In South L.A., Young Gay Black Men are Mired in Old Taboos -- and HIV
PHOTO BY AMANDA LOPEZ
In many ways, Gabriel Maldonado was the last person you would expect to contract HIV.
He grew up in "the Twilight Zone," an unincorporated chunk of county land between Compton and the 110 freeway, best known for its own Crips set and failing neighborhood schools.
His Mexican dad stayed in the picture but never married Maldonado's mom, a longtime U.S. Postal Service employee. A thoughtful and tireless black woman, she impressed upon her son the importance of reading and writing — " 'cause we got calculators and computers, so if you can't add, we'll figure it out. But you got to learn to read and write."
He grew up reading Nancy Drew mysteries and Harriet the Spy, writing stage plays and pretend newspaper stories about his neighborhood. All he wanted for Christmas one year was a typewriter, and he got it.
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When, during his junior year of college, he came out as gay, his mom said lovingly, "We was just waitin' on you."
The bright, confident young man got out of the 'hood, earning a political science degree at UC Riverside, where as a student he founded TruEvolution, a nonprofit youth-development agency. He earned his MBA at the University of Redlands and grew increasingly interested in social justice advocacy, especially related to LGBT issues. He took a seat on the Inland Empire HIV planning council, seemingly headed for great things.
So when Maldonado went in for a routine HIV test late last year, he was about as informed, aware and health-conscious as a man can be. He and the tester, a friend of his, were happily chatting away, when he heard his friend say, "So ... the test is showing reactive ...' "
The words hung in the air.
"I lost my whole cookies," Maldonado says now, laughing. "Oh goodness. I started crying. And I definitely went into an emotionally vacant space for a month or two."
How had Maldonado been infected? "I was involved with someone who ... " he says, struggling to find the words, "was not as health-conscious, and did not take the proper safety measures with their life as I did and was not aware of their status. Someone that I trusted. And it just happened."
He discovered he was infected just two months before his 25th birthday. As Maldonado well knew, HIV infections in the United States have been dropping in nearly every subgroup that is commonly tracked, with one exception: The numbers have been ticking up steadily among black men, ages 14 to 24, who have sex with men.
"I became the statistic," he says.
More and more, the face of HIV in Los Angeles and the United States is that of the young, black gay man. That trend has set off an exceedingly touchy debate among scientists, doctors, social workers, politicians, activists and gay men: Why?
Despite comprising only 13 percent of the U.S. population — only 9 percent in Los Angeles — African-Americans account for 44 percent of new HIV infection nationwide.
Starkly stated, black gay men are three times as likely to become infected as white gay men.
In L.A. County, "We're probably the gayest epidemic in the nation," says Dr. Douglas Frye, director of the HIV Epidemiology Program of the L.A. County Department of Public Health. He's referring to the fact that here, men who have sex with men (known as MSMs) make up roughly 97 percent of the male HIV epidemic, with needle use far behind as a cause.
Underlying these data is the fact that "People are really not prioritizing young black men," says Jeffrey King, a black gay activist who runs a group called In the Meantime. "We get a lot of lip service."
Michael Weinstein, co-founder and president of AIDS Healthcare Foundation, agrees: "If you decide that something is unacceptable, if you decide that the spread among black gay men is something that cannot continue as it has, and you mobilize ... we've never even had that discussion."
In L.A.'s heavily minority urban core, where a set of old social norms and fears still holds sway, the silence and lip service are killing young black men.
When Dr. Wilbert Jordan started the Oasis Clinic in 1984, an AIDS diagnosis was a death sentence, and people thought AIDS could be spread by kissing. Oasis was the only HIV/AIDS clinic in sprawling South Los Angeles. Yet even today, there aren't many more places to get treated in L.A.'s heavily black and Latino neighborhoods south of the 10 freeway.
Of the growing numbers of young people and adolescents who come to his AIDS clinic today, Jordan says, "They're poor. They're po' — they can't even afford the 'or.' That makes a big difference. It's not at all like the early, gay white community, where they basically said, 'Our friends are dying — we'll do something,' and they were able to pool their resources. They started their own organizations, they did things. This group doesn't have much."
A man newly infected with HIV, like Maldonado, is a rare sight for the doctor. Most men in the 'hood have been carrying the virus for years before they finally come in to be tested.
"I've seen one patient in 31 years of doing this — and he was white — who came in and said, 'I think I ...," Jordan recalls.
