All the World’s a Stage
ACCELERATE!’s “As Much As I Can” Amplifies the Voices of Black Gay Men through the Arts to Expand the Dialogue About HIV
by Candace Y.A. Montague and Chael Needle
Photos by Harley & Co.
“All the world’s a stage,
And all the men and women merely players;
They have their exits and their entrances,
And one man in his time plays many parts…”
Four Black men and one Black woman, interconnected by a highly stigmatized yet misunderstood virus. On a balmy January night in Baltimore, an intimate crowd of twenty-plus people got to witness how these friends struggle, dream, fight, cry and rejoice together. As Much As I Can, an immersive theater play, began its brief tour in Charm City.
As Much As I Can is one of the innovative, community-driven projects supported and funded by ACCELERATE!, a four-year, $10 million, collaborative health-impact initiative from ViiV Healthcare that works to support the health and well-being of Black Americans, a community that has been heavily impacted by HIV, and, especially, Black gay and bisexual men, and men who have sex with men, in two cities hardest hit by HIV, Baltimore and Jackson.
The approach of As Much As I Can is unconventional right from the start. Audience members are separated into groups by wristbands and guided by the actors themselves to different opening scenes. As the play goes on and the audience visits scenes, the ties between the characters begin to bind the storyline together. And they tighten around the audience, drawing them closer to the cast, closer to the truth, and closer to an emotional denouement. The show will go on for two more days before heading south to Jackson, Mississippi, to start the process again with a new and captive audience and local actors from the community joining the principles.
Immersive theater is an interactive tool designed to bring the audience into the performance and encourage participation. This form of storytelling creates a deeper imprint in the mind of the receivers and makes a durable impression. You’re not just watching a play, you’re experiencing it. The adventure is made to push those uncomfortable conversations into the spotlight so that people can have a clearer picture of what living with HIV/AIDS is like for black gay and bisexual men. The audience goes to the clinic, the barbershop, the club, the church and even the bedroom with these characters for a deeper look into the conflicts, both external and internal.
The audience members walk into each scene breaking through that “fourth wall” in order to witness the action, the agony and the exhilaration within a few feet of them. Marc Meachem, Director of External Affairs (North America) for ViiV Healthcare, says there’s a purpose for this design: “Immersive theater experiences are designed to break down the ‘fourth wall,’ where the performance happens in the midst of the audience and involves audience participation. This approach not only alters the course of the experience itself but also stirs genuine emotions in people so that they are more likely to remember the issue or topic and be inspired to take action.”
Immersive theater re-imagines audience engagement much like ACCELERATE! is trying to re-imagine engagement in prevention, testing, and treatment.
Breathing Life into the Numbers
Currently, Black gay and bisexual men face not only a high incidence rate of HIV but also barriers to sustained engagement with care. One in three Black MSM is living with HIV in the United States, with the CDC estimating that one in two Black MSM will be diagnosed in their lifetime if current trends persist. Only twenty-four percent of Black MSM who have tested positive stay engaged in care. Thus, only sixteen percent of Black MSM have achieved viral suppression from adherence to anti-HIV medications.
More specifically, Baltimore had the tenth highest HIV diagnosis in the nation in 2014 and thirteen percent of MSM were living with HIV in 2012. In Jackson, the numbers were even more dire with the city having the fourth highest HIV diagnosis rate in the nation in 2014 and thirty-nine percent of MSM were living with HIV between 2012–2013 (the highest in the nation).
As Much As I Can seeks to go beyond the science and statistics, addressing the lives of Black gay and bisexual men holistically and authentically so that the audience helps create the message they most need to hear. The theater piece emerged from the ethnographic research conducted by ACCELERATE! in both communities, and relied on sustained dialogues nurtured by organizations and individuals. It was created with the help of the Jackson State University Department of Speech and Theatre (Jackson, MS) and The Community Cares Project of LIGHT Health & Wellness Comprehensive Services, Inc. (Baltimore, MD). Says Meachem: “I think the answer to addressing the incredible and enduring disparities in HIV, among Black men as well as Latino men, is going to come from those men. And when I say ‘those men,’ I’m talking about going outside of the care community. So there’s the healthcare provider, the clinic, the ASOs, and all of that, and they’re good and important. But I think when you look at all the work that’s been done, and you look at that [estimated] 1 in 2 lifetime incidence rate for Black gay and bisexual men, we’re not going to close that gap with science alone. Closing that gap is going to involve people. And the people who we need to involve are Black gay and bisexual men.”
