Challenging Dogma


...Using social sciences to improve the practice of public health

Friday, April 27, 2007

Homophobia In The Black Community: The Underlying Resistance To Successfully Promoting Safe-Sex Campaigns Among Black Gay Men – Jerry Minor-Gordon

What does homosexuality mean?
The experience of homosexuality is certainly not new among humans as it has been around since the ancient times; however, its definition, identification, and connotation has changed over time. The term ‘homosexual’ as society refers to it today, was first documented by Karl-Maria Kertbeny in 1869 and became popular with Richard Freiherr von Krafft-Ebing's 1886 book Psychopathia Sexualis (1). Since then, there has been great debate among scientists and social theorists on what causes a person to become homosexual (the nature versus nurture argument). The debate is whether if it is a matter of choice that a person becomes gay (or if they are born that way), or if it is simply a phase that people eventually outgrow. Individuals form their own opinions about homosexuality, regardless of the scientific data that exists and unfortunately many, though not all, are in disagreement of that lifestyle.
Some people feel uncomfortable embracing issues that lay outside social norms, while others are convicted by their religious views that homosexuality is wrong and immoral. The tension that has build-up due to divide in opinions has resulted in widespread discrimination, targeted violent acts against gays, and out-casting them from society. In response to these vicious actions, several movements have arisen, both isolated and mainstream, of gay community members and supporters challenging the heterosexual social norms, fighting for basic human rights, and for gays to be recognized as positive contributing members of society. Great progress has been made for gay rights and several laws have passed that provide legal rights and protections (2,3); yet homosexuality still provokes heated discussion and volatile arguments.
The Changing Face of AIDS
The beginning of the AIDS epidemic in the 1980’s negatively changed how people viewed homosexuality. People referred to gays as ‘those people’ who were dirty, spread disease and were a threat to everyone else’s health. The truth is that everyone’s health was, and still is, at risk. Not because gays physically live among straight people posing a health risk, but because people have been careless with their own sexual encounters, not using protection and not taking the responsibility to get tested for HIV. This new epidemic has prompted public health practitioners and health agencies to create and implement campaigns to inform and educate the public on how to engage in safer-sex practices to reduce the transmission of the virus that leads to AIDS, as well as other sexually transmitted diseases. These campaigns have achieved some level of success, yet 15 years later the same basic safe-sex messages are still promoted.
What was once thought by blacks as ‘the white man’s disease’ has now infected over 40 million people globally (4), both gay and straight, and across all color lines. Although blacks comprise only 13% of the US population in 2005, the incidence of HIV/AIDS cases among blacks was estimated around 18,510 (49%) and reporting the primary route of transmission as men who have sex with men (5). These statistics clearly show that black gay men are in greatest need of an intervention. Why aren’t the campaign messages making a difference for blacks?
The Role of the Black Church
During slavery, blacks were forced to abandon their native religions and follow Christianity. Since then, even after slavery was abolished, the black church has played a pivotal role and has remained the unwavering and prevailing force in the black community. It is a central cultural institution that offers its community spiritual guidance and social order. The church serves as a safe haven for people to congregate, seek refuge, share ideas, discuss community and political decisions, and hosts non-religious events. When people have no where else to turn, they go to the church. The doctrines and views of the church prevail throughout the community and are accepted as the social norm. The black church view on homosexuality is one with which everyone may not agree, however it is what is widely recognized and most commonly adhered.
Although Christianity teaches acceptance of others without judgment, the church has often been hypocritical by discriminating and marginalizing people who do not fit into their selective mold of what a perfect Christian should be (6). The church condemns homosexuality and identifies people who live a gay lifestyle as sinners that will not go to heaven after death, rather will burn in hell (7). This has created such an uncomfortable and unwelcoming environment to openly discuss sexuality and has lead to an array of social and intrapersonal development challenges (identity crises, low self-esteem, lack of self-awareness and identification, and feeling isolated from the community). Due to the view of the church and its strong influence in the community, black gay men are facing a unique situation that has been the underlying hindrance for safe-sex campaigns to be successful.
Erikson’s Stages of Development
Being comfortable with one’s identity is extremely important to lead a healthy life, as it is the foundation of who we are, our values and how we relate to our surrounding environments. Finding or creating an identity is not an instant occurrence, rather it transpires gradually over periods of a person’s life. Erik Erikson, a German developmental psychologist and psychoanalyst, developed a theory in the 1950’s that describes the eight stages of psychosocial development that every person experiences throughout their lives (8). Each stage is categorized by a particular age range, and must be ‘mastered’ to avoid the negative consequences that result from an unsettled resolution of unhealthy psychosocial development (9). The two stages, according to Erikson, in which people search for identities corresponds to the age ranges usually targeted for safe-sex campaigns: adolescence and early adulthood.
