Health News

Is homophobia a factor in HIV racial gap?

NEW YORK (Reuters Health) - Among gay men in the United States, blacks are more likely than whites to believe that homosexuality is “wrong” - and these feelings might be contributing to the black men’s higher risk of HIV infection, researchers suggest.

According to the U.S. Centers for Disease Control and Prevention, in 2006 African-Americans accounted for nearly half (45%) of new infections in the 50 states and the District of Columbia. Also, according to recent estimates, they account for a disproportionate 24 percent of reported HIV cases among gay and bisexual men in the U.S. The reasons are not clear. Studies have not found a higher rate of risky sexual behavior among black men versus white men -- but a range of factors are likely at work.

The current study was an attempt to look at one possible social factor: the stigma attached to homosexuality.

Using data from a U.S. health survey conducted periodically since 1972, the researchers found that, in general, African-Americans were more likely than whites to report a negative attitude toward homosexuality.

In 2008, 72 percent of black adults said that homosexuality was “always wrong” -- a rate that had changed little since the 1970s. Among whites, 52 percent expressed that view in 2008, which was down from 71 percent in 1973.

A similar pattern was seen among men who reported having sex with other men. Of these men, 57 percent of African Americans said they believed homosexuality was always wrong, versus 27 percent of whites.

When the researchers looked at the men’s reported rates of HIV testing, they found that those who regarded homosexuality as wrong were less likely to have ever been tested: 36 percent, versus 73 percent of those with a more favorable view of homosexuality.

This pattern does not prove that homophobia is a factor in the racial disparity in HIV infection among gay and bisexual men in the U.S., the researchers report in the Journal of Acquired Immunodeficiency Syndromes.

But it does raise that possibility, they say. For one thing, men who know they’re infected with HIV are likely to change their behavior to avoid infecting others. Also, they’re likely to seek treatment. According to the researchers, other studies have shown that black men who have sex with men tend to prefer other black partners - who would inevitably bear the brunt of any reluctance to go for HIV testing.

“Negative attitudes toward homosexuality, either from their surrounding community or from within themselves, could make it difficult for men who have sex with men to acknowledge their risk for HIV and seek testing,” lead researcher Sara Nelson Glick, of the University of Washington in Seattle, told Reuters Health in an email.

“These kinds of studies are important,” said Francisco Roque, director of community health for Gay Men’s Health Crisis, a New York-based non-profit that provides HIV/AIDS education and services.

Such research-based data are helpful for gaining support for campaigns to address homophobia, as well as HIV/AIDS prevention, according to Roque.

However, he cautioned against seeing homophobia as an issue particular to African Americans, as the factors that go into such attitudes are many and complex.

In this study, respondents’ attitudes toward homosexuality varied according to education, income, religious affiliation and other variables. Among Americans with less than a high school education, for instance, 83 percent said homosexuality was always wrong, compared with 47 percent of those with a college degree.

Roque did agree that homophobia, in general, may be a factor in HIV transmission among gay and bisexual men. Men may be less likely to take care of their health, he told Reuters Health, “if they are hearing that they don’t matter, or if they don’t feel good about themselves.”

One issue, according to Roque, is the lack of positive media representations of gay and bisexual men of color.

Last week, Gay Men’s Health Crisis launched a campaign called “I Love My Boo,” which it says is designed to raise the visibility of black and Latino gay men, and challenge homophobic attitudes.

The campaign involves posters placed throughout the New York City subway system that feature black and Latino same-sex couples, with the words, “We’re about love, respect and commitment.”

The images, Roque said, “give a face to what’s possible for young people.”

Glick agreed that raising the visibility of minority gay and bisexual men might prove helpful.

She and her colleagues found that survey respondents who said they knew a gay person were less likely to harbor a negative attitude toward homosexuality. “This finding,” Glick said, “suggests that increasing the visibility of sexual minorities might help diminish the stigma of homosexuality, and perhaps help some men who have sex with men adopt healthier behaviors.”

It is not yet known whether any efforts to address homophobia will ultimately curb HIV rates among gay and bisexual men.

“However,” Glick said, “homophobia has many other negative consequences, so in my opinion, any effort to reduce fear and discrimination toward gays and lesbians is just.”

Even if the researchers’ suspicions are confirmed, homophobia is certainly not the only factor to blame for the particularly severe burden of HIV in American blacks. The U.S. Centers for Disease Control and Prevention says on its web site that it is presently “conducting research to better understand and plan interventions to address the social, community, financial, and structural factors that place many African Americans at risk (for HIV) and hinder access to prevention and care.”

SOURCE: Journal of Acquired Immunodeficiency Syndromes, online September 10, 2010.