Black people account for almost 40% of people living with HIV in the U.S., despite only representing 12% of the population.

To address this disparity, Emil Wilbekin — the founder of Native Son, a platform created to inspire and empower Black gay men — assembled a panel of Black HIV activists and health experts during the last World AIDS Day to discuss how the medical, media, and queer communities can engage the topic of HIV among Black people with greater effectiveness. LGBTQ Nation attended the discussion.

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Wilbekin spoke with David Malebranche, senior director of global HIV medical affairs at the HIV pharmaceutical company Gilead; Dominique Morgan, a transgender content creator, artist, and queer activist; Byron Perkins, a queer activist who was the only out gay player in the 2024 NFL Draft; and
Ashley Cobb, a sexual health expert and writer.

(The following conversation has been edited for brevity and clarity.)

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Emil Wilbekin: Where do you see the biggest structural, cultural, and social barriers in Black Americans still grappling with HIV prevention and care?

David Malebranche: I think [what we’re seeing] right now, in this current time, it’s basically the administration and policies … are kind of decimating everything from the research infrastructure, to the implementation science, to the community funding, to academics and what they can do… and we may not see some of the ripple effects until a few years down the road.

It’s traumatizing enough, seeing people lose their jobs, seeing community-based organizations lose funding, seeing people have less access than they even did before to HIV-treatment and -prevention services. That’s a huge problem, But … if you look at the states that don’t have approved Medicaid and don’t have Medicaid expansion, that’s a huge thing. About 50% of people with HIV get their HIV services through Medicaid and the AIDS Drug Assistance Program, [the] Ryan White [HIV/AIDS Program], etc. So not having that in certain states where half of the new cases of HIV are being diagnosed is problematic.

Finally, our healthcare system just in general [is a barrier]…. I don’t mean simply just the problems that we’re seeing with healthcare insurance, with cost of medications, with access to care … but the interactions between healthcare staff and people that walk through the doors…. We have to do some training to the human beings that sometimes serve as the biggest obstacles to getting people the care that they deserve.

And I think from a medical perspective, we need to actually focus on primary care… that means getting general care providers, physician assistants, nurse practitioners, family practitioners, internal medicine doctors to take care of both HIV prevention and then also take things on with treatment, because once a person has a relationship with a clinician, that relationship is golden.

Sometimes … if you get diagnosed with HIV while you’re seeing your primary care person … they shunt you off to another person — that can be traumatic. A lot of people with HIV, especially for Black people navigating the medical system, there’s enough BS going on in medical systems with racism and discrimination that we have to deal with. So once we find a provider, and if we get diagnosed with HIV, we don’t want to have to go to somebody different, because that relationship means a lot. We may not be able to talk about that with our family, with our coworkers, with our friends.

Byron Perkins: There’s definitely a stigma that is directly attached to HIV through the Black community. I feel like there was a 2020 consensus that said that over 400,000 Black men were infected with HIV in the US alone: That’s one in 16 men, and that’s one in three gay Black men. So with all that information and people still not getting the help that they need, there’s a disconnect.

So the disconnect probably exists … between the healthcare providers and the community. The community feels as if healthcare has been predatory to them. If you look throughout history, Black people have usually always been the victims of malpractices from doctors. So there really needs to be, like, a bridge … [in] that cultural bond between healthcare providers and the Black community, specifically the gay Black queer community, in order for us to reconcile any type of trauma that’s happened…. and also just making sure that we as a community have these discussions, to make sure that we’re knowledgeable, that we’re not ignorant to the topic, that we’re not spreading misinformation….

We have to understand that HIV… is not discriminatory. It doesn’t care if you’re Black, white, Latino, Hispanic, it affects everyone. It doesn’t even care if you’re straight…. We have to stop and detach the gayness or homosexuality directly to HIV, because that’s not fair…. I feel like once we get rid of the labels, once we get rid of the talking points of, “Oh, it’s a gay disease. Oh, it’s a gay Black disease,” specifically, that’s very harmful language…. Once we start getting away from that avenue of approach, it’s going to be better….

