NAPWA and I personally salute the CDC for reporting Wednesday what we all already guessed: the number of new HIV infections is level for the country as a whole but is steadily rising in young gay Black men. Tom Frieden spoke for all of us when he said, “We’re very concerned about this trend.” As an openly gay Black man who has lived with HIV for twenty-two years and seen friends and partners die, I wholeheartedly agree: we have to change this.

Studies show that young gay Black men are at least as likely to use condoms as their non-Black peers, so we cannot blame the rapid spread of HIV among them on riskier behavior. On the contrary: it is driven by the high number of young gay Black men already infected and the high number of them who do not know they are infected. The special impact of HIV on these young people is caused by structural issues in American society that mainstream politicians and press don’t like to talk about – especially in this Tea Party-driven political climate.

Structural issues are always hard to talk about. Poverty and prejudice are harder than any. But let’s face facts: HIV’s disproportionate impact on African-Americans and other Americans of color is the price this country pays for letting color mean poverty, and poverty mean substandard healthcare and health literacy. And HIV’s disproportionate impact on young gay men has everything to do with stigma and homophobia, which discourage young men from learning their status and seeking treatment. Let those two problems come together and you have the perfect storm.

We need to address unequal economic and educational opportunity, which keep poor people poor, but that will be a generation’s work. In the mean time, all lower-income Americans, White and Black, straight and gay, need fairer access to healthcare and support services. Achieving that, in this political climate,  means driving home relentlessly the objective truth that three-quarters of HIV-related healthcare costs are borne in the public sector, and it costs the public less to test aggressively and treat early than to do nothing and let more people get sick. Our best defense in the coming deficit reduction negotiations is a good offense: it costs more to do less, and we can prove it.

We need to address stigma, too, and Washington is not the only place we have to do that – although repeal of DADT was a great step forward, and we look forward to an eventual Supreme Court decision throwing out DOMA. We also need to work with faith groups and leaders in communities that have traditionally been unfriendly to same-sex sexuality, to spread the word that it’s more important to save the lives of a generation of young Black men than it is to worry about what they do in bed.

And we need to work with those who have been the target of stigma and don’t want to hear what anyone else has to say about their intimate lives unless it comes from a very trusted source. Our Washington, D.C.-based Bayard Rustin Project trains openly gay, openly positive young Black men to do outreach in their own social networks, spreading the word about risk awareness and the need to get tested more often than people in less heavily infected populations, and helping those who test positive navigate the healthcare system to find the treatment and services they need.

The great promise of expanded testing, especially in groups that already have a high incidence of infection, is that most people who learn they are positive change their behavior to protect others, and people who are in treatment with undetectable viral load are less likely to infect others, even when their safer behavior sometimes lapses. Young gay Black men who already live with HIV are uniquely qualified to reach their at-risk peers with the Take the Test, Take Control message. The Bayard Rustin Project is working among D.C.’s young gay Black men, and it should be a model for peer outreach across the country.

Wednesday’s CDC report is a call to action. We lost a generation of young men in the first fifteen years of this epidemic. I was there. I saw it. We can’t let it happen again.

Frank J. Oldham, Jr.
President and CEO
National Association of People With AIDS