Reclaiming Our Future - Black Youth Project

ReclaimingOur FutureThe State of AIDS amongBlack Youth in AmericaBy Dr. Cathy J. Cohen,Alexandra Bell and Mosi IfatunjiBlack AIDS InstituteSeptember 2005

Reclaiming Our Future: The State of AIDS among Black Youth in Americais a publication of the Black AIDS Institute, 1833 West Eighth Street,Los Angeles, California 90057-4257, 213-353-3610, 213-989-0181 fax,info@BlackAIDS.org., www.BlackAIDS.org. © 2005 BAI. All rightsreserved. The slogan “Our People, Our Problem, Our Solution” is atrademark of the Black AIDS Institute.Views and opinions expressed in this publication are not necessarilythose of the Black AIDS Institute. Publication of the name orphotograph of a person does not indicate the sexual orientation orHIV status of the person or necessarily constitute an endorsement ofthe Institute or its policies. Some photographs in this publication useprofessional models.Reclaiming Our Future: The State of AIDS among Black Youth inAmerica is designed for educational purposes only and is not engagedin rendering medical advice or professional services. The informationprovided through Reclaiming Our Future: The State of AIDS among BlackYouth in America should not be used for diagnosing or treating a healthproblem or a disease. It is not a substitute for professional care.Special thanks to Andrew Dilts.Printing of Reclaiming Our Future: The State of AIDS among Black Youthin America is supported, in part, by a grant from the John M. LloydFoundation, www.johnmlloyd.org.Rev. 1.0

Table of Contents5Chapter OneIntertwined EpidemicsLiving in an Environment of Risk11 Chapter TwoSex and the EpidemicOur Aversion to Reality23 Chapter ThreeToo Many UnknownsDrugs and HIV31 Chapter FourPinned Down, Locked UpPoverty, Prison and Black Youth39 Chapter FiveSilencing the TeachersSex, Education and Abstinence47 Chapter SixA Bad Rap?The Role of Hip Hop Media52 About the Black AIDS Institute

CHAPTER ONEIntertwined EpidemicsLiving in anEnvironment of RiskIIt was, perhaps, the defining moment of2004 for Black America. Entertainmentgiant Bill Cosby took to the podium at aceremony marking the 50th anniversary ofBrown v. Board of Education and lashedinto poor African Americans. In Cosby’seyes, the civil rights movement’s work hasbeen wasted, because the community’s“lower economic people are not holding uptheir end in this deal.” As proof, he citedrepeated examples of the debased state ofBlack youth. “People putting their clotheson backwards: Isn’t that a sign of somethinggone wrong,” Cos asked, later answering,“The white man, he’s laughing.”Cosby’s controversial remarks touched offa firestorm of debate within the Black communityabout the state of Black youth culture.Some argued he was scapegoating and—asMichael Eric Dyson pointed out in a followupbook—that he was doing so while abusingthe facts about things like drop-out ratesand teen pregnancy. 1 But few argued withthe basic truths that drove Cosby’s frustratedoutburst: Black youth are in a state of crisis.When we think of the multiple challengesAfrican American youth face, many of ourminds rightly turn to mass incarceration,failing public school systems and an economywithout living wage jobs. Clearly, our community’syoung people are disproportionatelyaffected by these and other social ills. Together,they dim our children’s horizons, limittheir opportunities and, broadly, make theirpursuit of happy, healthy lives more difficult—andin some cases impossibly daunting.But in the following pages we will highlightanother side effect of this broad crisisthat we have too often overlooked. Ultimately,these collected forces have added upto make Black youth the new face of AIDS inAmerica.Today, people under the age of 25 accountfor half of all new HIV infections eachyear. Within that group, African Americansaccount for 56 percent of new infections. 2We must begin to recognize HIV/AIDSas one of the leading challenges to thesurvival of young African Americans. Butultimately, this epidemic cannot be separatedfrom the countless others our youth faceevery day. This report highlights some of thekey places that HIV intersects with the largersocial challenges Black youth navigate. Itdissects how both public policymakers andthe industries that shape popular culture have

Intertwined Epidemics 7The Hot Spots:Gay Menand StraightWomenWhile the threat of HIV must be understoodas a danger to the lives of all AfricanAmerican young people, the numbers areespecially troubling for certain groups in Blackcommunities—young gay and bisexual menand young African American women.The BoysIn June, the CDC released results from areview of youth HIV diagnoses in the 25 stateswith longstanding HIV monitoring systems,covering the years between 1994 and 2003.Among 13 to 24-year-old men, new diagnosesfell by 30 percent in the first four years of thestudy. But they rose again, by 41 percent, between1999 and 2003. What drove the trend?Black gay and bisexual men in their early 20s.Among 20 to 24 year old men who have sexwith men, new infections shot up 47 percentbetween 1999 and 2003. Of those new infections,60 percent were among African Americans.The GirlsThe same June study found good news amongyoung women overall. During the ten-yearperiod, new HIV diagnoses among girls andyoung women aged 13 to 24 dropped by 20percent. But the good news is dampened forAfrican Americans, since our young womenrepresent the bulk of what new infections didoccur.As of the end of 2001, African Americansrepresented 68 percent of all HIV diagnosesamong 13 to 24-year-old girls and youngwomen.Sources: CDC. “Patters of new HIV/AIDS amongadolescents and young adults in 25 states.” Presentedat 2005 National HIV Prevention Conference, oralsession. June 13, 2005.; CDC. HIV/AIDS Surveillancereport, v. 13, n. 2, table 8.«that young African American women wereeight times more likely than young Latinasand seven times more likely than young whitewomen to be HIV positive. 7 More recent datafrom the CDC indicates that African Americanfemales comprise 72 percent of all youngwomen newly diagnosed with HIV betweenthe ages of 13 and 19 and 66 percent of allyoung women newly diagnosed with HIVbetween the ages of 20 and 24. 8Americans have gotten used to the ideathat there is an easy solution for everything.But to truly understand the impact HIV/AIDS is having in Black communities, especiallyamong youth, we first have to recognizethat there is no magic bullet that will endthis epidemic. We must abandon the huntfor easy targets—men on the “down low,” hiphop music, Internet dating—and face all ofthe uncomfortable truths and intertwinedpressures that put young Black Americans atgreater risk for everything from homelessnessto HIV.We know that young people who live inpoverty, who have dropped out of school,and who are homeless are more likely to beforced to make decisions that will put themat risk for transmission of the virus. Everytime a young woman who lives in povertyfeels like she cannot demand that her malepartner use a condom when they have sex,because she worries that he will leave her andstop providing the financial support on whichshe depends, then the potential for transmissionof the virus increases. And every timeyoung people who are homeless or in need of

8 Reclaiming Our Futurea fix decide to trade unprotected sex for foodor drugs or shelter, they put themselves andothers at risk of infection. Our fight againstAIDS is not a singular one; it must include,and make central issues of, poverty, jobs,education, housing and other factors.We also know that the rates of HIVand AIDS in prisons and jails are estimatedto be three to eight times higher than theyare among non-incarcerated populations. 9That means that every time a young AfricanAmerican man or woman is incarcerated theyenter an environment with higher rates ofHIV and AIDS, possibly increasing their riskof infection. Without attention to the escalatingrates of incarceration in Black communitieswe will never be able to rid Black communitiesof the threat of AIDS.What We Must DoIncreasingly, African Americans in generalare recognizing that HIV is wreakingdevastation across our communities. Thosewho have joined the fight against HIVand AIDS in Black communities are comingto understand that it is a difficult andmultifaceted problem—but that it is also awinnable war. With this report, we aim toarm those people with the information theyneed to get there.Each of the following chapters exploresome of the most persistent questions surroundingthe Black youth epidemic. How dosex, drug use, poverty, incarceration, violence,hip hop and other factors contributeto the virus’ spread among African Americanyouth? What can organizations, leaders,parents and individuals in Black communitiesdo to halt it? And what must policymakersbegin doing if we are to see the end AIDS inour lifetime?While these are complicated and difficultquestions, we already know some neededsteps: Reject Defeat. We must build a newsense of urgency in Black communities, sothat no one accepts the idea that the presenceof HIV and AIDS is inevitable. Start Talking. We must make ourhomes, schools, churches and neighborhoodssites of open and honest discussionabout what sometimes can be uncomfortabletopics—sex, drugs, poverty and culture. Thesurvival of young African Americans dependson this. Demand Information. We must ensurethat all young people, but in particularAfrican American young people, have theinformation they need to make decisions thatwill protect them and save their lives. We canno longer allow those with little investment inBlack communities to limit the informationyoung Black people receive in schools andcommunity-based programs. Get Tested; Get Treated. We must makesure that more African Americans knowthe how, why and where of HIV testing. TheCDC estimates a quarter of people living withHIV don’t know it—and thus are more likelyto spread it unwittingly. African Americansare more likely to learn their status only oncethey get sick, which severely diminishes thelikelihood of successful treatment. AfricanAmericans with HIV are seven times morelikely to die from it than whites. Defend Smart Public Policy. We mustdemand federal and state legislators providefull funding for programs like the RyanWhite CARE Act, which funds hundredsof AIDS service organizations around thecountry, and Medicaid. We must also insistthe programs that have a proven track recordof reducing the transmission of HIV—programslike needle exchange—be adopted andfunded across the country. See the Big Picture. We must understandthat the fight against HIV and AIDSis actually a broader fight against an environmentin which poverty, homelessness,unemployment, incarceration and violence

Intertwined Epidemics 9exacerbate the risk young African Americansface daily, including their risk for HIV andAIDS.Notes1. Dyson, Michael Eric. Is Bill Cosby Right?: OrHas the Black Middle Class Lost its Mind? New York:Basic Civitas Books, 2005.2. Office of National AIDS Policy. Youth and HIV/AIDS 2000: A New American Agenda. Washington,DC: White House, 2000.3. Nahnahsha Deas. Advocates for Youth.“Adolescents and HIV/AIDS” fact sheet. January 2003.4. Centers for Disease Control and Prevention(CDC). Pediatric HIV/AIDS Surveillance, L262 slideseries, slide #11.5. CDC. “HIV/AIDS among Young People” factsheet. May 2005.6. CDC. “Patterns of new HIV/AIDS amongadolescents and young adults in 25 states.” Presentedat an oral session during the 2005 National HIVPrevention Conference. June 13, 2005.7. CDC. “HIV/AIDS among Young People” factsheet. May 2005.8. CDC. HIV/AIDS Surveillance Report, 2001, vol.13, no. 2, table 8.9. Kantor, Elizabeth. “HIV Transmission andPrevention in Prisons.” University of California, SanFrancisco Center for HIV Information.