He says, "Black patients and Latino patients tend to come in late. They've been infected for years" — but many are in denial, ashamed or simply don't understand the risks.
The L.A. County Department of Public Health believes that up to 65 percent of new infections are fueled by men who are HIV-positive but don't know it. And a large number are black men who live in, and form relationships with other men in, the region's tough urban core.
Typical is the 24-year-old Latino who walked in to see Jordan a month and a half ago, healthy-looking and built like an ox. He was shocked when his test results came back: He was HIV-positive.
"He had had 44 different sex partners," Jordan says. "He'd been fucked in the ass over 100 times. He was a total 'bottom.' He never used a condom. So I said, 'Well, why are you surprised?' He said, 'Well, they all looked good.' "
Jordan was dumbfounded by his ignorance, despite all his years of caring for gay and bisexual men and confronting similar attitudes. "I said, 'You cannot look at someone and tell they have HIV!' "
Misinformation about how you contract HIV still stubbornly persists in concentrated black neighborhoods of Los Angeles. Many young men are poorly educated and often uninsured, and they rarely even cross paths with a doctor.
"You hear so many ignorant things out there," says Ronald Jackson, an HIV tester at In the Meantime. "When you administer the test, [some think] you're actually giving them the virus. Or the origins of the virus — they say, 'Is it man-made?' "
At a recent West Adams town hall meeting to address concerns about a contagious meningitis outbreak, convened by gay black activist King, one black man asked, for all the crowd to hear, "Is it possible this could be germ warfare?"
Still fresh in the minds of many African-Americans is the infamous Tuskegee experiment in the 1930s, when the U.S. Public Health Service secretly determined that 399 of 600 black sharecroppers they were studying had syphilis but never told them or treated their disease. The government health agency instead quietly studied the effects as the syphilis raged through the men's bodies and minds for 40 years.
Deep distrust of the government in the black community is still powerful, thanks, in part to the Tuskegee experiment. Some even believe the government purposely infected the sharecroppers, a false but persistent urban legend.
And there's no shortage of reasons for gay men to be suspicious of the medical establishment and pharmaceutical industry when it comes to AIDS. During the early 1990s, the drug AZT was widely prescribed to AIDS patients. It had serious side effects, including anemia, chills, nausea and even seizures, and often didn't extend anyone's life.
But profound change followed — the first AIDS cocktails required as many as 96 pills a day, many of them taken at specific times, such as two hours before eating. But lives were finally being prolonged. Now, Gabe Maldonado stays healthy by taking a single pill each day.
But at Dr. Jordan's 30-year-old AIDS clinic on 120th Street across from the Martin Luther King Jr. Care Center, gay black men seem to be far out of the loop. They don't get tested, and they don't get treated. Some don't even talk about being gay.
Academics, activists and community leaders have strained to explain why. One explanation offered by, among others, The New York Times, focuses on the phenomenon of the "down-low" black man, a masculine, "straight-acting" guy who may have a wife or a girlfriend but has sex with men, usually in secret.
These down-low men are having sex without condoms, contracting HIV and then passing the virus on to male partners — as well as to their unsuspecting wives or girlfriends.
At least that's how the story goes.
Anecdotes about down-low (or "DL") men abound. Jackson says he's heard men say, "The front is for my girl, the back is for you."
But those who study the data say this supposed black subculture is not a significant driver of the HIV epidemic.
Phil Wilson, founder of the Black AIDS Institute, the only national HIV think tank focused on African-Americans, says, "The narrative that there are these DL sexual predators, and they're responsible for spreading the epidemic in these communities, that's just not true."
Yet this false view has so stigmatized some black men that they're too ashamed to speak up and seek help.
Gregorio Millett is a senior policy adviser at the White House's Office of National AIDS Policy. A black gay man, he's sort of the Nate Silver of HIV statistical analysis. He has been aggregating numerous studies to draw out better facts, and has found no evidence that black gay and bisexual men — closeted or not — engage in sexually risky behavior more often than white men.
In fact, he says, black gay men are 40 percent more likely than others to engage in specific behaviors "to protect themselves from getting HIV."
So what is pulling thousands of black men each year into a fully preventable illness that should be dying out by now — one that is fading among most other subgroups of men?
A terrible, unseen mathematical reality is in play. Explains Millett: "A black gay man can have unprotected sex just once, but their risk is exponentially higher, just because there's so much more HIV in the black community."
