When asked, Dr. Carl Bell defined a "family" as a "network of mutual commitment." The National Institute of Mental Health uses this same definition.
This definition is one that most aptly applies to the types of "families" that LGBTQ individuals create as well as many of those in marginalized racial, social and economic groups.
Bell and Willo Pequegnat co-edited a collection of essays Family and HIV/AIDS: Cultural and Contextual Issues in Prevention and Treatment, by Springer books.
The book's main premise is that there is "evidence that family strengthening-prevention intervention can increase the likelihood that youth can be prevented from engaging in risky behaviors that lead to HIV infections."
Bell compared this type of social intervention strategy to the same kind of strategies adopted by Jane Addams more than 100 years ago in Chicago.
"After the Chicago fire, there were large waves of European immigrants coming to the city," Bell said. "As it turned out, the domestic homicide rate was 75% higher in those immigrant communities than in other communities. Jane Addams developed settlement houses. These individuals learned socio-emotional skills. For example, if you find out your wife might be cheating on you, it is not a good idea to kill her. The children of these disrupted and fragmented families were also affected."
Bell further explained that a juvenile brain first develops the limbic system. This is the same system that causes a human's fright, flight or fight response. Although Addams did not know it then, this overdeveloped limbic system and underdeveloped frontal lobe of the children of troubled families was exactly what she was dealing with at the turn of the last century.
"Children under the age of 26 are all gasoline but have no brakes and no steering wheel," Bell said. "Brakes and a steering wheel during these younger ages are found within the community and within their families. Read any ancient literature and those people knew that, though they did not know the biology behind it, they still knew it."
In essence, families that better monitor their children's behavior, teach children appropriate social and emotional skills, and improve the personal relationship between "parent" and child, keeping those children protected from trauma and victimization, like bullying and domestic violence, have a better chance at preventing HIV than "families" who suffer a dearth of these essential skills.
"If a kid is going to engage in risky behavior, it doesn't matter what race or socio-economic status they hail from," Bell said. "It's all the same kid. It is up to the adults to improve their communication and connectivity with children. If you're going to pursue anything serious in your life, you need a team. Changing behavior is extraordinarily difficult.
"When you're younger, you don't know what the hell you're doing. You may understand the difference between right and wrong but you haven't developed the capacity to weigh the consequences of your actions."
Bell pointed out seven field principles, as he called them, that can help not only actual parents strengthen their families but can also work within the self-created families of LGBTQ individuals.
"These principles will only work if they are both deliberate and intentional," said Bell. First, we need connectivity to each other. Second, we need access to both ancient and modern science and technology. Third, we need a sense of self-esteem. Fourth, we need social and emotional support and skill building. Fifth, children and young adults need protective adult shields. Sixth, we need to be sure to minimize the trauma of young people. And finally, we need to rebuild the "village" and reweave the social fabric of a community.
These principles are based on research done in South African communities as well as on the many decades of field research from Bell himself. "We went to South Africa to help and the Zulu people basically asked, 'Who the hell are you?' We're Americans. So we have money. If you want some of it, you'll calm down and listen. As it turns out, the principles worked," bell said.
Bell found that young people who engage in risk-taking behavior more often than not come from social groups that are products of "multiple deficiencies." Bell opined that, "Whether you're Black, gay, poor, a female or an immigrant, you can either conform to that deficit or you can observe, 'I am being denigrated and only I will define who I am. What happens to me does not define who I am.' This is taking a frontal lobe picture, an adult picture as opposed to taking a limbic or young adult or child's picture."
It does "take a village" to raise our children and Bell's research and theories are now finding that when done properly, these children, with the proper direction from their "families," not only are less likely to contract HIV, but that this involved a host of other societal ills that also are less likely to be present.
"When we wrap these kids up in a homeland community system, like when we say, 'Stop it! I'm your mother!' or 'Stop it! I'm an adult!' it turns out that such behavior modification over time actually works. Family strengthening-interventions also reduce youth violence, substance abuse, suicide rates and high school drop-out rates, in addition to lowering the infection rate of HIV," said Bell.
Despite these revolutionary studies, we may be years away from implementation strategies for family-based HIV-prevention and treatment.
"Science must be popularized in the public consciousness," said Bell, "before it can become public policy."
But the climate for prevention of disease and societal ills is shifting.
"We are slowly turning helplessness into hopefulness. There is actually a non-partisan push for prevention," Bell said.
The preface of Family and HIV/AIDS: Cultural and Contextual Issues in Prevention and Treatment hypothesized that "the causes of behavior are multi-determined and without a model of health behavior change that involves multiple levels of culture, society, social class, ethnicity, family dynamics, developmental stages and personality and biological dynamics our programs to address HIV risk factors in families will fail."
As Bell had put it, our futures and the futures of our children are determined by our own actions. "We should be focused on practicing medicine not money or focused on health and not disease."
This story is part of the Local Reporting Initiative, supported in part by The Chicago Community Trust.