CHAPTER TWOSex and the EpidemicOur Aversion to RealityFew things agitate America’s dark imaginationlike teen sexuality. We’re uncomfortablyobsessed with it—neither able to avertour eyes nor look directly into it. Of course,our culture has a volatile relationship withsex at all ages. On one hand, it’s everywhere;marketing campaigns for everythingfrom body spray and cologne to shampoounsubtly suggest their products will bringusers to orgasm. Sex is a part of our music,our magazines, even our video games. Onthe other hand, real conversation about sexleaves most policy makers and communityleaders tongue-tied at best.So perhaps it should come as no surprisethat we find the conversation about teensexuality so difficult to have in an honestway. America’s anxiety about youth sexualattitudes and behaviors is a fixture in today’snews media and popular culture—and rarelyfor the better. Among the most telling examplesof the way in which the conversation toooften plays out is that of the now-infamous“sex bracelet.”In late 2003, reports began circulatingabout a game called “snap,” in which the jellybracelets teens have worn since the early1980s morphed into secret symbols to communicatesexual preferences to one another.As the rumor went, if one kid broke another’sbracelet, they would have to engage in thesex act that corresponded with that bracelet’scolor—red for a lap dance, blue for a kiss,black for intercourse, and so on. The storygrew so wide that schools began banning thebracelets. Problem is, it now appears the rumorwas nothing more than urban legend—atleast originally. In a fitting absurdity, teenswho did begin talking about the game saidthey learned about it from news reports. 1Everybody from the New York TimesMagazine to the Today Show’s own KatieCouric have gotten in on the teen sex act,offering lurid reports of supposed sexualsubcultures and deviances lurking behindthe innocent veneer of teen hang outs likethe shopping mall. 2 The problem with thesereports is two-fold: They crowd out the importantconversations parents, families andcommunity leaders direly need to have surroundingteen sexuality—replacing careful,thorough research with rumors and anecdotes—andthey too often ignore race withinyoung America.

»12Reclaiming Our FutureYoung Folks and SexEvery year, the U.S. CDC surveys the “riskbehavior” of high school and college-agedyouth on things ranging from diet to violence.On sexual activity, the survey found that sincethe early 1990s teens increasingly have had lesssex and done it safer. There have been distinctracial differences in the trends, however.African Americans report having more sex,at an earlier age than any other group…And within the racial categories, there aredistinct gender differences. Black males reportfar more sexual activity than Black females…And within the racial categories, there aredistinct gender differences. Black males reportfar more sexual activity than Black females…Black youth who reported ever havingsexual encounters, 2003:8070605040302073.860.9Youth who reported ever having sexualencounters, 2003:80706050403067.351.441.8100Black youth who reported having morethan four lifetime partners, 2003:45403530Male41.7Female2025100Black Latino White20151016.3Youth who reported more than four lifetimepartners, 2003:35302520151028.815.710.850Black youth who reported having sex bythe age of 13, 2003:4540353025Male41.7Female50Black Latino White20151016.3Youth who reported having sex by the ageof 13, 2003:20181614121086420198.34.2Black Latino White50MaleFemaleWe will require far more qualitative researchon teen sexual behavior to understandboth the racial and gender disparities—andwhat they mean for controlling STDs.Source: CDC. Youth Risk Behavior Surveillance—United States, 2003. Morbidity and Mortality WeeklyReport. May 21, 2004.

Sex and the Epidemic 13Fact and Fantasy inYouth SexUnfortunately, much of the discussion thatdoes focus on Black adolescents and youngadults paints exaggerated and hostile depictionsof their sexual attitudes and practices.Whether it be the demeaning representationsof Black women and men found in toomany hip hop videos, or the biting criticismspewed by celebrities and commentatorssuch as Bill Cosby and Bill O’Reilly, Blackyouth and their decisions about sex areusually presented as wrong, immoral anddangerous.Too often, these stories and myths aboutBlack youth and their sexual decision-makingare then used to justify the adoption of policiesthat do more harm than good. Until weare ready to both discover and acknowledgethe facts surrounding teen sexuality, bothamong African Americans and at large, we’llnever begin to address its negative consequences—particularlyHIV.So what do we actually know about thesexual behaviors of African American youth?The research reveals contradictory and sometimesdisturbing patterns.Every year, the U.S. Centers for DiseaseControl and Prevention (CDC) surveys highschool and college-aged youth on their “riskbehavior” in areas ranging from diet to violence,and including sex. The Youth Risk BehaviorSurveillance survey consistently showsthat African American male and female teenagersare more likely to report sexual activitythan their white and Latino counterparts.Black respondents more often report havinghad sexual intercourse, having had four ormore sex partners and having initiated sexualintercourse before the age of 13. 3These facts, however, do not necessarilymean Black youth are more likely to putthemselves at risk. When CDC asks studentsabout measures they take to protectthemselves, it becomes clear that the sexuallandscape of teen life requires a more nuancedanalysis to understand. While Blackyoung people report more sexual encountersthan their counterparts, they are also morelikely to report both having used condomsand having had open communication with anadult family member about AIDS. They arealso less likely to report having used drugs oralcohol during their last sexual encounter. 4Still, African American youth ultimatelysee more adverse outcomes to their sexualbehavior. Our youth may be more likely tosay they protect themselves, but they’re stillmore likely to contract sexually transmitteddiseases such as Chlamydia and HIV. Teenpregnancy may be going down, but the racialdisparity persists.These sorts of conflicting reports onBlack youth sexual attitudes and behaviorillustrate that quantitative research, whileimportant, is insufficient. It is critical that wepush beyond the statistics to understand themultiple factors that contribute to the differingsexual behaviors and attitudes of youngAfrican Americans. Is there a gap betweenwhat young people, of all races, say and do?When youth use condoms, are they usingthem correctly? In what social contexts aredecisions about “risk” made?While unsafe sex increases one’s likelihoodof contracting HIV or getting pregnant,youth often experience competing concernsand pressures in far more immediate waysthan such distant threats—particularly youngpeople in poor communities. As one researcherwrote in her 2004 study of youth andrisk, “Urban minority adolescents reportedhigh levels of worry about AIDS, but theyreported equal or greater concerns about havingenough money to live on, general health,doing well in school, getting pregnant, andgetting hurt in a street fight.” 5Any number of these pressures cantrump concerns about protection from anSTD, no matter how virulent. Moreover,

»14 The Time Is NowCondomsWhile African American youth reporthaving more sex, at younger ages,they also report doing so more safely. It’sone of the many contradictions that weneed more qualitative research on youthsexual behavior to understand.Among the 34 percent of students whosay they are sexually active currently, 63percent say they used a condom the lasttime they had intercourse. Black malesused them at the highest rate.Reported condom usage among malestudents surveyed by the Centers for DiseaseControl and Prevention:LatinoWhiteBlackLatinoWhiteBlackMale Student Condom Usage0 10 20 30 40 50 60 70 80 90… and among female students:Female Student Condom Usage0 10 20 30 40 50 60 70Source: CDC. Youth Risk Behavior Surveillance—United States, 2003. Morbidity and MortalityWeekly Report. May 21, 2004.some of them can actually lead to self-inflictedwounds. Research shows adolescentvictims of both physical and sexual abuse, forinstance, are more likely to engage in sexualbehaviors that might increase their risk forHIV. This finding is especially relevant forAfrican American youth, who more oftenreport having been forced to have sex thantheir white counterparts. 6Real Black Men Aren’tGayToday’s dominant representation of youngBlack men on television seems to be limitedto the hyper-masculine, violent thugwho’s been shot nine times or the ultrasuave“pimp” with multiple women at hisside. Rarely do more diverse Black malesexual identities and behaviors—those thatinclude same sex attraction—appear on themedia landscape.When homosexually or bisexually activemen do emerge, they are typically presentedin one of two caricatures: as effeminate andweak, or as threats to innocent Black women—suchas the seemingly ubiquitous Blackman “on the down low.” Our youth notice thisdynamic, even if we don’t. One study foundthat 80 percent of gay and lesbian youthconsider media depictions of themselves tobe negative and to be rooted in feminine andmasculine stereotypes. 7For young gay and bisexual Black men,this rigid representation of masculinity,which labels heterosexual relations as theonly acceptable form of sexual expression,can crowd out a healthy view of the sexualand emotional feelings they experience asthey grow into adulthood. As the rapper IceCube once famously reminded us, “Trueniggas ain’t gay.” 8 More recently, DMX wentfurther, advising listeners to “show no loveto homo-thugs/ Empty out, reload, and thwo

Sex and the Epidemic 15mo’ slugs.” 9 For young Black gay and bisexualmen absorbing these messages, the disconnectbetween the idealized Black man theywant to be and the seemingly incompatiblefeelings they are experiencing does little topromote a healthy sexual life.Over the years researchers have come torealize that young Black men who have sexwith men have some of the highest rates ofHIV infection in the world. In a CDC studyreleased in June 2005, researchers reviewedHIV infection rates among 13 to 24-year-oldboys and young men from 1994 to 2003. Newdiagnoses fell by 30 percent in the first fouryears of the study. But they then shot backup in between 1999 and 2003, by 41 percent.That trend appears to have been drivenprimarily by Black men in their early 20s whohave sex with other men. Researchers founda 47 percent spike in infections during thattime period among gay and bisexual menoverall, and 60 percent of those were AfricanAmerican. 10The June 2005 study was sadly not thefirst indication of HIV’s rampage amongyoung Black gay and bisexual men. The CDCconducted a five-city study in the 1990s,looking at infection rates among gay and bisexualmen in large urban areas. In that study,called the Young Men’s Survey and covering1994 to 1998, 14 percent of young AfricanAmerican men who have sex with men, ages15 to 22, were HIV positive. That’s comparedto seven percent of the overall population andjust over three percent of their white counterparts.11 Nationwide, male to male sexual contactis the leading form of HIV transmissionamong young men ages 13 to 24, accountingfor 40 percent of all male HIV cases among13 to 19 year olds and 64 percent of all maleHIV cases among 20 to 24 year olds. 12In late 2002, it became clear that thiscarnage has not been confined to urban centerswith large gay communities. Two Blackmale college students at different colleges inthe same North Carolina city tested positive,both reporting sex with other men. Testsshowed they both had been recently infected.Given the relatively few infections among collegestudents in the area, the North CarolinaDepartment of Health feared something wasup, and through contact tracing researchersidentified 69 linked cases of HIV infectionamong college-age males, dating backto 2000. Those 69 infections were among 84male college students diagnosed with HIV infectionsbetween 2000 and 2003, 73 of whomwere African American. 13Over half of the 84 young men said theyonly had sex with men, while a third indicatedthey had sex with both women and men.The outbreak among a group previously notconsidered to be at high risk—college studentsoutside of major urban centers—suggeststhe intensity of the epidemic amongBlack gay and bisexual young men is widespread.For many, including members of thenews media, the central question was howcould this outbreak happen among collegestudents. But before real research could bedone to answer that question, tales of youngBlack men in college with “invisible networksof sexual liaisons” or on the “down low” beganto appear in the press. 14 The way the storyof the down low is commonly told, it focuseson a supposed subculture of exclusively Blackmen who identify as heterosexual.The idea of the “down low” has receivedmedia attention, not only because it is thekind of salacious media story the public livesfor, but also because “DL” Black men arebeing used to explain the escalating rates ofHIV among Black women. This part of thestory suggests that Black men on the downlow are bringing HIV back to unsuspectingand innocent Black women. Of course, theproblem in the North Carolina outbreak andacross the country is that there is little to anyresearch to support such claims—about howwidespread the “down low” phenomenonis or about its relevance to infection rates

