On Wed., Oct. 10, the HIV Prevention Conference ( presented by AIDS Foundation of Chicago's Service Providers Council ) will kick off with 'Gay, Sexy, and Healthy: Strengthening Prevention for Men Like Us' at University Center, 525 S. State. One of the speakers will be the CDC's Gregorio Millett, MPH, who talked with Windy City Times about prevention, apathy and the '80s.
Windy City Times: What will you be discussing at this forum?
Gregorio Millett: Since my research deals with Latino and Black gay men, I'll be talking about what's taking place in the epidemic with each one of these communities, what type of implications they have for intervention research and ways to incorporate intervention research so that these communities feel less stigmatized.
Some specific things that I want to discuss [ are ] that the risk factors for HIV differ between Black and Latino MSM [ men who have sex with men ] . For Latinos, the risk factors are somewhat the same as conventional risk factors: substance use, sexual risk, etc. With Black men, those traditional risk factors are not explaining why the rates of HIV are so high, and it's something that has vexed researchers for the last 25 years. One of the basic theories is that the sexual networks are different, not only in Black MSM communities, but in the Black community, period—such that people in the Black community are coming into contact with people who have higher rates of HIV or STI [ sexually transmitted infections ] than people in other communities. There's this implication that, since rates are so high in one community, people must be doing something wrong or must be engaging in greater rates of risk—and that's not necessarily the case.
I also want to discuss two issues that are somewhat tangential to that last point. If we focus on individual risk behavior, we might miss other potentially important issues that impinge on the lives of these men. We need to look at interpersonal and structural factors, such as discrimination ( whether it be homophobia or racism ) and other issues, to see how they may or may not be influencing sexual risk in these communities.
WCT: It's interesting that homophobia may play a role.
GM: The hard thing with it—and we see this with any type of research dealing with homophobia—is that the scientific community is still fairly new to trying to grapple with and operationalize issues that are on the macrosocietal level. It's tough to quantify it in some way and come up with reliable measures for it, so what social scientists have conventionally done is stay away from it. The problem is that those issues figure so prominently in gays' and lesbians' lives that, if we stay away from it, we're potentially losing explaining a large part of the equation that might be influencing HIV risk in these various communities. Thankfully, a cadre of scientists is now earnestly looking at these types of issues.
WCT: How much of a role do you think apathy has played?
GM: I'm a behavioral scientist, it's tough for me to talk about apathy. In terms of risk and apathy regarding gay men, we don't have a lot of information about that. There's some preliminary data regarding how much treatment optimism might be influencing risk behavior; unfortunately, the studies there are still somewhat mixed. There are too few of them to see a general pattern.
In terms of apathy, I think we need more qualitative research that's looking at that. There's a potential that these men in these communities might [ feel ] that the prevalence rates are so high that it's inevitable that [ they're ] going to become infected at some point. There might be some fatalism to it—but [ scientists ] don't know.
We really need to have a good study that finds out to what degree does HIV figure in the lives of these men. Are they dealing with many other issues that they would rank much higher than HIV infection? Some of these men are dealing with not having a job and a whole host of other issues that might be more pressing to them than HIV infection.
WCT: From a sociological perspective, what would you say is the main difference between now and the 1980s?
GM: There was a lot of fear in the 1980s because we didn't know what was exactly taking place; we didn't know what was putting men at risk for infection. There were so many people who were recognizably positive, and so many people who were dying from HIV. Now, people are not necessarily recognizably positive, mortality rates have decreased quite a bit and we know more about how the virus operates and about how people maybe placed at risk for it, so [ things are ] definitely different. Whether or not that may or may not play into apathy, we don't know. We [ also ] don't know if there are other issues operating that are beyond the individual.
To register for 'Gay, Sexy, and Healthy,' call 312-334-0908 or visit www.aidschicago.org/events/conferences.php. To register for the Oct. 12 day-long 'The Power of Prevention: Meeting Today's Challenges' HIV prevention conference, call 312-334-0965 or visit the same Web site.