Young black men
the new face of HIV
Part four of The Silent Epidemic:
Black Gay Men and HIV
This week, tens of thousands are expected to converge on Atlanta to celebrate Black Pride Week, one of the largest in the country. For many gay black men, the celebration is mixed with a harsh reality. According to CDC, 1 in 2 gay black men will be diagnosed with HIV at some point in their life. In this five-part column series, you will hear from five gay black men—including two who are HIV positive—who will share their personal stories and perspectives on why the epidemic has continued so long and why no one seemed to care. This is Part IV.
For two days early last month, Daniel Driffin hunkered down at the Westin Hotel working to create ways to improve the lives of young people ages 13-24 who are living with HIV.
As the 31-year-old co-founder of the non-profit THRIVE SS, this is Driffin’s life as he tries to make good on a mission to ensure black gay men no longer feel ashamed about who they are or live in isolation because they are HIV positive.
Driffin has been waging this public fight for nearly a decade now, exposing both his dreams and despair for the sake of making a difference.
His reason is both selfish and altruistic.
Driffin is HIV-positive, diagnosed in the summer of 2009, when new HIV infections among black gay men 13 to 29 years old exceeded new infections among white men who have sex with men aged 13-29 and 30-39 combined.
According to the Centers for Disease Control and Prevention, black gay men like Driffin were the only population group in the United States to experience a statistically significant increase in new HIV infections between 2006 and 2009. While HIV incidence was relatively stable among men who have sex with men overall, new HIV infections among black gay men ages 13-29 increased 48 percent. The HIV infections for those men rose from 4,400 HIV infections in 2006 to 6,500 in 2009.
Although the analysis did not examine the factors driving the trend, other studies suggested a range of possibilities, including: higher proportions of young, black gay men unaware of their infection than other ethnic groups; stigma of HIV and homosexuality, which can hinder utilization of HIV prevention services; limited access to healthcare, HIV testing and treatment; and higher rates of some sexually transmitted disease that can facilitate HIV transmission.
These are all the things Driffin is waging war against.
Thirty years ago, none of this may have mattered. During the darkest days of the epidemic, 1980s and ’90s, AIDS was almost always fatal. Now, not only are more people learning their status, but people are also living longer thanks to updated treatment guidelines in 2012 that recommend treatment for all people with HIV infection.
That was not the case in 2009 when Driffin received his diagnosis.
Driffin had been getting annual HIV tests since his 17th birthday, the year he had his first sexual encounter.
But when the April 25, 2008, date rolled around, Driffin didn’t notice until nearly two months later.
“One day in June, I thought to myself I should go get tested,” he said. “I walked into the agency, pricked my finger and 15 minutes later, I was told I was preliminary positive.”
Driffin was shocked.
“Well, you know what this means?” the prevention specialist asked.
Driffin told him that he didn’t. He was confused. If someone just walks into an agency to get tested, how would he know what it means, Driffin thought.
“It’s like your doctor showing you an X-ray and expecting you to know how to decipher it without any medical education,” Driffin remembered.
That ended the conversation.
Driffin walked out and called a friend, a nurse practitioner who is also black and gay. For the next hour, he listened to Driffin. His was a beatable diagnosis, he told him, but he would have to decide what he wanted to do.
Driffin called more people that night, subconsciously building his support network and re-emerging from the closet he’d retreated to on the day his parents sent him off to Morris College in Sumter, S.C.
It wasn’t easy.
Driffin had known he was “different” since elementary school. But it wasn’t until 2002, while in middle school, that he began to accept that he was gay.
“I started working at a library in the eighth grade and one day putting books away, I started reading different ones, especially those with homosexual themes,” he remembered. “I borrowed a couple of the books and took them home.”
When his grandmother and legal guardian found one, she asked if he was gay.
“I said, ‘Yes,’ and she said, ‘Regardless, I want you to be the safest, and I love you,” Driffin said. “I was lucky to have my grandparents not throw me out on the street.”
He was also lucky to attend a high school — Wilson Magnet in Rochester, N.Y. — that made it easy for him to come out, to be in a place that was affirming for LGBTQ students and encouraged them to be themselves.
Now, he was leaving that for a Baptist-owned historically black college.