Ashley Cobb: So we don’t talk about sex, right? It’s very hush-hush. It’s very taboo. So … if we don’t talk about sex, then we’re not gonna be able to talk about HIV or STIs… People feel so much shame about having sex, particularly having sex outside of, you know, whatever, like you feel like [is “right”]: “Oh, I’m not heterosexual,” then there’s this other stigma that comes along with that, so you’re not going to talk about it. We cannot prevent HIV if people have to hide who they love and how they love. So we have to make it, make people feel comfortable and let people know that it’s okay to have sex, there’s nothing wrong with having sex, and how you have sex is also fine in order to be able to overcome the stigma.

Most of my work is done with cisgender, heterosexual women. So I think one of the biggest stigmas with women that we see with HIV is that [the epidemic] is over, there’s only certain type of women who acquire HIV. And so my job is to let people know that you’re either someone who is HIV-positive, or you’re someone who is HIV-possible, right? And if you’re someone who is having sex — regardless if you’re married, because being married is not a prevention method, right? No matter if you’re monogamous, [because] monogamy is not a prevention method, right? — that you too can acquire HIV, you know…

A lot of us see it as something that, “No, I’m a good girl,” whatever that means. “I don’t have that type of sex. So it’s something that [I] don’t have to worry about.” So I try to help [people] by having conversations like this on my platform, to help them understand that you too are not as safe as you might think.

Wilbekin: Transgender individuals have faced disproportionate burden of the epidemic, and what do we get wrong in public conversations about their specific risk factors and needs?

Dominique Morgan: The most platformed in large platforms’ experience with trans-ness are white trans folks, but most directly impacted by people’s misunderstandings and the way that people engage in their phobias and their biases lands on the body of Black trans folks and, historically, Black trans women, because we are most on the front lines. Right? Not that it doesn’t on other folks, but it’s most on the front lines…. I believe the Black trans femme experience is classified in this sexually deviant manner.

I also remember that this type of stigma felt like it existed on the bodies of Black queer men in the ’80s and the ’90s… When we look at this hierarchy of oppression, what allows me to have grace for my brothers is that no one wants to be the group that is piled on when it comes to like, “These are the reasons that our community can’t be respected,” right? “These are the reasons that people treat us poorly. These are the reasons we’re not engaging in quality health conversations.” And just naturally, I think it rolled downhill to Black trans folks.

The stigma of your entire life being framed in sexual deviancy removes your humanity. And as a formerly incarcerated person as well, I know that when people can remove your humanity, it’s easy for people to throw you to the side. It’s easy for bad things to happen to you, and people be like, “Oh, that sucks. But you know this person who was doing sex work, yes, it’s sad that they were killed, but you know what? They probably shouldn’t have been doing X, X, X, and X.”

They’re failing to see the life of us [Black trans women], the humanity of us… There needs to be a world where people do the work to realize that one version of trans-ness you see does not mean that’s the entire version of trans-ness, you see. And I think that comes from a conversation, that comes from opportunity, that comes from platforming, that comes from authentic relationships….

So how do we do authentic relationships with black queer men specifically? That’s where our solidarity needs to tighten. We, as a black trans woman, what is my responsibility to y’all as my brothers, to make sure that when things are happening or conversations need to take place, that I’m speaking up? And then what is your responsibility, not just to speak up, but to amplify, to talk, to be excited about the great things that we are doing?… You can’t erase a person’s humanity if their humanity is on full display, and that is the strategy I think we need to be implementing.

[Let’s] start not with the struggles, but the great things about us [Black trans women]…. Allyship is like being a trade at this point. It’s very it’s a very cursory set … [Allies] might give you a little bit of what you need, but it’s very extractive … [for] information. Information just handed to you doesn’t give you the ability to discuss the topic in a way that feels natural, right?… Authentic relationships help that happen.