Those numbers need voices behind them. Accountability is a crucial part of advocacy. Meachem strongly encourages people to advocate for their needs. “When we talk about the systems that provide care, again it’s around holding those systems accountable and saying these are the things that we need, these are the things that prevent us from remaining in care. Whether it’s knowing where to go when you move and you’re new to town; whether if it’s if you find that a clinic isn’t a good fit for you and you need another clinic. Making sure that those issues that aren’t working as well are the issues that are raised and elevated and shared. So jointly holding society accountable both in the communities and the systems that provide care is important.”
So, what are the needs that should be addressed to help with engaging people in care and keeping them in care?
One need is an environment, inside and outside of healthcare settings, free of stigma. Notes Meachem about what ACCELERATE! learned from interviewing Black gay and bisexual men and other research, stigma can be silencing; individuals are hesitant “to talk about or disclose their HIV status, to disclose the fact that they’re gay, to disclose the fact that they’re in love, frankly.”
Other needs include a compassionate, humanizing healthcare environment and the security of privacy, especially in small cities and towns.
An important need is an individualized approach to healthcare. Says Meachem: “Different people want different things, right? Some people want just the facts when they approach their care provider: ‘What do I need to do? When am I coming in for my next blood draw? Show me the pictures of the pills….Goodbye.’ They don’t want the pat on the back; they don’t want the ‘I feel your pain’ approach. Other people…can’t even think about starting treatment until they deal with some emotional issues or social issues that might prevent them from getting care. They might not be in stable housing [for example]…a host of issues that interfere with them engaging in care.”
Addressing these needs is important. If people don’t see that their needs are being met in a healthcare setting, they are less likely to come back or spend time and energy searching for another clinic. If options for healthcare are already limited, they may fall out of care entirely.
From its research, ACCELERATE! seeks to invest in four truths: feelings of empowerment and support networks need to be strengthened; sex ed needs to be made relevant; testing is a critical opportunity for care engagement; and navigation services need to be made more robust.
After the Lights Go Up
As Much As I Can was positively received by the audiences after each performance. Many people raved about the superb acting and the emotions they felt while experiencing the play. Other audience members praised the education they subliminally collected that night. During an open discussion after the play, the audience and actors shared their revelations. Audience dialogue is critical to the success of the play, says Meachem. “We feel like the engine that is going to drive reducing these disparities is dialogue, participation, and engagement by Black gay and bisexual men, in both their communities and the systems that provide them care.”
Moderated by Kali Lindsey, member of the Content Guidance team for ViiV Healthcare, the actors spoke about how doing this play pushed them out of their comfort zones and challenged their personal advocacy. “I feel like I have so much knowledge that I did not have before. When I talk about the piece I talk about the crisis and what’s going on. I find myself talking less about the ‘gig’ and more about the fight that we’re in. It’s really kinda changed everything. It’s not just a gig. It’s my fist in the fight. I feel like when I talk to my friends it’s a chance to educate people. Before this I knew nothing. Now I feel so empowered.” Monique Scott, who played trusted friend Voya/Shawna. Actor Aaron Tisdale, who played a quiet barber in the barbershop scene, says playing this character made him more reflective. “I’ve been in situations where I was called faggot or sissy because of my mannerisms. People can be so judgmental because of that. So playing that character made me reflect on that. We judge each other based on experience when we should actually love each other for it.”