During adolescence, men are searching for their identity, sense of self, and trust. They are concerned with how others view them and seek acceptance amongst their peers through membership in groups and sexual relationships. It is during this stage that people generally suffer from identity crisis that will stifle further development. “If the adolescent can not make deliberate decisions and choices especially about vocation and sexual orientation, …role of confusion becomes a threat.” (10)
During early adulthood, men are searching for intimacy, the fostering of stable relationships, and life-long partners. The consequences for not mastering this stage are feelings of isolation and the inability to commit to a relationship. It is extremely difficult for gay men living in a hostile, homophobic community to foster meaningful relationships (9).
Going through an identity crisis and not finding intimacy results in unresolved feelings of self-awareness and insecurities about how to fit into society. Safe-sex intervention messages therefore may not be a priority. Some men end up living a life of secrecy, will not admit to being gay, and will not participate in intervention efforts for fear of being seen and labeled as gay. Other men are in self-denial about their own sexuality because the community has conditioned them that homosexuality is wrong and they have internalized and suppressed their true feelings to the point they do not identify themselves as homosexual. For this group, health interventions targeted towards gay men are not of concern since they don’t think of themselves as belonging to that group.
Erikson’s views do not come without criticism. His theories of human development are seen though a heterosexual lens; however, the concepts are also applicable to homosexuals, as they also experience the same emotions as straight people.
Maslow’s Hierarchy of Needs
Maslow’s Hierarchy of Needs, depicted as pyramid, describes the five stages of psychological and physiological needs people experience in their lives; each stage needing to be completed before the higher stages become a priority. Once the goals in the lower level are fulfilled, then a person can advance to the next stage of the pyramid (11). Maslow believes the highest stage, self-actualization, every person should strive to achieve. It is at this stage that a person is considered whole with clear morality, accepting of facts, lacking prejudice and able to solve problems (11). It is at this stage where interventions are effective in influencing behavior change, since a person’s basic needs have been met. Each stage presents a unique challenge for gay black men to reach their level of self-actualization; and as each stage is not satisfied the more likely it is for a man to stifle in his development leading to issues of low self-esteem (10).
The lower four stages of the pyramid are known as deficiency needs and are associated with physiological needs. These include basic needs such as having food, water, air to breathe, and the need for sexual activity (10). A black gay man who is subjected to homophobic attitudes may be hesitant to seek a relationship with a man and therefore settle to interact with a woman; suppressing his true sexual feelings. This can lead to issues of lowered self-esteem, especially if the man feels he will never be able to live openly and has to conceal his sexual desires.
The second stage of the pyramid is safety needs: security of employment, family, property, and resources, as well as security of health (11). One can assume the meaning of assume health in this context, is considered sickness that has a quick onset and is easily identifiable even with limited medical knowledge; such as a cold or the flu. This stage presents a great threat for blacks who live in less affluent neighborhoods who are concerned about basic safety issues, and for gay black men living in this community presents two issues. One, the safety and security issues that all black people in the community face and secondly, additional safety and security issues faced by open or suspected gay men who are discriminated against and ostracized by members of their own community.
The third stage of the pyramid is belonging and emotional needs: sexual intimacy, having support and being accepted by society (11). Gay black men greatly suffer from lack of support by their communities since most members follow the doctrines of the church. The consequence of not having these needs met are loneliness and depression (11). The priorities at this stage are finding a place of belonging, comfort, and feeling accepted, thus messages promoting safe-sex campaigns may not be of great concern.
The fourth stage of the pyramid is self-esteem. Self-esteem means to respect oneself, respecting others and being respected by others (11). People who have high self-esteem have higher levels of self-worth and values of themselves, as compared to people who suffer from depression or feel isolated. Unfortunately, the black community’s homophobic attitudes do not respect the lifestyles of gay men. Furthermore, they do not accept gay men, purposely making them inferior, and less worthy to be a part of the community. Eventually a person will start taking the attitudes of others and internalizing those feelings which can lead to low self-esteem. A person with deficient levels self-esteem, according to Maslow, will not advance to the level of self-actualization, and therefore will not perceive health promotion messages as a priority.
Tailoring campaign messages for the real sub-group
As new health issues emerge in society, the role of public health continues to expand in order to address these issues and create ways to prevent or minimize adverse health effects. How to effectively address these issues, communicate risk, and promote health behavior changes, is an extremely important and arduous task to accomplish. Some public health programs and interventions only benefit a particular segment of the target population and unintentionally exclude the subgroups within the larger group. Other campaigns and interventions are well-organized and have properly identified a target audience, but still do not translate into improved behaviors.