People are so excited to be allies that they rush and they grab information, and they’re not really positioned, because it’s great when someone asks you a question and they’re in and they’re affirming your perspective. But what happens when you are on a show, on a platform, and someone wants to challenge that? If you don’t have a deep, rich understanding, you’re not able to also hold the line and be in solidarity. But [start] with the great things, because allyship usually is based in saviorship, and so they’re just like, “These are the atrocities.” … You should be able to ramble off like 10 great things about a Black trans woman.

Black men in our lives make our lives better. And we’re talking about health. We’re talking about wellness. When you’ve been exposed, and you can call your brother, and he can go to the clinic with you, right? The access of Black gay men in the conversation of HIV is drastically different when compared to Black trans women, right? And so knowing about who we can be in our greatness and being able to describe that the same way we should be able to, that’s where we begin. And maybe say, once a month, you go sit down and have a meal with a girl, right?

Emil Wilbekin: What language and framing do you recommend … to discuss topics concerning HIV/AIDS, such as PrEP and testing, in ways that reduce stigma and are culturally relevant across black communities of different ages and gender identities?

Dominique Morgan: I don’t think we get to a space where we’re ending this epidemic if we don’t connect how everything is connected, that you can’t focus on making sure people are complying with their medication if they’re not housed. There’s not a world where, when people weren’t caring about possible food stamps [they’re] not going [adhere] well [to] certain medications… they need to eat something when they take that medication, right?

And we can’t not think about incarcerated people living with HIV and AIDS and wondering, “Why can’t we get PrEP inside of these federal prisons?” So doing the work is to acknowledge that these tendrils create true opportunity for transformative change. [That’s] something that I hope to see happen, and that’s going to take a lot of collaboration, and hopefully this kind of breakdown of funding resets people to where it’s not so adversarial.

Byron Perkins: I don’t know if you guys ever filled out an HIV questionnaire form: It’s like, “Have you ever been exploited, per se? Are you exchanging your body for monetary compensation? Are you exchanging your body for housing, things like that?”

If we come to the realities of situations and circumstances that people have to deal with in the real world — survival and some of those things might be necessary — it’s also bringing to life, not just the reality of those situations, but also making sure that we’re not shaming those people… The biggest thing that is attached to HIV is shame, and that needs to be cut at the root.

Ashley Cobb: [We need to] just get away from framing [HIV prevention] as something that is like, harmful and risky. For starters, we can lean more into the pleasure aspect of it. For example, when you talk about PrEP, and particularly with black women, like on ads, usually the black woman is there with like her good friend, and you don’t see her as someone who has sex and enjoys it and that could might use [PrEP]. So reframe it from like, “Oh, I’m I’m taking control of my sexual health, because I too, as women or whomever, I have sex, and I enjoy having sex.” So framing it as that would help.

David Malebranche: Not everyone is an influencer, not everyone is a physician, not everyone is a sexual health educator, not everyone is living with HIV. But there are small, tiny things we can do…. There are small things that happen between the gaps. You don’t have to create a community-based organization. You don’t have to do a big intervention. There are people that will be doing that, but sometimes it’s between the gaps in these smaller interactions that we have where a lot of that meaningful influence. You don’t know if you affect one person’s mind, you change one person’s perspective, the ripple effects that can have moving forward….

[Fear-mongering doesn’t work.] The medical community needs to hear that, because the medical community is the worst at fear-mongering. And I even had somebody on social media hit me up because they tried to bring up PrEP to their primary care clinician, and all the clinician said was, “Well, you don’t want renal concerns, and you don’t want this, and you don’t want that, and your kidneys are this, and you shouldn’t take I’m not going to recommend it for you…”

And I was like, “Dude, you need a new clinician.” If you start off negative immediately, instead of saying, “What are the positive aspects of you wanting prep or wanting to employ an HIV prevention method?” …. The medical community, our communities are probably on board with that, but the medical community really needs some enhanced education.

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