A key reason for this is that black homosexual men tend to have sex with other black men — a fairly small, much more tightly knit pool than, say, white homosexual men on the Westside. Professionals have a name for the resulting disease phenomenon: "HIV is primarily a disease of sexual networks," Wilson says. "If you don't get ahead of the disease, what you have is 'community viral load.' "
The personal "viral load" of most HIV-positive patients who take medication regularly has dwindled to nearly undetectable levels today. Not only do they stand a very good chance of living long and healthy lives, such as Magic Johnson, but their virus counts are so low that they're also unlikely to pass it on — even during unprotected sex, according to the County Health Department.
But in historically black areas of Los Angeles and other urban areas, activists and those working in HIV prevention and treatment say the AIDS viral load is thriving.
Beyond the fact of a relatively small pool of black men having sex with black men is another, equally complex contributor to the stubborn epidemic: low self-esteem that dogs many poor, gay black men.
"When someone feels devalued, they want the man to say, 'I love you, you're sexy,' " says Greg Wilson, a deputy director at Reach L.A.,an HIV-prevention and treatment outreach group downtown. "They're not gonna ask the guy's [HIV] status. We tell them how to use condoms, but we don't teach how to negotiate it with their partner."
"Most folks here don't know what real love is," Jordan says. "Love is just — he's hot tonight, and his arms are wrapped around me. That ain't love."
But there's far more going on in the 'hood than a lack of love. Gabe Maldonado still remembers how he was called a "fag" on his first day of kindergarten, 20 years ago.
"I'm very animated, I'm very theatrical, I talk with my hands a lot, my voice was very high-pitched as a kid," he explains. "My gender expression was very much feminine — or what people would attribute to being feminine."
Not a day went by, between his early childhood in the Twilight Zone and his graduation from San Pedro High School, that he did not hear the word "fag" directed at him or at someone else — or just tossed around in casual conversation.
Maldonado had a supportive and understanding mother, but many of his peers aren't so lucky. His first boyfriend came out of the closet to his parents at the age of 17, about seven years ago. The mother and father reacted by kicking their teenager out, leaving him homeless on the streets.
Jordan has become almost a human data mine for what is unfolding in South Los Angeles. Over the past few years, the doctor has treated 82 patients between the ages of 14 and 24, and kept track of their personal and family histories. He tells L.A. Weekly that 70 of these young men were kicked out of their parents' house, or, more often than not, their mother's or grandmother's house — usually for being homosexual.
"In the black community, we have a strange value," Jordan says. "It is easier for a mother to accept the fact that her son is in jail for killing two people than that he's homosexual."
Jordan explains a harsh reality: Once young men are kicked out of their homes, "The place you can find is often with someone who is HIV-positive. An older man. Whom you may have snubbed two weeks ago at a bar. 'And now your little ass is coming wanting me to help you.' So he takes it out on you. 'Yeah, you can stay with me. But you gonna give up some ass and not use a condom.' And that's your choice."
A General Social Survey in 2008 found that 72 percent of African-Americans thought homosexuality was "always wrong" — an attitude that has remained steady among the U.S. black population since the 1970s. By contrast, 71 percent of the white population agreed with that statement in 1973, but by 2008 that figure had dropped to 52 percent.
That data are six years old — years that have seen profound changes in attitudes toward gay culture in America and the world. President Obama, who once supported civil unions but opposed same-sex marriage, changed his mind in 2012.
Much was made of how blacks voted in the 2008 election, when California passed Proposition 8, which banned gay marriage in the state — until the courts struck down the law last year. Blacks were overwhelmingly in favor of banning gay marriage — by a staggering 70 percent, according to an Associated Press exit poll.
The church was seen as a major factor driving black sentiment.
"The black church is the most important institution in the African-American community," says Michael Weinstein, whose AIDS Healthcare Foundation, operating clinics in 26 countries, says it is the largest such care provider in the world. He gets fired up about black preachers' influence, saying, "You have lots of preachers doing fire and brimstone on Sunday, talking about how homosexuality is an abomination."
There are a number of gay-friendly black churches, most notably Unity Fellowship Church, founded by openly gay Motown singer Carl Bean (he had a minor disco hit in 1978 with a cover version of Valentino's "I Was Born This Way"), who became a priest.
It's a running joke in the black community that, even in the many socially conservative Baptist and evangelical congregations, gay men aren't in the closet — they're in the choir stands.
Yet among black pastors and church leaders in Los Angeles and other cities, the norm is a sort of quiet intolerance toward homosexuality. That has meant that the church, the key institution in the black community and one that could be doing much to fight the outsized spread of HIV, is at best missing in action — and at worst, doing harm.