»The16 HIV/AIDS and Black Americaamong Black women. Indeed, while observerspointed to the third of the North Carolinayoung men who reported having sex withboth men and women, no one ever askedwhether they did so as openly and honestlybisexual men, or secretly. Nor do we knowwhat precautions they did or did not takewith their female sex partners. What we doknow is that health officials found no linkbetween any of the cases and HIV infectionamong young women in the area.In the absence of an environment wherepeople can talk openly about their sexualidentities, practices and partners, we forceindividuals to make decisions to protect theirreputation, image and family name, insteadof taking the necessary precautions known toprotect themselves from HIV and AIDS. Datafrom the CDC’s Young Men’s Survey indicatesthat 55 percent of young men did not letother people know they were sexually attractedto men. Many of these young men decidedto remain silent about their sexuality becausethey know to speak openly is to risk physicaland emotional harm. In the 2003 NationalSchool Climate Survey, researchers foundthat approximately 46 percent of GLBTQyouth of color reported physical violence asa result of their sexual orientation. Althoughthese pressures may not be race specific, datasuggests that Black young people report moreviolence associated with their sexual orientationthan other young people. 15Price ofHomophobiaTwo federally-funded surveys in themid-to-late 1990s found HIV infectionrates among young, gay African Americanmen akin to those in southern Africa.Percent of survey participants found tobe HIV positive:, among 15-22 year olds:161412108642016141210867.214.113.4Among 23-29 year olds:6.93.3Overall Blacks Mixed Latino Whites7.214.113.46.9Real Black Women areSlutsYoung Black women also face stifling andoften conflicting pressures when developingtheir sexuality.In today’s sex-obsessed culture, youngwomen, and young Black women in particular,face more than a few contradictionsconcerning sex. From the classroom to4203.3Overall Blacks Mixed Latino WhitesSource: Valleroy, Linda and others. “HIVIncidence Among Young Men Who Have SexWith Men—Seven U.S. Cities, 1994-2000.”Morbidity and Mortality Weekly Report, v. 50,n. 21.popular culture, the idealized strong womanappears at one of two poles: either asexual orhypersexual. Magazine covers with thong-

Sex and the Epidemic 17clad women, videos with popular vixens andchart-topping acts featuring sexually aggressivewomen such as rapper Foxy Brown havecarved a niche from which women can bothassert themselves and, if they aren’t careful,have their sexuality exploited.Young women of all races are being toldthat to be a “lady” you have to wait until youare married to have sex—from church tosex education classes, this ideal of a sexuallyreserved and, in some cases, submissivewoman is reinforced. A 2004 study conductedby California Democratic CongrerssmemberHenry Waxman’s office looked at messagesused in the most popular federally-fundedabstinence-only sex education curricula.Among other things, it that one of the widelyused curricula advises young women thatmen, by nature, want sex from them whilewomen primarily want “financial support”and “domestic support” from a man. “A maleis usually less discriminating about those towhom he is sexually attracted,” it teaches,adding later that, “Women usually have agreater intuitive awareness about how todevelop a loving relationship.” 16The truth, of course, is young womenstruggle with how to manage the sexual andromantic desires they feel in puberty justlike their male counterparts. As the CDC’sstudent surveys show, not only are youngwomen having sex before marriage, they arehaving sex with more than one person. Inthe 2003 survey, 60 percent of Black youngwomen reported having had sex and 16 percentreported having sex with more than fourpartners in their lifetime. Moreover, a whopping16 percent reported having had sex bythe age of 13. 17 Until we recognize these realities,we’ll be unable to either change themor ensure these young women are protectingthemselves from STDs and unintended pregnancieswhen they do have sex.But society’s refusal to acknowledge thereality of young women’s sexual lives is notthe only explanation for HIV/AIDS amongBlack girls and young women. Like their malecounterparts, a significant part of the problemis that they don’t believe they’re at risk.Nanetta Payne of Jackson State Universitypresented a study in June 2005 at the NationalHIV Prevention Conference that revealedtroubling misperceptions about HIV amongyoung African Americans.Payne surveyed 151 African Americanmale and female students enrolled in JacksonState during the 2005 spring semester.She asked about their attitudes toward HIV.Initially, 70 percent of the sample said theywere not at risk. But after answering questionsabout their sexual activity in the pastthree months, Payne saw discrepancies. “Ifound that when you ask the students if theysee themselves being at risk for HIV, manyrespond, no. But then you have dialogue withthem. ‘Have you been having unprotectedsex these last 90 days, whether it’s vaginal oranal?’ Then they’re honest. ‘Yes, I have.’”Payne also found few students voluntarilygetting HIV tests. Less then half had beentested, and the majority of those who hadbeen tested only did so as part of a pap smearor in routine prenatal care. 18But ultimately, most damaging may bethe reality that young Black women face anumber of circumstances that continue toplace them at risk for contracting HIV. Thesame CDC surveys that have found youngBlack women having multiple sex partnershave also found a host of reasons that Blackfemale students chose not to use condoms:having older partners, being of low socioeconomicstatus, having expectations ofpregnancy, and having weak family relationsall registered. 19 Conversely, statistics showthat young Black women who possess higherself-esteem, have higher levels of educationalattainment and come from more financiallystable households are more likely to use condomsduring sex. 20

18 HIV/AIDS and Black AmericaNotes1. Associated Press/CNN.com. “Student ‘sexbracelets’ an urban legend?” December 12, 2003.2. Denizet-Lewis, Benoit. “Friends, Friends withBenefits and the Benefits of the Local Mall,” New YorkTimes Magazine, May 30, 2004.3. CDC. Youth Risk Behavior Surveillance—UnitesStates, 2001. Morbidity and Mortality Weekly Report.June 28, 2002.4. Ibid.5. Augustine, Jennifer. “At Disproportionate Riskof Negative Sexual Health Outcomes.” Advocates forYouth. January, 2004.6. Grunbaum, Jo Anne, et. al. CDC. Youth RiskBehavior Survey. 2001.7. Earls, Meg. “GLBTQ Youth: At Risk andUnderserved.” Advocates for Youth.8. Ice Cube on the track “Horny Lil’ Devil,” from1991 album Death Certificate.9. DMX on the track “Where the Hood At?” from2003 album Grand Champ.10. CDC. “Patterns of new HIV/AIDS amongadolescents and young adults in 25 states.” Presentedat an oral session during the 2005 National HIVPrevention Conference. June 13, 2005.11. Valleroy, Linda and others. “HIV IncidenceAmong Young Men Who Have Sex With Men—SevenU.S. Cities, 1994-2000.” Morbidity and MortalityWeekly Report, v. 50, n. 21.12. CDC. HIV/AIDS Surveillance Report, v. 13, n.2—Table24.13. Altman, Lawrence K. “New H.I.V. TestIdentifies Cases in College Students.” New York TimesMagazine, February 11, 2004.14. Brown, David. “HIV Outbreak is IdentifiedEarly,” Washington Post, February 11, 2004.15. Kosciw, Joseph G. The National School ClimateSurvey. The Gay, Lesbian, and Straight EducationNetwork.16. Committee on Government Reform, MinorityStaff. U.S. House of Representatives. “The Contentof Federally-Funded Abstinence-Only EducationPrograms.” December 2004.17. CDC. Youth Risk Behavior Surveillance—United States, 2003. Morbidity and Mortality WeeklyReport. May 21, 2004.18. Payne, Nanetta et al. HIV Testing amongAfrican American College Students. Poster presentationat the 2005 National HIV Prevention Conference.19. CDC. Youth Risk Behavior Surveillance—Unites States, 2001. Morbidity and Mortality WeeklyReport. June 28, 2002.20. Kosciw, Joseph G. The National School ClimateSurvey. The Gay, Lesbian, and Straight EducationNetwork. 2004

Sex and the Epidemic 19

20 Reclaiming Our FutureKanye West RewritesHip-Hop’s Gay RecordKenyon Farrow traces a hip-hop icon’s roadmap to healthyconversations about sexuality.In August 2005, Roc-A-Fella recording artist and producer extraordinaire Kanye West didsomething most would think to be career suicide for a Black hip-hop artist, and just daysbefore dropping his sophomore effort, “Late Registration.”During an August 18 MTV interview, Kanye spoke candidly about the impact ofhomophobia on his own life. He touchingly recounted his own insecurities as a not-masculine-enoughyouth and challenged hip-hop artists to end the homophobic content of theirmusic. “I wanna just come on TV and just tell my rappers,” West said, “just tell my friends,‘Yo, stop it fam.’”Kanye’s astounding interview is being talked about all over the world right now, but the impactis really yet to be fully seen. I certainly hope his remarks will help bring about the day when I have tohear less of the words “faggot” or “chi-chi man” every time I turn on the radio or go out to dance. ButKanye’s story may be more important for what it demonstrates about the process of social change thanany particular outcome that follows.Kanye’s remarks are making such a seismic impact because no part of the explosion of mediaimages dealing with LGBT people in recent years has come from or been targeted at the Black community.Despite all of the talk about how easily gay people have integrated into pop culture, as KanyeWest points out, “the exact opposite word of ‘hip-hop,’ I think, is ‘gay’”—which makes it the opposite ofa defining part of young, Black life and culture.Black people must see other Black people confront homophobia, and must see LGBT people asBlack peopleas well, if we are ever going to make real progress shifting attitudes. Kanye, bravely andboldly, has realized this fact. And his testimony couldn’t have come at a more apt time, in the midst ofa summer in which we have once again heard startling news about HIV’s rampage among Black gaymen—a reality that, in no small part, is driven by the Black community’s failure to embrace and supportus.Kanye opened his story on MTV by talking about his close relationship with his mother, which iscaptured in a song on his new CD entitled Hey Mama. He explained that growing up with his mothermeant that he also took on some of her mannerisms. When he got to high school, this fact meant hewas often ridiculed for being a “fag.” And, in turn, he became very homophobic.But when Kanye learned through one of his cousins that another cousin in the family was gay, hebegan to rethink his stance. “It was kind of like a turning point,” he told MTV VJ Sway, “when I waslike, `Yo, this is my cousin. I love him and I’ve been discriminating against gays.’”And there it was, the cycle of homophobia broken.Kanye’s seeing his cousin as gay helped to humanize Black LGBT people in his eyes and promptedhim to in turn abandon the sort of knee-jerk attitudes that prevent people like his cousin from beingable to come out in the first place. As Kanye so articulately explained in describing the roots of his ownhomophobia, “If you see something and you don’t want to be that because there’s such a negative connotationtoward it, you try to separate yourself from it so much that it made me homophobic by thetime I was through high school. Anybody that was gay I was like, ‘Yo, get away from me.’”It is often assumed that the Black community is more homophobic than the white community. But

