This article originally appeared on Tonic in the US
The stigma that comes with HIV has prevented a lot of people from seeking treatment, or even entering facilities that test for it—and this is a part of why we have nearly 1.1 million people in this country unknowingly living with the virus, with the risk of potentially spreading it to others.
As someone who's been in healthcare for years—working my way up from a community health care worker to a director of testing and counseling—I've learned that I couldn’t afford to be shy when fighting an HIV epidemic that is estimated to hit nearly half of black men who have sex with men (MSM). Black women are still the highest group infected of all women, and Latino MSM have a contraction rate of 24 percent over their lifetime—numbers that are disproportionate in comparison to our white counterparts.
It was while working at one of the oldest black community-based organizations fighting HIV in the country that I learned the importance of going into the community and becoming a familiar face people saw. Building trust with people who have been jaded by poor treatment from the medical industry is a necessity to any advancement in the work.
As a black queer person myself, I worked in the same community in Washington, DC, that I socialized (and dated) in. Twice a week, I would take my traveling screening kit—including HIV, Hep C, gonorrhea and chlamydia tests—to a local bathhouse. For those unaware, a bathhouse is similar to a spa, some with rooms and spaces dedicated for sexual activity to take place both privately and publicly. The one I tested at was, for all intents and purposes, an adult sex club and spa. It, just like most bathhouses, brought in all types of clientele from every race, class level, and age demographic.
The bathhouse was one of my favorite locations to work in, because it brought necessary advocacy into an environment where STI transmission could happen at a higher rate. Testing there also allowed people who may never come to a clinic for treatment take a vested interest in their sexual health. Facilitating this was one of my responsibilities as the director of testing.
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One of my favorite discussions to have with people there was about harm reduction, which in this case, meant recognizing that sex is going to happen, so how do we teach principles that reduce a person’s risk? Sex education in schools is lacking—it’s even worse for those who are of an LGBTQ identity because there may be no education at all targeted toward them. Abstinence-only sex ed, which has been proven time and time again an ineffective teaching method, is still a very large part of the conversation for much of the country. Harm reduction, in the context of safe sex practices, is a much more realistic approach to saving people and/or improving their quality of life.
In the bathhouse, my harm reduction conversations included the importance of condom use, since some people were likely to have multiple sex partners during a single night. Other discussions were about how if you insist on having oral sex without a condom, at least use one for anal intercourse—the risk of transmitting an STD through anal sex is higher. In a traditional testing environment at our clinic, I would deal with clients who weren’t willing to give full sexual history out of fear of being shamed. However, in this environment people were much more willing to discuss past STIs and inquire about PrEP or other treatments.
Most testing environments include people being fully dressed, which made this environment much different. My setup was in the main room where people walked around with a towel wrapped around their waists or naked. When a person agreed to be tested, they and I would go into the bathroom together to do the session, which typically lasted 15 minutes. During this session, I would prick their finger to run the HIV test as well as the Hep C test. The client was also required to do an anal swab (that they did themselves), and I conducted the final swab, which was oral, to detect any other STDs.
While attempting to change the culture around HIV by working in the community, I found my own mind expanding and was able to apply the lessons learned to myself. The bathhouse pushed me past my own boundaries and fear of sexual exploration. I was timid about these environments, more fearful of what people would think if I was there. It wasn’t until I started seeing friends coming there while I was working that I was able to break some of the stigma I was quietly carrying—stigma centered in how gay men are viewed as more sexually deviant and reckless, and how attached those views were to establishments like this. I also realized how important is is to acknowledge subcultures like ballroom, leather, kink, bathhouse—bringing testing into these worlds and building trust with the people in them.
Knowing the daunting rates of transmission among LGBTQ people of color, I take what I learned from working at the bathhouse and apply it to much of the work I do now on a national level as a writer and advocate. We have continuously experienced the out-of-touch rhetoric of health officials as well as their lackluster actions to help us live our healthiest lives. There are budget cut attempts and no policy, yet lofty statements about ending HIV by 2030.
Those of us in the field know that no matter what’s going on at the top, we have to work on a micro level, going into those vulnerable communities that need us the most and building trust from people who are often viewed as sexually deviant—or, much worse, as just a number.