Successes & Challenges Fighting AIDS in African-American Communities: An Interview with Gregorio Millett

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Taking Stock
Scientist Gregorio Millett cites successes and challenges in fighting HIV/AIDS for African Americans
by Larry Buhl

The statistics from the Centers for Disease Control and Prevention (CDC) are heartbreaking: While among all populations in the United States, the estimated number of annual infections has been declining, Black/African American gay and bisexual men still for the largest number of HIV diagnoses every year. One in twenty black men are likely to become infected with HIV in their lifetime, one in forty-eight black women, one in two gay black men.

That’s the bad news, and Gregorio Millett, vice president and director of public policy at amfAR, acknowledges the crisis for black men and women in the U.S. But when I spoke with him just before the nineteenth anniversary of National Black AIDS Awareness Day, he said that progress shouldn’t be overlooked. Millett, who served in the Obama administration’s Office of National AIDS Policy as a senior policy advisor, and was one of three principal writers of the National HIV/AIDS Strategy, said that since 1999, there has been a decline in infections for black women and stabilization in infections for gay back men.

Larry Buhl: In what other ways has the landscape changed for African-American communities over the past two decades?
Gregorio Millett: We are in a better place nationally in terms of the HIV epidemic when it comes to the number of new infections. We are in a good space in terms of policies. We have the ACA, which is still on the books. We have the National HIV Strategy still on the books. Both are intentional in a way that they direct resources to African American communities. With the ACA those with less income and less access to health care, are more likely to get access to health care. That’s primarily African-American communities and Latino communities. President Obama, under the National HIV Strategy, was intentional in calling out the disproportionate impact on African-American communities and the steps to address that. So we’re in a fundamentally different space than 1999.

But the current President has been, in the most generous interpretation, indifferent to the issue of HIV/AIDS and to Black Americans generally. How to you avoid rolling back some of those gains?
Engage our partners on Capitol Hill. HIV/AIDS has had bipartisan commitment on Capit0l Hill for both domestic and global HIV and for HIV research. The reason that some of the proposed cuts to CDC last year—I think it was $500 million in cuts for CDC HIV and another round for NIH—did not pass was because members of both parties looked at the president’s budget and said no. So funding was held neutral. We already know that this year the White House is proposing cuts to HIV research and domestic and global HIV. They are proposing everywhere across government. We ask that our friends on the Hill stand firm again and make sure those cuts don’t take place.

Despite the gains you spoke of, in terms of new diagnoses of African Americans not increasing, disparities remain. How do we account for those?
Most African-American men still live in the South. In 2016, fifty-four percent of new diagnoses in the South were among African Americans, whereas on the West Coast, only nineteen percent were among African Americans. The South is still the locus of the Black population in the U.S. and it is where we also see the fewest states with Medicaid expansion. That has implications for people being in care in a timely fashion. We also see laws on the books in the South around HIV transmission, but much more of a punitive air.
There is also HIV stigma overall, operating rather differently in the South than in other places. It’s really a combustible mix.

Can faith groups do more to reduce stigma?
Everyone has a role to play. The African American community has not been good with gay and bisexual men. The gay community overall has moved on to marriage equality and other issues. We have heard less from national LGBT organizations around HIV issues. African-American legislators nationally and locally need to talk about where HIV is and isn’t in the black community. There is a lot of work to be done to stop talking about the myths around HIV and frankly talk about what’s happening. Thankfully that dialogue started by a Black President and I hope other Black legislators follow his example.

Talk a little about how beliefs about HIV/AIDS in the African American community has changed since you started at the CDC.
When I was a younger scientist, it was assumed that the high rates of HIV infection among black gay men was due to high rates of drug use and unprotected sex and other high risk activities. My research and other researchers showed that black gay men were engaging in fewer high-risk activities than white gay men but were still more likely to be infected, mainly because of the networks they find themselves in, where there is a high prevalence of HIV, such that if you engage in one act of unprotected sex you are more likely become infected. The scientific community has moved past the victim-blaming stage, saying that if you engage in any unprotected sex or IV drug use you are at high risk for HIV without the context of the prevalence of HIV in the community. That has led to less victim blaming among African-American gay men. That is a good thing because you are seeing the science community figure out other ways to reduce the infection rate of black gay men without just focusing on individual risk behavior.

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To further reduce stigma among more vulnerable communities, amfAR has launched an online video series focused on younger people of color who have HIV. Several influential members of the LGBTQ and HIV/AIDS community across the United States shared their experience and insights on living with HIV, as well as some steps they have taken to fight the epidemic.

The latest video features Daniel Driffin, co-founder of THRIVE SS, a 501c3 nonprofit organization that combines online, traditional in-person, and social support to address issues that many same-gender-loving (SGL) men of color face surrounding HIV infection. Daniel, well known as a leader in HIV advocacy in Atlanta, where he is based, garnered attention on world stage when he addressed the Democratic National Convention in 2016 and spoke powerfully about the impact of HIV.

The amfAR Epic Voices series can be found here: http://www.curecountdown.org/epicvoices/.


Larry Buhl is a multimedia journalist, screenwriter, and novelist living in Los Angeles. Follow him on Twitter @LarryBuhl.