Sex and the Epidemic 21while there is certainly homophobia in the Black community, the buzz surrounding Kanye’s remarksshows the real issue may be how rarely the topic is actually addressed substantively and humanly.Black people still rely most heavily on indigenous sources for information about the world aroundthem, particularly about issues like sexuality and health. Several studies have reminded us of this fact,and of its impact on the way we’ve responded to the AIDS epidemic—our griots, from media mavensto ministers, too often chose silence or disdain over education and communication. Not until mothersof dying gay men began to organize AIDS ministries in congregations did ministers speak on the issue.And still today, as AIDS becomes a growing concern of mainstream Black organizations, we heara deafening silence about what the epidemic means for Black gay and bisexual men in particular—thegroup of people most impacted by the epidemic. Black media, from entertainment to news, has largelyignored this aspect of the epidemic.Recent years have certainly seen an unprecedented increase in the amount of news coverage, TVprogramming and public relations efforts by white gay advocates and celebrities that has put a “face”on the gay and lesbian community. But the rising tide truly does not lift all boats equally.Black LGBT faces have been made invisible by this media blitzkrieg of white middle-class gays.While Black folks may watch Queer Eye or Will & Grace, the white gay images they project do little tosensitize straight Black viewers to the needs, issues, and concerns of Black LGBT community.And that’s what makes Kanye West’s bold statements so remarkable, and gives them such potentialas a catalyst for healthier discussions around gender and sexuality in the Black community. He isa cultural icon who has a reputation for breaking molds and taking on issues in his music that peoplethought could not be broached in hip-hop—all while still selling millions. He also has “street cred”among Black youth, and even Black people disgruntled with the hyper-consumerism, sexism and homophobiain hip-hop respect Kanye for his work.Most importantly, he has access to the sort of mass media that can carry his message far and wide.But change cannot begin or end with Kanye West. It was really Kanye’s seeing his cousin as gaythat caused his shift his thinking. While public education campaigns and more visible opposition tohomophobia in the Black community is key, it is ultimately the work that we, Black LGBT people do inour families and in our communities that will make the difference.This summer may go down in history as a huge turning point for the Black lesbian, gay, bisexualand transgender community, and for our relationship to the Black community at large. On one hand,we have seen great setbacks: the down-low craze continues to demonize us; new research suggestedhalf of us in major cities may already be positive.But on the other hand, we are engaging the community with renewed determination and hope.A few weeks ago Rev. Al Sharpton announced that he was launching a public education campaign tocombat homophobia in the Black community. In early July, the Black LGBT community in the nation’scapital publicly challenged Rev. Willie Wilson’s homophobic remarks. The New York State Black GayNetwork’s July Revival! was a direct call to challenge the spiritual violence of Black clergy, and to affirmthe lives of Black LGBT people of faith. And in June, The Souls A-Fire! Conference in Chicago broughttogether activists, academics and artists to discuss sexuality and the Black church.Maybe we have finally reached the “sick and tired of being sick and tired” point. Everyday, I’msensing greater resolve in the voices of weblogs, at community planning meetings and even in socialspaces that suggests a collective statement: I am fed up. But I am ready to fight. Maybe it is now, whenour backs are against the wall and we have nothing more to lose, that we can begin to see that what wehave is everything to gain.But in order gain, we must be willing to tell our stories to our families, our neighbors, and ourcommunities. And we must support (and continue to challenge, as we must also deal with how Blackwomen are depicted in hip-hop) brothers and sisters like Kanye, who take great risks to get our backs.Kenyon Farrow is co-editor of the anthology “Letters from Young Activists: Today’s Rebels Speak Out,” due out thisNovember with Nation Books, and the communications and public education coordinator for New York State BlackGay Network.

22 Reclaiming Our Future

CHAPTER THREEToo Many UnknownsDrugs and HIVIImages of Black youth using or selling illegaldrugs have become a regular part ofAmerican society. It is hard to turn on apopular television show or rap music videothese days where young Black people, inparticular young Black men, are not seen“slinging” drugs and smoking “blunts.”Similarly, the young Black women in thestorylines are usually down for the cause,helping their man in his trade and lightingup a joint on the side.The truth, of course, is that in mostcases African American youth tend to drink,shoot-up, snort and freebase less than youngpeople from other racial and ethnic groups.According to the Centers for DiseaseControl and Prevention’s (CDC) 2003 YouthRisk Behavior Surveillance study, AfricanAmerican youth reported lower rates of havingever used almost every drug than theirwhite and Hispanic counterparts. 1 Whiteand Latino students reported more lifetime,current and episodic alcohol usage thanBlack students surveyed. White and Latinostudents were three to four times more likelyto use some form of cocaine—powder, crackor freebase—over their lifetime than Blackstudents. And similar patterns of racial andethnic differences in drug use are evidentfor substances such as ecstasy, methamphetamine,inhalants, and steroids.Black youth did however lead in sometroubling ways. Black male students reportedslightly more lifetime and current marijuanause than Latino males and significantly morethan white males. And while African Americanyouth generally report using alcohol andillicit substances less than white and Latinostudents, they are more likely to report theinitiation of such behaviors before the age of13. Moreover, males across race and ethnicityregister more use with nearly every drug thanfemales in their racial or ethnic group.These findings belie the hyper-negativeportrayal African American young peoplereceive in both popular culture and thehalls of public policy. That said, Black youthstill represent 56 percent of HIV infectionsamong young people ages 13 to 24 in theUnited States—and a significant number ofthose cases are tied to drug use. 2

Too Many Unknowns 25and sterilizing them, they are also passingon their blood, and possibly the virus thatremains in it.While the youth epidemic is considereda largely sexual one, injecting drugs still accountfor a startling number of new infectionseach year. Injection drug use accountedfor nine percent of male AIDS cases amongthose ages 13 to 19 and 13 percent of casesamong those 20 to 24 through 2003. Amongfemales, injection drug use accounted for 18percent of cases among those ages 13 to 19and a whopping 28 percent of those aged 20to 24. 3The impact of dirty needles doesn’tstop with the person actually using them.A significant portion of the female youthepidemic, as with the female Black epidemicas a whole, stems from young women havingunprotected sex with men who are shootingup with dirty needles. Among females ages13 to 19, 16 percent of AIDS cases and sevenpercent of HIV infections reported through2001 came from having unprotected heterosexualsex with someone who contractedHIV through injecting drugs. Among youngwomen ages 20 to 24, the numbers of these“secondary infections” go up: 19 percent ofAIDS cases and nine percent of HIV infectionsreported through 2001 resulted fromunprotected heterosexual sex with someoneinjecting drugs. 4 If we could stop the initialinfection through the use of contaminatedneedles, we would also stop these secondaryinfections—and cut at least the female youthepidemic nearly in half.But while the nexus of drugs and HIVis most clear when it comes to dirty needles,substance use plays an outsized role in sexuallytransmitted infections as well. We knowthat individuals, especially young people, areless likely to make healthy decisions aboutsafe sex and condom use when drug use(including alcohol) is a significant part of thesexual interaction. Influenced by desire—andmaybe pressure—individuals too often attemptto negotiate sexual decision-makingwith a partner while their thinking is cloudedby intoxicants. In the CDC’s 2003 youthbehavior survey, 25 percent of sexually activeteens reported that they “had used alcoholor drugs at last sexual intercourse,” while 63percent of youth reported that they or theirpartner used a condom during their lastintercourse.Consistent with other findings, Black studentswere more likely to report being sexuallyactive but less likely to report using drugsor alcohol during last sexual intercourse,compared to both white and Latino students.They also reported higher rates of condomusage during their last sexual intercoursethan their counterparts. 5So as with so many things in the Blackyouth epidemic, when it comes to the questionof the influence drugs and alcohol haveon the sexual decision-making and behaviorsof African American youth we face a contradictorypicture. The good news is that Blackyouth are drinking alcohol and taking drugsless, while using condoms more than otheryoung people. The bad news, of course, is thatthey are nonetheless disproportionately representedamong young Americans diagnosedwith HIV and AIDS.We must, therefore, figure out why AfricanAmerican youth are at the center of thisepidemic among young people. While muchof our attention has necessarily been focusedon dealing with the transmission of HIVthrough unprotected sex, we cannot forgetthe role drugs and alcohol play.An Answer We Won’tAcceptOne intervention that has shown greatpromise in arresting the spread of HIVthrough injection drug use is needle exchange—or,programs that provide clean

26 Reclaiming Our Future»TShooting Up AIDShe youth epidemic is a largely sexual one,but like with adults, many roads still leadback to dirty needles.Cumulative AIDS cases reported amongyoung men through 2003:AIDS Cases - Males 20-24 through 2003needles to injecting drug users. Theseprograms are rooted in an intervention philosophycalled “harm reduction”—whichseeks to limit the collateral damage peopledo to themselves when abusing drugs andalcohol, while simultaneously helping themget addiction treatment.Needle exchanges acknowledge that weare not yet equipped, as a nation, to adequatelyconfront drug addiction. Ideally, therewould be drug treatment programs availableto all those using illicit substances andseeking treatment; however, that currently isnot the case. The U.S. Department of Healthand Human Services has estimated that morethan three million people are in need of drugtreatment but aren’t getting it. 6 Much of thedebate about needle exchange programsCumulative AIDS cases reported amongyoung women through 2003:AIDS Cases - Females 13 to 19 through 2003TotalOtherOtherHeterosexual ContactTransfusion RecipientHeterosexual ContactInjection Drug Use(IDU)Hemophilia0 500 1000 1500 2000 2500Male to Male SexualContact and IDUInjection Drug Use(IDU)Male to Male SexualContactNumbersPercentage0 2000 4000 6000 8000 10000 12000 14000 16000AIDS Cases - Females 20-24 through 2003NumbersPercentageTotalAIDS Cases - Males 13-19 through 2003OtherOtherHeterosexual ContactTransfusion RecipientHeterosexual ContactInjection Drug Use(IDU)Hemophilia0 2000 4000 6000 8000 10000Male to Male SexualContact and IDUInjection Drug Use(IDU)NumbersPercentageMale to Male SexualContact0 200 400 600 800 1000 1200 1400Sources: Centers for Disease Control and Prevention.NumbersPercentage

