wilson, talk for a moment if you will about those distinctions and how significant they are in terms of coming up with a way, a plan, an intervention, if you will, like that one that Cleo was talking about, that will really make a difference.

Mr. WILSON: Well, I think that it's important for us to look at HIV for what it is. Now - that it is a public health threat, and so we need to meet people where they are, wherever they are. And we should not impose identity issues on them. We need to separate our biases, our cultural biases and race biases or sexual-orientation biases and look at behavior. And that allows people to integrate behavioral change.

And that's why it's so important to actually address people in the terms in which they identify themselves. That allows folks to take responsibility. Denial is a major part of the challenge, and people are more able to deny their behavior and how their behavior contributes to the spread of the disease if they can say that term does not describe me.

COX: My last question is for you, Cleo. In terms of this intervention, are you just now beginning to try it, to see if it works? Has it already worked, and that's why you got the money from the CDC to pursue it further?

Mr. MANAGO: We piloted the intervention in South Central, Los Angeles in the early '90s. And based on the pilot, it was quite successful with transforming the behaviors of 80 percent of the men involved with the pilot. To qualify to go into the study, you had to be someone who tested high in terms of having HIV knowledge and tested low in terms of how you behaved and what you did with your sex life, whether you protected yourself or not. That was our target group.

And as a result of the CTCA intervention and the work that we did with them, 80 percent of the people in the study, of our subject pool, changed their lives. And we checked with them again over three months, a six-month and 12-month period, and consistently, among over 70 percent of the people that were among the initial 80 percent that was, at that point, permanent behavior change.

COX: Cleo Manago of the AmASSI Centers for Wellness and Culture joined us from Georgia Public Broadcasting in Atlanta. Phill Wilson, the head of the Black AIDS Institute, joined us from NPR West in Culver City, California. Gentlemen, thank you both.

Mr. WILSON: Thank you.

Mr. MANAGO: Thank you, Tony.

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