"To a large degree in the black community, AIDS has been seen as a moral issue," says Weinstein, who has made it his personal mission (one of many) to change that.
AHF's latest public information campaign involved billboards erected throughout L.A. and many parts of the southern United States, featuring a photo of Martin Luther King Jr. above the slogan, "AIDS Is a Civil Rights Issue."
Weinstein has recruited an all-star cast of civil rights leaders — including Coretta Scott King, Julian Bond and the Rev. Al Sharpton — to convince black audiences all over the country that it's time for an attitude shift.
In February, at a service at Holman United Methodist Church on West Adams Boulevard, some 1,000 people turned out for one of Weinstein's productions — many of them gay black men and their supporters, just hoping to hear it from Sharpton.
Sharpton, the once-portly political flamethrower, now a slim and widely admired national leader, did not disappoint.
"The challenge 50 years ago was the right to vote and the right to public accommodations," Sharpton boomed in his rich voice. "The challenge today is health care and HIV/AIDS, and civil rights for everyone."
He excoriated pastors for using the Bible to preach intolerance:
"When we hide behind the Scriptures, [we are] just like those that subjugated and enslaved us hid behind the Scriptures to justify racism and slavery."
Weinstein believes that with famous civil rights leaders such as Sharpton entering the cause it shows that the culture is finally "getting to a tipping point. ... When you hear Sharpton and some of these other civil rights leaders, they're in essence pointing a finger at black clergy and other people who promote homophobia. That's leadership, but it also reflects a changing attitude."
That change is increasingly clear each time a prominent black athlete, such as University of Missouri football player Michael Sam or the Brooklyn Nets' Jason Collins, comes out.
Yet many within the black community would prefer to maintain a "don't ask, don't tell" policy. "We don't air our dirty laundry, and being gay is considered dirty laundry," Maldonado says. "It's one of those taboo things we don't talk about. And because we don't talk about it, we don't engage in knowing our status."
The grip of the old ways can be strong. Jordan has one gay black patient who simply can't bring himself to take his HIV medicine.
"I couldn't accept it, I couldn't deal with it," the patient told Jordan.
"HIV is not killing you," Jordan told him, becoming flustered. "Your bad habits, your refusal to deal with it, is. And you're one of the most intelligent patients I have, one of the most accomplished patients I have."
"But," as Jordan explains his patient's seemingly baffling behavior, it's "because he's in it alone."
In 2012, an odd sight graced streets in South L.A.: a billboard depicting two muscular, shirtless black men locked in a warm embrace. They were standing on a beach, their faces nestling into each other's necks, unseen. Just above the ocean horizon was the message, "Our love is worth protecting," followed, in capital letters, by, "WE GET TESTED."
Most of the people calling black gay activist Jeffrey King to complain about it were polite.
"What is your name?"
"Um ... Jeffrey ..."
"What is your last name?"
"King. My name is Jeffrey King."
"Mr. King, take that billboard down!"
"It really came down to people not knowing what to say," says King, who designed the billboard paid for by AHF. "They were so far from understanding what it means to be gay or same-gender loving, or whatever.
"They had no concept that this [billboard] would not influence somebody who wasn't gay to be gay."
King's organization, In the Meantime, provides free HIV testing and counseling, and promotes HIV awareness. It also operates community support groups, the most popular of which consists of 30 to 60 gay black men (and one white man), who meet every Tuesday night behind the Catch One, the most famous gay club in South L.A.
"As a young black person, there's no one to talk to," says Ronald Jackson, an HIV tester for In the Meantime. "You don't know about West Hollywood."
The Catch One bar and club is so central to gayness in the 'hood that it's sometimes used as sort of a shibboleth: When a black man is arrested and booked into the Los Angeles County jail system, and subsequently claims he's gay — this in order to get assigned to the quieter, less violent wing reserved for homosexuals — he may be asked the location of the Catch One to prove he's gay.
In past decades, gay white men rejected by their families made a one-way journey to San Francisco or West Hollywood, where they found solace in a new community — a family of other gay men.
That was never the dominant narrative for black gay men. They tend to come from a more tightly knit community, where mothers and grandmothers stress the importance of family. But many felt a certain coldness from the white gay world.
In the 1970s and '80s, Los Angeles gay bars used to ask black men for two or three forms of ID in order to keep them out, according to Weinstein and others. Some still don't feel comfortable in WeHo, whether because of the music (too much techno), the drink prices or a racial mix that's still light on black men.