Too Many Unknowns 27The New Drug on the Block?U. S. Attorney General Alberto Gonzaleshas called methamphetamine “the mostdangerous drug in America.” David Jeffersonwrote in a Newsweek article on methamphetamineuse that, “once seen as a trailer-parkhigh, methamphetamine has gone upscale—and national—to become America’s fastestspreading and most devastating drug.” Initially,crystal meth (also known as “Tina,” “crank,”“Chrissy” and “tweak”) was thought to bepopular primarily in rural areas, among poorwhites. But it is now being used across classes,regions, and races. And as the number of usersof methamphetamine continue to climb—onereport states that over 12 million Americanshave used the drug with 1.5 million regular users—theconnection between crystal meth andHIV transmission grows.When using meth, individuals report feelinghypersexual. In this sexualized, euphoricstate, some researchers say, users’ inhibitionsare lowered and they are more likely to engagein unprotected sex acts. So far, most of theattention surrounding meth use and HIVhas focused on gay men, primarily white gaymen. However, Dr. Alex Stalcup reminds usin Jefferson’s in Newsweek cover story thatcrystal meth is not only popular with men whohave sex with men, but also with heterosexualyoung men and women. He reports seeing“plenty of straight high school and college menuse meth to have ‘speed sex’” with lots of girlsand young women. Similarly, the risk of HIVtransmission through the sharing of equipmentto inject crystal meth is a real concern.Some Black AIDS activists have complainedthat the attention paid to crystal methis overshadowing the devastating rates ofinfection among Black people overall. Unfortunately,we do not have enough data to tell ushow wide-spread meth use is in Black communities,or specifically among Black youth.Sources: Jefferson, David. “America’s Most DangerousDrug.” Newsweek. April 8, 2005; Kaiser FamilyFoundation, Kaiser Daily HIV/AIDS Report. “SanFrancisco Chronicle Examines ‘Dual Epidemic’ ofCrystal Meth Use, HIV Infection.” May 5, 2003.«creates a false dichotomy: either we helppeople kick drugs or we help them avoid HIVand other diseases that come from sharingneedles. But needle exchange programs assertwe can do both. Drug addiction is certainlythe core problem, but while we’re workingagainst it we must also try to prevent thoseaddicted from killing themselves. Indeed, thetwo goals often reinforce one another.Fresh needles are hardly the only serviceneedle exchanges offer. They teach usershow to clean their works, and provide themwith the necessary materials. Most programsprovide referrals to drug treatment, distributecondoms and conduct HIV testing, amongother services. But their primary goal isamong one of public health’s most clear-cut,effective interventions: reduce the amount ofHIV circulating in drug using communitiesby taking infected works out of using networks.Study after study has shown the programsto be effective. At least eight government-fundedstudies since 1991 have shownthey work. Nevertheless, opposition to themremains staunch, particularly in Black communities.7One of the oft-voiced arguments againstneedle exchange programs is that they makeusing illicit drugs easy—by providing theequipment needed to shoot up—and thusencourage individuals not currently usingto start. Given the justified belief held bymany Black people that the federal governmenthas not only been neglectful of the drugcrisis in our communities, but may also haveencouraged it, it is not surprising that manyof our leaders would voice strong opposi-

28 HIV/AIDS and Black America»tion to anything that appears to worsen theproblem. It was just such an argument thatled Black leaders to oppose these programsinitially in New York City, which boasts thenation’s largest population of injection drugusers. 8 But since the 1992 onset of needleexchange programs in New York City, the rateof HIV infection among injection drug usersdropped from 50 percent to approximately15 percent. 9 Moreover, there is no scientificevidence to support the belief that needleexchange programs lead to more drug use ina community.Today, most states criminalize the possession,sale or distribution of injecting paraphernalia.Although some states and citieshave moved to allow syringe exchange programs,many have not. As of 2000, there wereNew York City has the nation’s largestpopulation of injection drug users—anestimated 150,000 to 175,000 people, or twiceas many as that of the next largest population,in Los Angeles. Somewhere between 10 and 20percent of those people are believed to be HIVpositive, which means New York also has morepeople living with HIV who caught it throughshooting up than any other city.These facts make New York City an idealtest market for needle exchange programs.And even in a drug-using epidemic as intransigentas this one, the local programs havefound remarkable success. Here are some factsabout the local network of syringe exchangesthat the city health department has used topromote its expansion: The average annual budget for a needleexchange in NYC is $200,000; the estimatedlifetime cost of treating one person with HIVis $150,000.127 needle exchange programs operating in35 states. 10 Congress continues to bar the useof federal funds to support syringe exchangeprograms, so they are wholly dependent onstate and local governments along with privateinstitutions and individuals for support.But ultimately, syringe exchange programswill not be enough to deal with therole of drugs in the AIDS epidemic. Increaseddrug treatment programs are needed, as wellas culturally and age-appropriate educationand prevention programs that incorporateinformation on both drug use and safer sexpractices. We will need to take such programsto the streets, jails, neighborhoods and workplaceswhere people are using drugs.If You Can Make It Here…Needle Exchange in New York Collectively, the programs have achievedan estimated 63 percent reduction in needlesharing among users. The vast majority of the city’s needleexchange clients reside in the same zip codeas the program they visit. This means theprograms do NOT draw drug users to neighborhoods. Within the first three years of needleexchange operation in the city, the rate of newinfections among drug users each year was cutby more than half. In the first ten years of operation, theprevalence of HIV infection among drug usersdropped from 51 percent to 12.5 percent.Source: New York City Department of Health andMental Hygiene. Presentation to Queens CommunityBoard 2. March 4, 2004.

Too Many Unknowns 29Notes1. CDC. Youth Risk Behavior Surveillance—United States, 2003. Morbidity and Mortality WeeklyReview. May 21, 2004.2. CDC. HIV/AIDS among Young People. May2005. http://www.cdc.gov/hiv/pubs/facts/youth.pdf.3. CDC. HIV/AIDS Surveillance in Adolescents:L265 Slide Series. April 2005.4. CDC. HIV/AIDS Surveillance Report, vol. 13, n.2, tables 13-14.5. CDC. Youth Risk Behavior Surveillance—United States, 2003. Morbidity and Mortality WeeklyReport. May 21, 2004.6. Open Society Institute. Drug AddictionTreatment Program overview, available online athttp://www.soros.org/initiatives/baltimore/focus_areas/drug_addiction.7. Wright, Kai. The Time is Now: The State ofAIDS in Black America. The Black AIDS Institute,February 2005.8. Cohen, Cathy J. The Boundaries of Blackness:AIDS and the Breakdown of Black Politics. Chicago:University of Chicago Press, 1999.9. Staples, Brent. “How Needle Exchange ProgramsFight the AIDS Epidemic,” The New York Times.October 25, 2004.10. DesJarlais D and others. 2000 United StatesSyringe Exchange Program Survey. The Baron Edmundde Rothschild Chemical Dependency Institute.Presented at 12th North American Syringe ExchangeConvention. April 12, 2002.

30 Reclaiming Our Future

CHAPTER FOURPinned Down, Locked UpPoverty, Prisonand Black YouthEverybody knows the Q101 bus line. It’siconic in Black and Latin neighborhoodsaround New York City—the line that runsout to Riker’s Island. On any given afternoonon the island, which is totally turnedover to the city department of correctionsas real estate for the nation’s largest jail, anunnervingly commonplace ritual unfolds.Hordes of young women, universally Blackand Latin, pile off the Q101 and gather atthe jail’s front door. They mill about smokingand chatting under the watchful eye ofprison guards, awaiting their turns to seeboyfriends, husbands, “baby daddies” andjust guys-of-the-moment who—like nearly13 percent of the nation’s Black men in their20s—is locked up. 1The Q101 has a late-night counterpart.This one runs in the wee hours of the morning,shuttling its charges from Riker’s to thedark, run-down corner of Queens where thecity dumps all male inmates being releasedon a given day, right around four o’clock inthe morning. The passengers—uniformlyBlack or Latin, almost as uniformly under theage of 30—tumble off the bus literally poundingtheir chests in defiant exclamation of theirregained freedom. Some have been locked upfor months, many for just days, most will beback—indeed, most are already repeat customers.A higher percentage of them are HIVpositive than any other geographic groupingin the nation.“It’s 3:30 in the morning and folks arecoming off the bus. You get that image: I’mcool, I’m out,” says Douglas Miranda, whoruns a Fortune Society project that meetsthe young men as they hit the street, tryingto capitalize on one last opportunity to gettheir attention about HIV prevention andAIDS care before they disappear back intotheir volatile lives. “But it’s almost like that’snot what they’re feeling; that’s just the imagethey present. But it goes,” he snaps his fingers,“that quick.”And with it goes any chance at conductinga real intervention that could havestopped them from passing on their infectionor gotten them into desperately needed supportservices. “The folks that we’re workingwith and dealing with who are HIV positive,it’s just this other problem on top of a wholepot full of problems,” Miranda explains.“But more and more, these are the folks that

»32 The Time Is NowYoung, Blackand BrokeAfrican American youth, even whenemployed are far more likely to live inpoverty than their white peers.Share of 16 to 24 year olds with jobswho still live in poverty:Black – One in fiveWhite – One in tenPercentage of 16 to 19 year olds whoare unemployed:WhiteBlack16 to 19 Year Olds Who Are Unemployed0 5 10 15 20 25 30 35… And of 20 to 24 year olds:20 to 24 Year Olds Who Are Unemployednobody cares about. That nobody’s dealingwith. It’s like,” he stops, sighing through along, frustrated pause, “that’s why folks aredropped off here in the middle of the night.We can make believe they don’t exist.”Today in the United States, it is morelikely that a young African American man orwoman will live in poverty or end up in jailor prison than attend a four-year college oruniversity. Although Black youth represent14 percent of the total youth population, theyrepresent 39 percent of all incarcerated juvenilesand 45 percent of all those incarceratedbetween the ages of 18 and 24. 2Meanwhile, 29 percent of African Americanyouth ages 15 to 24 are living in poverty,compared to 12 percent of white youth in thesame age group. 3These may seem like abstract figures, butthey add up to very real disadvantages in life.They mean that shocking numbers of youngAfrican Americans receive poor, underfinancededucations; confront limited job opportunities;live below the poverty line; andultimately are at greater risk for HIV/AIDS.While poverty is widely understood to beassociated with the spread of HIV and AIDSamong youth in developing countries, andincarceration is increasingly understood tobe associated with high rates of HIV infectionamong the adult prison population inthe United States, there is much less mentionof the impact both of these important factorshave on the high rates of HIV infectionamong African American youth.WhiteBlack0 5 10 15 20Source: U.S. Department of Labor, Bureau ofLabor Statistics, Labor Force Statistics from theCurrent Population Survey.Poverty’s LingeringMiasmaThe relationship between poverty and HIV/AIDS among African American youth hasrarely been explored, but the few studiesthat exist show strong evidence of a connection.4

»34 Reclaiming Our Futuremay make them worry less about contractingHIV—we must also recognize that youngAfrican American women and men whofind themselves in poverty, with little hopeof doing better economically, may believethey have no real reason to take preventivemeasures to protect themselves from HIV.More likely, they may simply face more immediatepressures and concerns than a longterm,slow-developing disease. When youface crises all day, you’ve got no choice but toprioritize the most acute ones.“Folks are in many ways just unpreparedto deal with life,” says Fortune Society’sMiranda, of the young men tumbling off theRiker’s bus every morning, “never mind havingto deal with this health issue”Black KidsBehind BarsAs of June 2004, Black males betweenthe ages of 20 and 39 accounted fora full quarter of all people incarcerated inAmerica, and a stunning 12 percent of 25to 29-year-old Black men were locked up.African Americans are just 14 percentof the youth population, ages 15 to 24. Butthey are an overwhelming presence in thenations’ prisons and jails.Racial breakdown of teens incarceratedin juvenile detention facilities:Behind BarsCurrently, there are over two millionAmericans in jails or prisons; a vastly disproportionatenumber of them are young,Black men. 9 It’s a problem that is worseningrather than improving: Between 1974 and2001, according to the U.S. Department ofJustice, the annual estimate for the numberof African Americans that were likely to beincarcerated at some point during their lifetimetripled. 10 As of 2001, it was estimatedthat one in three African American malesand one in 20 African American womenwill be in jail or prison at some point intheir life. 11For youth, the racial divide is stark. AfricanAmerican youth ages 15 to 24 representjust 14 percent of the total youth population,but they represent 39 percent of all incarceratedjuveniles and 45 percent of all thoseincarcerated between the ages of 18 and 24. 12These numbers are staggering in andof themselves, but they take on even graverconsequences when we consider how thedisproportionate rates of incarceration relateto HIV infection rates among Black youth.Teens Incarcerated in Juvenile Detention FacilitiesBlacksPopulationRacial breakdown of young peopleaged 18 to 24 in prisons and jails:Ages 18 to 24 in Prisons and JailsBlacksPopulationSource: U.S. Department of Justice, Office ofJustice Programs, Bureau of Justice StatisticsBulletin, Prison and Jail Inmates at Mid-year2004.

