In Cleveland, the Rock and Roll Hall of Fame as well as the Terminal Tower will glow red as part of this day's events.
I cannot help but think about the challenges and contradictions surrounding HIV in 2011. Despite all the advances in medicine and science, disparities remain in HIV care and outcomes in the US and around the world. Medications have been developed which provide those with HIV infection the ability to control the infection and lead healthy, productive lives. However, many of these medications are still not readily available to those in areas of greatest need, including SubSaharan Africa. Here in the United States, minority populations, especially young African American MSM still have the highest rates of HIV infection, and rates of HIV transmission may continue to climb.
Last month, I had the great fortune to participate in a two day conference at the Center for the Elimination of Minority Health Disparities at the State University of New York in Albany. At the invitation of Dr. Robert Miller, the Center's Director and Associate Professor of the School of Social Welfare, myself and five other colleagues invested in minority LGBT health spoke on the conference theme of "Health Disparities in Sexual Minorities Along the Life Cycle: A Beginning Community Discussion." What was striking about this experience was not the topic, nor the statistics on HIV infection or health disparities facing LGBT people, especially LGBT Persons of Color, but that all of the speakers acknowledged and understood the intersectionality of sexual orientation, race, gender. gender identity/expression, age, and ability status and their effects on health, health care access, health behaviors and health disparities.
One of my colleagues from this meeting, David Malebranche, MD, an Associate Professor of Medicine at Emory University wrote on his observations in an electronic article entitled " Black Same Gender Loving Men and HIV: Plantation Politics, Resiliency and Defying Gravity." Dr. Malebranche wrote that he observed:
*Initiatives for “LGBT health” that actively deny the role of race and culture in sexual expression and identification
*Federal meetings on HIV that bemoan the horrific statistics among Black SGL men, yet only 2/30 people at the table during these discussions are Black and SGL, including myself.
*Realizing that I am only one of a handful of Black SGL medical providers that do clinical HIV work in this country
*Hearing that a student health center at an Black male historically Black college has no young Black male medical providers
*Listening to stories of young Black SGL men working in environments supposedly dedicated to addressing the racial HIV disparity, yet the white heterosexual and gay male leadership only sees them as window dressing and use them as “key informants” to gain access to a “hard to reach” and “at risk” population
*Black SGL junior researchers and faculty being railroaded by both White gay men, White heterosexual women and Black heterosexual women who use key code phrases like “feeling threatened” and “felt unsafe”
The authors of the Institute of Medicine's report on LGBT health framed their research on four central constructs: the minority stress model, the life course perspective, intersectionality perspective and social ecology perspective. In this conceptual framework, the minority stress model calls attention to the chronic stress that sexual and gender minorities may experience as a result of their stigmatization; the life course perspective looks at how events at each stage of life influence subsequent stages; the intersectionality perspective examines an individual’s multiple identities and the ways in which they interact; and the social ecology perspective emphasizes that individuals are surrounded by spheres of influence, including families, communities, and society.
Until our health care and scientific institutions take into consideration these perspectives, health disparities will likely persist, especially for those populations most marginalized and pathologized in our society. This is why I believe health care equality is a necessary for eliminating health care disparities - and health care equality only begins with universal health care. Health care equity will be the result of fundamental changes in the way Medicine and Science approach the affirmation and care of LGBT persons, including LGBT People of Color, as well as re-evaluating how scientists and federal agencies engage and fund research on disenfranchised and medically vulnerable populations.
Many years ago, one of my mentors, Dr. Melanie Tervalon, taught me the concept of Cultural Humility. Cultural humility is the concept of allowing the patient or research participant to be the expert and teach the "teacher." I know now that while this idea was new to the practice of Medicine, and perhaps to this day is still a foreign practice for many medical providers, this idea has been a central practice of Social Work. Perhaps we all can learn a bit more from our clients, patients, and research participants if we just listened actively and tried to hear what they are really telling us. Perhaps then we can turn the tide of the HIV epidemic and other health disparities.
For those of you who are out there - I see you. I hear you. I am listening.
Henry Ng, MD
For more information:
Center for the Elimination of Minority Health Disparities website:
http://www.albany.edu/cemhd/index.php
Dr. Malebranche's electronic article:
http://www.facebook.com/notes/david-malebranche/black-same-gender-loving-men-and-hiv-plantation-politics-resiliency-and-defying-/287303607969228
Cultural Humility:
http://info.kp.org/communitybenefit/assets/pdf/our_work/global/Cultural_Humility_article.pdf
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