Maldonado and many of his peers turn out to be more comfortable than their elders in venturing to WeHo. But most don't find enough of a support structure there.
That's what In the Meantime is trying to create. "When I've talked to Jeff [King], I've said, 'Now Jeff, how do we take your model and scale it up?' " says Mario Perez, director of HIV and STD programs at the L.A. County Department of Public Health. "Because 40, 50 [men], consistently, every Tuesday is terrific. But how do we make it four, five, six hundred?"
King, though, is not a charismatic Al Sharpton with a long fundraising reach. Nobody like that has emerged to lead black and gay L.A. — yet.
King's talents lie in connecting people with people. "The kids tell me everything," he says.
And he's a guy who's always up in people's business.
"Oh, he's calling people," Maldonado laughs. "He's on that Facebook. That just shows his ability to meet people where they're at. It's not backseat activism."
One member of In the Meantime recently told King another young member was on Grindr, a mobile app often used by gay men to hook up with men nearby.
King explains, "I'm, like, 'What?' Well, I figured out a way [to bring it up]: 'I was on there the other day.' ... I open up a conversation. I always throw myself out there, lie a little here and there. It's part of the work. The therapeutic work looks a little different here."
Two other groups are doing this kind of personal bonding work in the area: the Minority AIDS Project, founded by the Rev. Carl Bean, and Reach L.A., which does HIV outreach among gay black men and black transsexuals.
In contrast with the rich programs in and around West Hollywood, there are barely enough funds to keep these three going — by all accounts, the Minority AIDS Project has fallen on hard times.
"We have tons of black millionaires," King says. "And the issue of HIV and black gay men is not a priority for them."
King says he was told by a program officer at the California Endowment, a fantastically wealthy private health foundation in control of $3 billion, that "HIV was no longer the disease du jour." According to Phil Wilson, HIV funding per capita has fallen.
"We're so cavalier about HIV," Weinstein says. "You wouldn't let somebody walk around with active tuberculosis, coughing and being untreated."
Infighting among L.A.'s health care power players isn't helping. Most prominently, Weinstein and the Los Angeles County Board of Supervisors (and its Department of Public Health) are mired in a long-standing feud — Weinstein recently accused county officials of "institutional homophobia" after the Health Department announced the meningitis outbreak involving eight people — but did not disclose that four were gay men, three of whom died.
Weinstein has sued the county many times — once over its $100,000 contract with Reach L.A. to link young black men to HIV care — saying AHF should have been allowed to bid on it. Weinstein won the case.
"It became who has the bigger balls," says Reach L.A.'s Greg Wilson. "It wasn't even about the patients. They weren't considered. It was more of a personal thing between the county and AHF."
Weinstein says, "It has nothing to do with Reach LA specifically. It's corrupt for the county to give out no-bid contracts."
Weinstein has called longtime L.A. County Supervisor Zev Yaroslavsky an "arrogant jerk." Yaroslavksy has called Weinstein a "thug."
Greg Wilson says of Weinstein's role in L.A.: "Every room I see him in, he's always negative, he's always attacking, attacking, attacking. He's great nationally, globally. But here, I don't know that they really understand the community that we reach."
But King, who gets stuck in the middle of these debates, says, "Michael wants to have a big impact. And I imagine doing this for such a long time and just really feeling like you're surrounded by a bunch of numb-nuts is hard."
Solutions, if not a cure to the HIV epidemic, can appear tantalizingly close. One program, PEP, functions as a sort of "morning-after" HIV treatment. It must be started within 72 hours of being exposed, and it is not 100 percent effective.
There is also PREP, which involves taking the HIV drug Truvada preventively. One trial showed the medication, taken daily, has a 96 percent success rate, while another found it worked only about half the time.
Weinstein has called Truvada a "party drug" and attacks the 96 percent prevention figure as fiction — because few people actually take it as directed. His comments set off yet another firestorm in the gay community, with some calling for Weinstein's head.
But Weinstein is all about making waves, and he's among the few gay leaders aggressively pushing to change the black community's silent stance on homosexuality and HIV.
"If Rip Van Winkle woke up and he walked to West Hollywood, and he was walking down the street, he would see periodicals about AIDS, there'd be posters about AIDS, everything about AIDS," Dr. Jordan says. "If he got in a cab and came down Crenshaw, he wouldn't see one damn thing about AIDS. The community does not discuss it. It's not the agenda. That's the difference."
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