Pinned Down, Locked Up 35Some estimates put the HIV infection rateinside prisons as much as five to six timeshigher than the rate in the general population.13 The Bureau of Justice Statistics putsthe rate of HIV infection at three and onehalftimes the rate in the general population.Moreover, it has been reported that 20 to 26percent of people living with HIV/AIDS inthe U. S. have spent time in the correctionalsystem. 14Unfortunately, no real information existson how many African American youngpeople in prison and jail are HIV positive,since the Bureau of Justice Statistics does notbreakdown its epidemiological data on HIVin prisons by both race and age. However, amere glance at both the overall infection ratesand the lopsided racial demographics of inmatesstrongly suggests that the epidemic inprison is a distinctly African American one.Of those in prison who have ever beentested for HIV, three percent of AfricanAmerican women are positive, comparedto 1.6 percent of white women—or, roughlydouble the rate of white female inmates. Asimilar disparity was found among men, withone percent of Black male inmates testingpositive, compared to 0.6 percent of whiteinmates.The same disparity exists among inmateAIDS death rates. Blacks who are incarceratedaccounted for two-thirds of all AIDS-relateddeaths in prison in 2002; a rate twoand-a-halftimes that of white inmates andtwo times that of Latinos. 15If there is any hope regarding HIVtransmission and young African Americanswho are incarcerated, it might be found inthe statistic that inmates 24 and younger havethe lowest rate of HIV infection among thosewho have ever been tested: 2 percent, comparedto 2.7 percent among inmates 45 andolder. 16Missed OpportunitiesJuvenile detention centers and prisonsare not prepared to deal with the realityof AIDS they face. Almost all ban fromtheir facilities the resources that have beenproven to stop new infections: condoms,clean needles and fresh tattoo ink. Whetherprison officials forbid sex and drugs ornot, inmates are finding ways to engage inboth. They are also using homemade tattookits and ingeniously created ink for tattooing—anothersupposedly outlawed practicein prison—all materials that capable oftransmitting HIV when shared betweenindividuals.Nor are prison systems providing adequatedrug treatment programs for the youththey have law enforcement has so aggressivelyrounded up as part of the war on drugs. Astudy by the National Center on Addictionand Substance Abuse at Columbia Universityindicated that although 800,000 people incorrectional settings could potentially benefitfrom substance abuse treatment, fewer than150,000 actually participate in these programs.According to the same study, notenough prison and jail systems have comprehensivedrug treatment programs, andthose that do focus on education rather thanbehavior change. 17Undoubtedly, there are those individualsthat do not believe we should provideindividuals convicted of a crime with theresources they need to protect them fromHIV/AIDS. But the risk of HIV and AIDScannot be kept behind bars. The epidemicbehind bars easily spills over into the generalpublic, particularly in poor neighborhoodsfrom which disproportionate numbers ofthose incarcerated hail. Correctional facilitiesnow release approximately 600,000 peopleeach year, and most of these people return tothe same neighborhoods where they used tolive. 18 There has been woefully little research

»36 Reclaiming Our FutureThe EpidemicBehind BarsAt the end of 2002, the nation’s correctionalfacilities reported 23,864 inmatesliving with HIV, or 1.9 percent of thenational prison population. Of those people,5,643 had been diagnosed with AIDS.Corrections officials boast that thenumber of positive inmates has steadily declinedsince the late 1990s. That is accurate,unless you discount New York State, whichuses a formula for estimating infectionrates that throws off the national numbers.Discounting New York, the number of HIVinfected prisoners has remained steady.tracing the direct link between epidemics behindbars and in communities. But Universityof North Carolina researcher Jim Thompsonhas begun an effort to do just that, looking atcounty-by-county STD and incarceration ratedata in North Carolina. His research suggestsa dynamic interaction between sexuallytransmitted disease patterns in the streetand in the jailhouse, as both rise and fall intandem. “The relationships are even strongerwhen you introduce a one-year time lag”between measuring incarceration and measuringSTDs, Thompson says. “It strengthensthe hypothesis that incarceration is leading toSTDs.”NotesWhile the known infections amongmen far outnumber those among women,a higher percentage of the female inmatepopulation is known to be positive.32.521.510.501.9MalePercent Positive2.8FemaleSource: Maruschak L. HIV in Prisons andJails, 2002. Bureau of Justice Statistics. U.S.Department of Justice. December 2004.1. Bureau of Justice Statistics. U.S. Department ofJustice. Prison and Jail Inmates at Midyear 2004. April2005.2. Ibid.3. U.S. Census Bureau. Current Population Survey,2004. Annual Social and Economic Supplement.4. While there are some studies of statesand metropolitan areas, there are no nationallyrepresentative studies that connect chronic poverty toAIDS among Black adolescents and young adults in theUnited States.5. Zieler, Sally, et al. “Economic Deprivation andAIDS Incidence in Massachusetts.” American Journal ofPublic Health, 90(1), pp. 1064-1073.6. U.S. Census Bureau. Community PopulationSurvey, Annual Demographic Survey. Table 8.7. U.S. Department of Labor, Bureau of LaborStatistics. Labor Force Statistics from the CurrentPopulation Survey.8. Ibid. The unemployment rate for white youthis 15 percent for those who are 16 to 19 years old and8 percent for those between the ages of 20 to 24. Theunemployment rate for African Americans ages 25 andolder is 8 percent.9. Kantor, Elizabeth. “HIV Transmission andPrevention in Prisons.” HIV InSite Knowledge BaseChapter, February 2003.10. U.S. Department of Justice, Bureau of JusticeStatistics, Prevalence of Imprisonment in the U.S.Population, 1974-200111. Ibid.12. Bureau of Justice Statistics. U.S. Department ofJustice. Prison and Jail Inmates at Midyear 2004. April2005.

Pinned Down, Locked Up 3713. Kantor, Elizabeth. “HIV Transmission andPrevention in Prisons.” HIV InSite Knowledge BaseChapter, February 2003.14. Hammett TM et al. “The Burden of InfectiousDisease Among Inmates and Releasees fromCorrectional Facilities.” The Health Status of Soon-tobe-ReleasedInmates. Report to Congress’ NationalCommission on Correctional Health Care. March 2002.15. U.S. Department of Justice, Bureau of JusticeStatistics. “HIV in Prisons and Jails, 2002.” 2004.16. Ibid17. The National Center on Addiction andSubstance Abuse at Columbia University. Behind Bars:Substance Abuse and America’s Prison Population.January 1998.18. Urban Institute. “Prisoner Re-entry: Overview.”Overview of policy center work. 2005.

38 Reclaiming Our Future

CHAPTER FIVESilencing the TeachersSex, Educationand AbstinenceAs safe-sex advocates seek fun and creativeways to promote methods of protection,condom negotiation, and STD testing, abstinenceor no-sex-until-marriage advocatesare starting their own revolution. Withthe support of the government, abstinenceprograms have evolved into mass-mediacampaigns with everything from blingedout “Worth Waiting For” chains to bumperstickers to weekend “abstinence camps.”Quickly, the abstinence-only movementis gaining momentum. But what does it offeryouth in today’s sex-obsessed culture? Is itpossible that abstinence is the most reasonablesolution against the spread of HIV? Andwhat does this approach offer those who aremore likely to engage in risky sexual behaviors?What They’re LearningDespite all the controversy surrounding sexeducation in America’s schools, it is actuallya quite popular and established partof the educational system. A recent KaiserFamily Foundation study found that nearly89 percent of the nation’s approximately 20million public secondary school studentswill take sex education at least once between7th and 12th grades. 1However, students will learn widely differentthings in these classes. While some studentswill get a comprehensive sex education, orwhat some call “abstinence plus,” involvingmessages about both delaying sex andpreventing disease and pregnancy, others willlearn solely about ways in which sex is damagingand skills for avoiding it altogether.Abstinence-only sex education programshave a two-fold requirement: teachers musttalk to students about refraining from sexuntil they are married, but they are also urgedto any information on condom use and birthcontrol, unless it is to present those tools failurerates. The educational philosophy is thataccurate information on contraceptives willencourage sexual activity. 2But parents largely disagree. In the Kaisersurvey, 46 percent of respondents believedthat an abstinence-plus approach—which

»40 Reclaiming Our FutureWhatParents andEducatorsWant 46% of Americans want kids to learnabout both delaying sex and preventingdisease in sex education classes. Just 15% of people surveyed wantlessons restricted to abstinence discussions. 71% think it’s “appropriate” for teensto be able to get contraceptives from clinicsand doctors without parental approval.WhatStudents Get 30% of middle schools and highschools that have sex education coursesteach only about abstinence. 47% of schools with sex ed classesteach both abstinence and safer sex. 34% of schools teach students how touse condoms correctly.Sources: Kaiser Family Foundation, HarvardUniversity John F. Kennedy School of Governmentand National Public Radio. “Sex Education inAmerica.” January 2004; U.S. Centers for DiseaseControl and Prevention. School Health Policiesand Programs Study. 2000.includes information about both delayingsexual activity and how to protect against diseaseand unintended pregnancy when havingsex—was the best curriculum for sex education.Only 15 percent of parents surveyedbelieved that schools should teach abstinencesolely. 3Yet, a separate Kaiser survey of publicsecondary school principals found that 34percent of principals said their school hadabstinence-only programs, while 58 percentsaid their school offered a comprehensive sexeducation program. 4Research suggests that comprehensivesex-education is closely associated with theuse of contraception, the delay of sex and areduction in sexual activity. But not all comprehensivesex education curriculums are thesame. 5Because of the broad range of curriculaoffered in such courses, not all comprehensivesex education programs cover the sametopics. So while all comprehensive sex educationcourses provide students with some sortof information concerning HIV/AIDS andpregnancy, even they seem to vary in how farthey are willing to go to arm students withneeded information about sex and sexualrelationships. For instance, a 2000 studyfound that while a high-percentage of schoolscovered topics such as abstinence (72%), howSTDs are transmitted (95%) and risks associatedwith multiple sex partners (85%), alower percentage dealt with condom efficacy(65%) and even fewer taught students how touse a condom correctly (34%). 6Moreover, few schools teach skillsdirectly related to sexual activity. The samestudy found that only 58 percent of schoolstaught communication skills related to sexualbehaviors and only 62 percent taught goalsettingskills related to sexual behaviors. 7The numbers were significantly lower whenrestricted to elementary schools.Likewise, many sex education programsare not introduced until late in junior high oreven high school, thus restricting informationfrom students that are perceived to be tooyoung for sex. This is particularly problematicfor Black youth who are more likely to havesex before the age of 15. 8Given these variations in programs andcurriculums, even if a student is receiving

