The risk of contracting HIV is one in two if you are a black man in the US who has sex with men. This statistic is all the more startling because so few people are aware of it.
“I was feeling very sick” says Daryon McCurdy, “so I went to the doctor and they said, ‘Okay, you have gonorrhea and acute HIV.’ I was so shocked.”
The 25-year-old was diagnosed with HIV in August 2017, three years after moving to Atlanta, the black gay capital of the US. The city provides a coming-of-age setting for men from across the US. For those from the south, it can be lifesaving.
The deep south is a notoriously tough place to grow up black and gay, as McCurdy knows too well. In his hometown of Huntsville, Alabama, he was outed by rumours that started at school and ended with his parents. “My stepdad said ‘If I hear one more thing about you being gay in middle school, I’ll ship you back to your dad’.” Years of bullying at school and at home were to follow.
For men who grow up gay in the south, this kind of shame and stigma makes them less likely to seek information about, and protection for, their sex lives. Closeted sex is inherently dangerous, because it happens in places where it is not safe to talk openly to people who may be able to help. What follows can be a lack of knowledge about safe sex or a huge underestimation of the risk of infection.
At 21, McCurdy followed the path of many like him and moved to Atlanta to start afresh. There is no doubt that the city provides refuge and a chosen family for those not accepted at home. But its concentration of gay black men presents dangerous health risks.
Black gay men tend to socialise – and therefore have sex – with other black men. And the smaller the pool of potential partners, the more quickly HIV spreads, especially if it goes untreated.
For most people, the “height of the epidemic” denotes the late 1980s and early 1990s. When white men got access to HIV medication – preventative and therapeutic – the pool of people with the virus became much smaller. Today, a white gay man in the US has a 1 in 11 chance of being HIV positive.
As the virus abated in the white population, it also dwindled in the public consciousness. Even charities set up to combat HIV and Aids changed focus: their attention turned to the equal marriage fight.
But, in the black gay community in the US, HIV is at an all-time high.
Tori Cooper, an HIV prevention specialist and trans campaigner in Atlanta, says, “We forget that there were black people suffering and dying at the very beginning as well. So we became an afterthought even from the beginning.”
This is reflected in funding and outreach. The deep south received $35 (£26) per HIV-affected person in private grants in 2014, while the national average was $116.
While the HIV and Aids epidemic took many lives and years passed before it began to fade, medical advances mean it should not pose the threat to any community that it now does. An HIV epidemic is medicinally simple to treat. PrEP, a drug that prevents people from contracting the virus, is taken once a day and has been found to offer close to complete protection when taken as prescribed.
Drugs for people who are HIV positive, such as Genvoya which McCurdy takes, are just as impressive. They reduce HIV in the bloodstream to such a point that it is impossible for carriers to transmit the virus. Both drugs work even in cases of unprotected sex and the evidence for their effectiveness can be seen in the white gay community.
The disparity between the two communities is a legacy of the focus on white gay America from the beginning of the epidemic. But it represents a lack of understanding and care for the real centre of the epidemic, or even acknowledgement that an epidemic exists.