One of the biggest challenges in theater is playing a role that is the complete opposite of yourself. Actress Roxie Johnson, a Baltimore native, claimed she hated playing the loud, rude, dispassionate, judgmental receptionist at the clinic. “She’s everything that I’m not.” Cory Gibson, heterosexual actor who started with the cast in New York, says it took some work for him to play drag queen Larry/Miss Hope Chest but it also inspired him. “As a straight black man from Texas I can say that it’s a lot of straight people who don’t have the courage to speak up for people that are gay and in situations. I feel honored to be in this production and to be Miss Hope Chest, in drag. I’m a straight dude and I speak up. I speak up for the goodness inside of people. We have to be responsible for that. Straight people who keep their mouths closed are just as bad as the people with their mouths wide open.”
ACCELERATE! affirms that real change around HIV and its impact will only be achieved through co-creation. With As Much As I Can, the initiative modeled collaboration from the first step to the last—drawing on ethnographic research, engaging and training local co-captains within the community to help assemble groups of men and elicit their concerns, working with playwrights on the script, enlarging the community of concerned stakeholders in the cities so that Black gay men and those who are caring for them are not going it alone, reflecting on and refining the script based on community feedback, and amplifying the voices of men living with and vulnerable to HIV so that challenges like stigma and universal truths about love, family, faith and self-acceptance resonate with others.
Launched in 2015, ACCELERATE! hews to ViiV Healthcare’s mission to go beyond the development of new HIV medications and address all the needs of individuals living with and impacted by HIV/AIDS. Solutions to problems along the continuum of care, from prevention to treatment, are patient-centered but also importantly people-driven. The practice of involving those most affected is essential for creating lasting and positive transformative change—after all, it’s people who need to act. And that’s how As Much As I Can flips the script.
After the performance, the creators hope that audience members continue the co-creation after they exit the play, when individuals potentially transform what they know and what they have learned from others into change that makes a positive difference as they navigate their relationships, communities, and healthcare settings. Shifts need to happen, too, within community-based organizations and healthcare sites.
Drivers of Hope
The statistics, however, can seem daunting, and HIV care researchers have pointed out that lasting engagement in care depends on having hope—having hope that you can prevent HIV, or having hope that you can lead a healthy life with HIV. Does ACCELERATE! seek to counter this potential sense of hopelessness? “Absolutely,” says Meachem, breaking the problem down into two parts.
Individuals do need to be educated about the statistics. But, Meachem says, his team has learned that statistics can drive individuals’ motivation toward a self-empowered approach to health and representing their lived experiences. “We’ve heard a number of people say that when they got a positive diagnosis, they didn’t want to be a statistic,” he says, adding that these individuals wanted to make clear that they were living their lives, living out universal hopes and dreams. “They were looking for a relationship; they thought they were in love; they thought they were in a committed relationship.”
And to nurture hope, says Meachem, there needs to be a greater awareness about advances in HIV medications and what it actually means to live with HIV. Some people, says Meachem, are relying on older narratives—about AIDS as a death sentence, about AIDS treatment with high pill burdens. “At the same time, when there’s a certain level of awareness that treatment has evolved and that there’s even this one pill a day you can take, people still [sometimes] have that selective memory of the way things were and how bad they were, and that can sometimes get in the way of people engaging in treatment.” Distrust in healthcare institutions (stemming from betrayals like Tuskegee) also “still weigh on people,” he adds.
A crucial part of our mission, says Meachem about ACCELERATE! and ViiV Healthcare in general, is “about telling people that treatment has evolved, that treatment today is better than treatment in earlier days, and about things like PrEP, and about things like Treatment as Prevention, because that stigma we talked about, it’s also within a community, between people who are HIV-positive and HIV-negative. I think that increasing the level of knowledge and discussion around these facts and hopefully bringing this up more will help decrease the stigma, ultimately. I think that will be a driver of hope.”
For more information about ACCELERATE!, log on to: https://us.viivhealthcare.com/emaccelerate-em-initiative.aspx.
Chael Needle is Managing Editor of A&U.
Candace Y.A. Montague is an award-winning freelance journalist based in Washington, D.C. Her work has been featured in a number of print and online publications including The Washington Post and The Grio.com. Follow her on Twitter @urbanbushwoman9.