Silencing the Teachers 41comprehensive sex education they may notbe receiving all the information they needto facilitate both their physical and sexualhealth. This means that Black youth—whoare more likely to be poor, more likely to beincarcerated, more likely to engage in sex atan early are—may not have access to “true”comprehensive sex education, which canprovide them with the information and skillsthey will need to navigate their sexual lives.Changing FederalPrioritiesThe federal government’s support for abstinence-onlyeducation began, in 1981, withthe Adolescent Family Life Act. The controversialprogram was the source of significantlegal wrangling and remained relativelymodest in scope until 1996. Then, underthe Clinton administration and through theAb EdAbstinence-only education is fundedthrough three federal programs:money budgeted annually under the1996 welfare reform law, which was mostrecently renewed in 2004; the AdolescentFamily Life Act (AFLA), which was firstpassed in 1981; and direct grants from theDepartment of Health and Human Services(HHS). Under the Bush Administration,the annual abstinence budget has morethan doubled, driven almost entirely bygrants from HHS.controversial Personal Responsibility andWork Opportunity Reconciliation Act, or“welfare reform,” Congress set aside $250million over five years for state-initiatedabstinence programs. That initiative wasreauthorized in 2004.In 2001, the Bush administration dramaticallyexpanded these fledgling efforts byestablishing the Special Program of Regionaland National Significance—Community-Based Abstinence Education, or SPRANS.This is now the federal government’s largestand fastest growing abstinence-only educationinitiative, operating through directgrants from the Department of Health andHuman Services to abstinence-only programsaround the country. In 2004, SPRANS had abudget of $75 million. 9 In 2005, it is expectedthat the government will spend nearly $170million on abstinence-only programs.All told, in the last five years almost $1billion has been allotted to abstinence-onlyprograms. 10 Given such financial support bythe Bush administration, it is not surprisingthat abstinence-only sex education programsare now estimated to reach “millions of childrenand adolescents.” 11These programs are rapidly evolvingand expanding. They feature innovativeapproaches designed to create in-groupsdefined by the members’ willingness to delaysexual activity. Students wear “purity rings”and declare themselves “secondary virgins,”or young people who have been sexually activein the past but now commit to abstinenceuntil marriage. 12 One study found that about16 percent of all American teenagers havetaken a public pledge to abstain from sex untilmarriage. And while there are numerousabstinence programs, with different emblems,slogans and practices, they all stress that sexafter marriage is the best way to protect oneselfagainst pregnancy, disease, and shame.Certainly, efforts to change social normsand make it cool-to-be-a-virgin are welcome.The question remains, are they sufficient?«

»42 The Time Is NowWhat Our Kids Are LearningSince 2001, when the Bush Administrationtook office, the federal budget forabstinence-only programming has doubled,reaching nearly $170 million in 2005 (of the$270 million originally requested). Because aportion of the federal money is distributed tostates, which are required to provide matchingfunds, the actual amount of spending drivenby federal policies is significantly higher.The federal spending increase during thelast four years has been driven almost entirelyby a U.S. Department of Health and HumanServices (HHS) program that gives grantsdirectly to community-based organizations todevelop and administer abstinence-only projects.The HHS initiative, named Special Programsof Regional and National Significance,or SPRANS, has grown from $20 million for33 programs in 2001 to $104 million for morethan 100 grantees in 2005.These hundreds of programs all utilizea handful of abstinence-only curricula. In2003, 13 curricula were used by more thantwo-thirds of the SPRANS programs. In 2004,California Democratic CongressmemberHenry Waxman ordered a Congressional reviewof those 13 curricula. The review foundthat 11 of the 13 abstinence-only curriculacontained “false, misleading or distortedinformation.” Here are some examples of thesorts of things Rep. Waxman’s review foundthat the SPRANS programs teach America’sschool children. You can get HIV from tears and sweat.One curriculum fantastically listed tears andsweat in a column titled “At Risk” for transmittingHIV. Both fluids have been dismissed astransmission routes for HIV since the earlydays of the epidemic. HHS funded 19 programsthat used this curriculum in 2003. Condoms don’t work. Several curriculacited a long-discredited 1993 study thatclaimed condoms prevent HIV transmissiononly 69 percent of the time. In 1997, HHSpublicly distanced itself from the study, echoingcountless other researchers in explainingthat the study was based on “serious errors” inmethodology. Another curriculum attackedone of the leading studies proving condomeffectiveness, citing “university groups” thatchallenged its findings. The study in questionlooked at 15,000 acts of intercourse betweenan HIV-positive and negative person in whicha condom was used; it did not find a single incidenceof viral transmission. The challenging“university groups” that the abstinence-onlycurriculum cites turn out to be six letters tothe editor of the New England Journal of Medicine,where the original study was published. Women need money from men. Thecurricula regularly presented gender stereotypesas scientific facts. One curriculum, usedby 19 HHS grantees, listed “Financial Support”as among the “5 Major Needs of Women” and“Domestic Support” under the same list formen. It goes on to explain, “Just as a womanneeds to feel a man’s devotion to her, a manhas a primary need to feel a woman’s admiration.To admire a man is to regard him withwonder, delight, and approval.” Another curriculum,used by 32 HHS grantees, taught that“guys are able to focus better on one activityat a time” because women “experience feelingsand emotions as part of every situation.” Men need sex from women. The samecurriculum that listed financial support as atop female need and domestic support as atop male need also taught, “A male is usuallyless discriminating about those to whom heis sexually attracted. … Women usually havea greater intuitive awareness about how todevelop a loving relationship.”In 2003, 69 programs in 25 states usedthe curricula in Rep. Waxman’s study. Those69 programs have received over $90 million infederal funding since 2001.Source: Committee on Government Reform, MinorityStaff. U.S. House of Representatives. The Contentof Federally-Funded Abstinence-Only EducationPrograms. December 2004.

Silencing the Teachers 43Little evidence suggests that youth arereally embracing the virginity-until-marriagemovement. A recent study showed that about88 percent of youth who sign abstinencepledges eventually break them, meaning theyhave sex before marriage. 13 And while somestudies show evidence that abstinence-onlyprograms and abstinence pledges delay sexualintercourse, almost none find that youth gothe distance, waiting to have sex until they tiethe knot. 14In fact, some studies are showing quitethe opposite—that some teens who takeabstinence pledges are having sex more thanthose who do not. A recent Texas study foundthat teens in that state actually increasedsexual activity after completing an abstinenceprogram. 15Hannah Bruckner of Yale University andPeter Bearman of Columbia University alsofound that youth who sign pledges are morelikely to engage in other risky sexual behaviors,such as unprotected anal and oral sex.Male pledgers are four times as likely to haveanal sex. 16 So the stakes of failure for abstinence-onlyprograms are not just that youthwill break their promise, but that youth whodo so will be unprepared to protect themselves.The lack of effectiveness of abstinenceonlyprograms may stem from the inaccurateinformation some of these programs present.A government-sponsored report on the contentof such programs found that “over 80%of abstinence-only curricula used by twothirdsof SPRANS grantees in 2003, containfalse, misleading or distorted informationabout reproductive health.” 17 For instance, thereport found that some lessons taught that“condoms fail to prevent HIV transmission asoften as 31 percent of the time in heterosexualintercourse,” despite scientific evidence thatshows, when used properly, condoms providesafe protection over 90 percent of the time. 18Similarly, the Washington Post reported in2004 that, “[M]any American youngstersparticipating in federally funded abstinenceonlyprograms have been taught over the pastthree years that abortion can lead to sterilityand suicide, that half the gay male teenagersin the United States have tested positivefor the AIDS virus, and that touching aperson’s genitals can result in pregnancy,” allassertions that are unsupported by scientificevidence. 19While the health of Black youth is constantlycompromised due to factors such aspoverty, lack of health care and incarceration,abstinence programs appear to be the latestin a long list of threats. These programsrestrict important information concerningHIV/AIDS that young African Americansneed. With HIV and AIDS ravaging youthcommunities across the country, religiousleaders, community organizations, schools,and political leaders must support techniquesand programs such as sex education that haveproven to be effective at protecting our youth.Fundamental to all such efforts has to be theprovision of accurate and truthful information.How will we explain to young peoplewho become infected because they did notknow how to use a condom that we kept thatinformation from them in order to maintainour moral vision of what their lives should be,instead of confronting the challenges they areactually facing?Notes1. The Henry J. Kaiser Family Foundation. SexEducation in the U.S.: Policy and Politics. Issue Update.October 2002.2. Rector, Robert E. et al. “What Do ParentsWant Taught in Sex Education Programs?” HeritageFoundation Backgrounder #1722. January 28, 2004.3. Kaiser Family Foundation, Harvard UniversityJohn F. Kennedy School of Government and NationalPublic Radio. “Sex Education in America.” January2004.4. The Henry J. Kaiser Family Foundation. SexEducation in the U.S.: Policy and Politics. Issue Update.October 2002.5. Kirby, Doug. “Do Abstinence-Only Programs

44 Reclaiming Our FutureDelay the Initiation of Sex among Young People andReduce Teen Pregnancy?” The National Campaign toPrevent Teen Pregnancy. October 2002.6. U.S. Centers for Disease Control andPrevention. School Health Policies and Programs Study.2000.7. Ibid.8. CDC. Youth Risk Behavior Surveillance—United States, 2003. Morbidity and Mortality WeeklyReport. May 21, 2004.9. United States House of Representatives,Committee on Government Reform—MinorityStaff, Special Investigations Division. The Contentof Federally Funded Abstinence-Only EducationPrograms. December 2004.10. Connolly, Ceci. Some Abstinence ProgramsMislead Teens, Report Says. The Washington Post.December, 2, 2004.11. United States House of Representatives,Committee on Government Reform—MinorityStaff, Special Investigations Division. The Contentof Federally Funded Abstinence-Only EducationPrograms. December 2004.12. Resnick, Michael D, et al. “Protectingadolescents from harm: Findings from the NationalLongitudinal Study on Adolescent Health.” Journalof the American Medical Association, vol. 278, n. 10.September 10, 1997.13. Altman, Lawrence K. “Study Finds thatTeenage Virginity Pledges are Rarely Kept.” The NewYork Times. March 10, 2004.14. Ibid.15. MSNBC.com. Teen sex increased afterabstinence program: Texas Study finds little impact onsexual behavior. February 1, 2005.16. Hannah Bruckner and Peter Bearman. “Afterthe promise: the STD consequence of adolescentvirginity pledges.” Journal of Adolescent Health. 36;271-278. 2005.17. United States House of Representatives,Committee on Government Reform—MinorityStaff, Special Investigations Division. The Contentof Federally Funded Abstinence-Only EducationPrograms. December 2004.18. Ibid.19. Connolly, Ceci. “Some Abstinence ProgramsMislead Teens, Report Says.” The Washington Post.December, 2, 2004.