“To be from the North was one thing,” he said. “To be gay at a religious institution was another. ”
Driffin retreated to the closet. Revealing his sexual orientation, he believed, would disqualify him from joining the fraternity he’d dreamed of pledging since the early days of Rochester Step Off, a black Greek competition.
Despite his fears, Driffin excelled both socially and academically at Morris. He consistently made the Dean’s List. For three years, he was captain of the Honda Campus All-Star Challenge. He was a member of the Science Club and Show Choir.
“That allowed me to be with students for whom sexuality wasn’t the first thing they worried about,” he said.
In 2008, he graduated at the top of his class, earning a bachelor of science degree in biology.
He was traveling back to Rochester with his grandmother for a job interview when his grandfather suffered a stroke. They immediately returned to South Carolina.
It was there that Driffin received his HIV diagnosis.
“It was scary and daunting,” Driffin said. “I decided I wasn’t going to be sexual again because it was easier not talking about HIV than to go through the disclosure process every time.”
Three weeks later, Driffin returned to the same clinic for a confirmation test. It came back positive.
He was 22, one of the thousands of young black gay who made up the 48 percent increase in HIV diagnosis from 2006 to 2009.
The news was numbing.
“I felt like a statistic,” he said.
Then he had a conversation with a young man from Oregon. Rather than look at this like a baseball game, look at it like it’s bowling, the man told him. In baseball, it’s three strikes and you’re out but in bowling, the more strikes you have, the better your score.
Driffin said he was born with two strikes against him. One for being black in a white world. Two for being gay in a heterosexual world. The third strike occurred when he tested HIV positive.
“Life could have very well been over for me with all those odds against me,” he said. “In bowling, you strike to get a strike for each frame for a perfect score. It was a shift. I think that should’ve come from the person who tested me in June.”
To receive medication at that time, guidelines required that a patient’s white blood cells, which help protect the body from infections, had to be under 350. The longer HIV is in the body, the number of white blood cells decreases.
Instead of medications, patients at initial diagnosis were encouraged to continue going to the doctor to have conversations about risk reduction: using condoms, eating better, having less stress.
Driffin’s viral load was detectable, meaning the virus was in his bloodstream. There was no need for medication, doctors told him.
By 2012, he said, his viral load had dropped but his white blood cellls had started to decline. Doctors finally prescribed a single dose regiment.
Driffin was sure now that there was something amiss within the medical system.
“I wasn’t the only one who didn’t get medication to suppress the virus,” he said. “More times than not, doctors are not recommending medication for black gay men immediately after testing positive. If someone is not in care, can’t afford care or have poor experiences with medical providers, they are more at risk for transmitting HIV.”
These are the biggest drivers of the continued increase in HIV infection among black gay men, Driffin believes.
According to a Lancet study, black gay men are six times more likely to have an undiagnosed HIV infection and 60 percent less likely to receive treatment. That, in turn, means their condition is more likely to deteriorate, and they’re more likely to pass on the virus to other black men they date because of smaller sexual networks.
In 2009, Driffin began working at a Florence, S.C., community health center, providing HIV tests to black gay men. When a CDC testing grant ran out 18 month later, Driffin moved to Atlanta where he continued work at a community-based organization.
He left there to manage a 670-person research study for six years examining new approaches to HIV testing.
“While doing that, I was still seeing more than 100 people yearly who were either testing positive for HIV or sexually transmitted disease,” Driffin said. “I began thinking about different approaches to assisting brothers to stay negative or, if they were positive, how to get them in care.”
So he and a group of friends co-founded the Young Black Gay Men’s Leadership Initiative and later the support group THRIVE SS or Transforming HIV Resentment into Victories Everlasting Support Services. Currently, there are some 700 black men living with HIV in the THRIVE SS network in Atlanta. Other networks, including one for women in Atlanta, are located in Oakland, Calif., Nashville and Washington, D.C.
He hopes to create non-traditional ways to solving HIV in the black community by “beefing up research capabilities and support systems here and across the country.”
Driffin, who is currently working to complete his master’s degree in public health at the Morehouse School of Medicine, wants black gay men to know they don’t have to live in isolation with HIV.
“You live in systems created against you, and you have the power to change it, he said. “Involve yourself in the policy structures. Place yourself on boards and agencies that decide healthcare in your community. Ask questions. If something doesn’t make sense, say it doesn’t make sense. Speak up when you hear inaccuracies about black gay men.”