In this particular situation, the groups are black gay men and the messages are tailored accordingly. However, within that group is a sub-group that is not being reached by the safe-sex campaigns. This sub-group are gay men who do not identify themselves as gay men. The Rap-it-up campaign, for example has a commercial featuring a gay black man urging the viewer to use a condom when engaging in sexual activity. The focus of the message is to influence behavior, and completely avoids the identification of gay men (12). Gay men who are in self-denial about their own sexuality are unlikely to relate to messages and interventions that target gay men. The homophobic attitudes that the black church promotes, permeates throughout the community causing black gay men to internalize and suppress their own sexuality and consequently suffer from identity crisis, be in self-denial and lack awareness. The campaigns fail to consider gay men who do not think of themselves as gay.
Community Involvement - Recommendations for improved interventions
The homophobia that persists in black communities has been the main resisting force against the success of safe-sex campaigns and interventions for black gay men. Intervention efforts mainly consist of messages aimed towards the individual – for the individual to take action and become more sexually responsible by getting tested for HIV and wearing a condom during intercourse. This approach in the black community, for even the most targeted campaigns, is not effective in promoting behavioral changes. Instead of addressing the individuals, interventions need to first address the community and their homophobic attitudes - the real source to why campaigns have not been successful.
The best way to reach people is not through advertisement or catchy slogans, but rather to sit down and talk with them. To begin, we need to include a representative from each group (gay men, straight men and women, homophobic and non-homophobic people) in the initial conversations to figure out the best way to approach that particular community. Having a range of viewpoints will provide a broad perspective and deeper understanding of the community’s values in order to develop culturally sensitive messages. It is always more constructive to plan and talk with the people who will be affected by a program, rather than talking at and planning for them. I would suggest hosting a series of discussion sessions, inviting only small groups at a time, facilitated by a trained individual from the community, to openly discuss issues and attitudes about sexuality, love, and acceptance. The overall goal is to examine their own (not the church’s) feelings and to provoke challenging conversations while advocating for people to have open minds about homosexuality. Further explaining and encouraging the group to consider that gay men are people, who like everyone else, want to be able to feel safe in their own environment, provide for their families, and experience love without the fear of being discriminated and humiliated. Perhaps appealing to the community members’ guilt of how they feel when discriminated simply because of their race or gender is effective to bring about empathy and compassion for gay men. Also, the discussions should include conversations to promote safe-sex practices for everyone, providing sex education materials, male and female contraceptives. Hopefully the message will also reach heterosexual, as well as, gay people who are in self-denial about their sexuality.
Understanding that changing how an entire community views homosexuality takes time, these discussion workshops can serve as an interim solution, making a difference in one person at a time. Once the attitude of the community changes and new social norms are established it will allow gay men to be more comfortable and confident to openly live their lives without fear of discrimination. When gay men feel like their lives are worth protecting, they will positively change their sexual behavior, and safe-sex practice campaigns will be truly successful.
REFERENCES
1. Feray, J. and Herzer, M. Homosexual Studies and Politics in the 19th Century: Karl Maria Kertbeny. Journal of Homosexuality 1990; 19 (1).
2. United States. 104th Congress. Defense of Marriage Act. House of Representatives Committee Report. 1996.
3. U.S. Office of Personnel Management. Washington, DC 2007.
http://www.opm.gov/er/address2/guide01.asp
4. World Health Organization & UNAIDS. AIDS epidemic update: December 2005. Switzerland. http://www.unaids.org/epi/2005/doc/EPIupdate2005_pdf_en/Epi05_13_en.pdf
5. Centers for Disease Control and Prevention. Fact Sheet: HIV/AIDS among African Americans. Atlanta, GA. January 2007. http://www.cdc.gov/hiv/topics/aa/resources/factsheets/aa.htm
6. Miller R. Legacy denied: African American gay men, AIDS, and the black church. Social Work. 2007 ;52(1):51-61.
7. The Holy Bible New International Version. Leviticus 18:22 and 20:13. Grand Rapids, MI: Zondervan Publishing House. 1984.
8. Wikipedia. Erik Erikson’s Biography. March 2007. http://en.wikipedia.org/wiki/Erik_Erikson
9. Wikipedia. Erikson’s stages of psychological development. April 2007.
http://en.wikipedia.org/wiki/Erikson's_stages_of_psychosocial_development
10. Krementz, J. ErikErikson: The Father of Psychosocial Development. State University of New York College at Cortland. http://web.cortland.edu/andersmd/ERIK/stageint.HTML
11. Wikipedia. Maslow’s Hierarchy of Needs. April 2007. http://en.wikipedia.org/wiki/Maslow's_hierarchy_of_needs
12. Black Entertainment Television. Rap-it-up Campaign. Washington, DC: BET.com 2007.
http://www.bet.com/Health/aboutrapitup.htm??Referrer={075A8562-234A-400A-BB5B-B2EFC7363045}

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