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46 Reclaiming Our Future

CHAPTER SIXA Bad Rap?The Roleof Hip-Hop MediaTo anyone watching, “American Idol” starFantasia Barrino’s story is a heartwarmingexample of success, of a talented Blackwoman making it against all odds. At age20, Fantasia is a single mother with a 3-year-old child who, remarkably, has balancedan exploding career with the responsibilitiesof parenthood. And for her debutalbum, Fantasia, she penned a song honoringthat achievement. But the song, “BabyMama,” touched a raw nerve in the Blackcommunity and among those concernedabout the sexual health of urban youth.In the song, Fantasia boldly challengesthe stigma attached to her place in life by callingher success “a badge of honor.” She championsyoung women who face the mammothchallenge of single motherhood and don’tgive up, singing, “There should be a holidayfor single mothers, but until then here’s yoursong.”Critics heard something entirely different:One more hip hop culture messagereinforcing depravity and self-destructivebehavior among Black youth. The song,they charged, perversely celebrates a tragicoutcome: babies having babies, as the phrasegoes.According to the 1994 National BlackPolitics Study, 78 percent of African Americansbetween the ages of 18 and 29 have beenexposed to rap media. 1 A more recent 10city study of urban Black youth conductedby Motivational Education EntertainmentCorporation found that African Americanyouth were active consumers of rap media viaavenues such as CDs, television, radio andmagazines. 2Yet, the vast majority of the images andportrayals of African American youth foundin hip hop media promote narrow, stereotypicaland largely negative caricatures of Blackyouth culture—particularly when it comes tosex. Young Black women are represented aswilling sexual objects who have no rightfulclaim to agency in the sexual-decision makingprocess. Conversely, young Black men arecelebrated for their sexual prowess, violenceand hyper aggressiveness, particularly in theirrelationships with women.The skewed picture doesn’t stop with sex.Drug use takes on an outsized role in hip hopmedia’s depiction of Black youth culture. 3Despair and nihilism are never far from the

»48 Reclaiming Our FutureHip Hop andHIV, by theNumbersDespite all the hand-wringing overwhat role the often negative imagesand messages found in hip hop media playin the sexual and drug using decisions ofBlack youth, one thing seems clear: Hiphop media has unparalleled potential as asocial marketing tool.Among the most successful HIV/AIDSawareness campaigns launched in any sectorof society to date is an innovative andbold partnership between the Kaiser FamilyFoundation and Viacom’s suite of mediaprogramming and platforms called “KnowHIV/AIDS.” It has inundated the Black medialandscape with popular figures—manyof them hip hop artists—talking aboutHIV/AIDS. Here’s some of the results. 94 percent of 18 to 24-year-olds interviewedhad encountered the campaign; 75 percent of those who had encounteredit said they’d come across it at leastthree times; 90 percent said that the ads madethem think about the seriousness of HIV/AIDS and the need to reduce their risk; 83 percent said that, as a result of theprogramming, they are more likely to taketheir sexual relationships seriously; 77 percent reported that they arenow more likely to use condoms if theyhave sex.surface of rap lyrics, with artists consistentlyreminding their listeners that their life opportunitiesare few. Unfortunately, many ofthese songs neglect to also notice the ways inwhich systemic racial discrimination restrictschoices in the lives of young Black Americans,much as they gloss over the real-worldconsequences of the behaviors that are glorifiedon screen or in lyrics.As out of sync with reality as these imagesoften are, given the prevalence of rapmedia in the lives of African American youth,we would be both naive and irresponsible ifwe chose to ignore the ways in which theyultimately can—and have come to—shapeBlack youth culture.Ultimately, that reality cuts both ways:hip hop’s powerful position in Black youthculture can be used to perpetuate old problemsor to build new solutions. It has thepotential to be among our most powerfultools in the fight against HIV/AIDS amongBlack youth.Indeed, some rap artists have alreadybegun to use their influence to heightenawareness of the epidemic among AfricanAmerican youth. They need our help just asmuch as their less responsible counterparts—and the corporations that carefully controlboth their public personas and the content oftheir music—need our admonitions. Whatis strikingly clear is that if we do not make aconscious attempt to employ rap media in thefight against HIV/AIDS, corporate greed willcontinue to create and maintain a social contextwhere high-risk behaviors are encouragedand their implications ignored.Causal—or Just anotherSymptom of Distress?I smoke (Yea!), I drank (Yea!)I’m supposed to stop but I can’t (Uh-huh)I’m a dog (Yea!), I love hoes (Yea!)And I’m addicted to money, cars andclothesDo it big thenI do it big nigga [3x]I Smoke, I Drank—Lil Boosie 2004

A Bad Rap? 49Imagine being a young African Americanmale, at a party or nightclub. You just arrivedwith some friends and the lyrics tothis popular rap song are blasting. The beatis irresistible, even transitory. You start tosubtly bob your head. As you walk in, andlook across the room, you see many fellowyoung African American men and womensigning or shouting out the lyrics whiledancing, smiling and laughing. You maynot even fully grasp what you’re saying, butyou begin to mumble to yourself, “I’m adog, I love hoes…”Just as you make these utterances,you make eye contact with a young AfricanAmerican woman. She is dancing in acelebratory fashion while smiling at you.You approach her and introduce yourself.Your body is moving with the rhythm of themusic and the lyrics are pounding into yourhead. Would your attitudes and behavior beaffected by what you’re hearing and singing?Or, if you are the women in this analogy, doesthe fact that you are dancing to or eveningsinging with this song reflect the ways inwhich you think about yourself, men, sex ordrugs?Some researchers aresaying yes—sort ofActually, few would suggest that one song,heard one time would significantly influencebehavior. But what researchers arefinding is that lyrics heard repeatedly, overtime may have an affect on the decisionmakingand behaviors of young people,especially those behaviors that can putthem at risk for HIV transmission. Moreand more studies are showing that the effectof high exposure to certain genres of rapmusic—like “gansta” rap—is associatedwith participation in the high-risk behaviorsassociated with HIV transmission. Thequestion is whether the music is causal, orjust one more part of the lives of peoplewho are put at risk for countless reasons.Although research on the relationship betweenhip hop and sexual behavior is limited,what does exist suggests that high exposureto rap media is associated with—though nota cause of—engagement in high-risk behaviorsand sexually transmitted infections.One important study conducted by GinaWingood and her colleagues examined theimpact viewing rap music videos had on thesexual behavior of young African Americanwomen. Researchers recruited 522 non-urban,sexually active African American youngwomen and girls to participate in the study.They found that those participants who had ahigh exposure to rap music videos were morethan two times as likely to have multiple sexpartners and one and a half times more likelyto acquire an STD during the twelve-monthperiod of observation. 4It’s important to note that there is nocausal argument here, nothing suggestingthat just listening to rap music causes suchbehavior. Ultimately, the question of hip hop’simpact on behavior may be a red herring.Rap music is merely a component of certaintypes of environments that can facilitate riskysexual behavior.However, other studies do demonstratea connection between the perceived powerlessnessthat is associated with being thetarget of sexual objectification and a lackof condom use among African Americanwomen. 5 Clearly rap media is not the onlyfactor contributing to a feeling of powerlessnessin young African American women, butwe must acknowledge that the vast majorityof mainstream or commercial rap media doesnot foster a sense of agency or empowermentin their sexual decision making.Rap media has also been found to be associatedwith sexually aggressive acts towardyoung women by young men. 6 The promotionof images representing “real” African

50 Reclaiming Our FutureAmerican males as sexually promiscuous,hyper aggressive, homophobic and violent islikely to have young African American malesaspiring to fulfill such corporate-constructedideals. 7Drug RapAlcohol and drug use are also prominentcomponents of mainstream, or commercialrap media. However the link between theimages and endorsements of rap artistsusing drugs and promoting alcohol and thesubstance use behaviors of young AfricanAmericans has been understudied. Hip hopscholar Tanji Gilliam notes the research“reveals an interesting relationship betweenadvertising and hip hop. Rappers often providecorporations with the opportunity toreceive free publicity. And the impact thatparticular brand marketing may have on thebehaviors of youth often goes unstudied.” 8There is at least one study that demonstratesboth the prominence of alcoholand drug use in rap songs and the lack ofinformation concerning the consequences ofsuch behavior. According to a 1996 study ofthe 1,000 most popular songs in the UnitedStates, references to alcohol and drugs weremost frequent in rap songs when comparedto other musical forms. In fact, substancesappeared in 75 percent of rap songs in thesample, compared to 20 percent of Hot-100,20 percent of alternative rock, 14 percent ofcountry-western and 12 percent of heavymetal. 9Forty-seven percent of the rap songsreviewed contained references to alcohol and63 percent referenced illicit drugs. The comparativepercentages for alcohol were: heavymetal 4 percent; 13 percent in country-western,12 percent in Hot-100 and 10 percent inalternative rock. Illicit drugs appeared in 11percent of both Hot-100 and alternative rocksongs and 9 percent of heavy metal. Only onecountry-western song referred to illicit drugs.While these percentages alone aretroubling, only 19 percent of all songs with areference to illicit drug use and nine percentof those referring to alcohol also providedinformation on the deleterious consequencesof alcohol and drug abuse. It is easy to imagethat youth who have particularly strongidentifications with rap artists who celebratesubstance use might begin to aspire to usealcohol and/or drugs like their favorite performers.Harnessing the MassivePotential“It was really important for me to beinvolved with a campaign that is raisingawareness of HIV/AIDS. I had an unclesuccumb to HIV, so I’ve personally feltthe impact of the disease. It’s importantfor everyone to be aware that thisdisease doesn’t just affect a single raceor sexual orientation. The ‘Knowingis Beautiful’ campaign was especiallyimportant to me because I’m a trueadvocate of taking care of and lovingourselves, and that’s really what thiscampaign is about. So I was glad to bea part of the mission to help raise theconsciousness about HIV/AIDS.”Common Sense,Grammy Award WinnerWhile rap media has been associated withrisky sexual and drug use behaviors, thereis also strong evidence that rap artists andrap media can be powerfully effective whenwe bother to recruit them into the fightagainst HIV/AIDS among African Americanyouth.Among the most successful HIV/AIDSawareness campaigns launched in any sectorof society to date is an innovative andbold partnership between the Kaiser Fam-

A Bad Rap? 51ily Foundation and Viacom’s suite of mediaprogramming and platforms called “KnowHIV/AIDS.” From billboards to public serviceannouncements on Black EntertainmentTelevision to radio spots to helping writerson Black-targeted programs like Girlfriends,the campaign has inundated the Black medialandscape with popular figures—many ofthem hip hop artists—talking about HIV/AIDS. This is an especially important initiativesince nearly 90 percent of the Black youthsurveyed in the Motivational EducationalEntertaintment study named BET as theirfavorite media source for rap music videos.The campaign seeks to heighten awarenessof HIV/AIDS among African Americanyouth and to create a sense of power andresponsibility. According to a recent evaluationof this intervention effort, not only is itsuccessful in reaching young African Americans,but it has also led to some attitudinaland behavioral change. 10It has been remarkably successful inreaching its audience: 94 percent of 18 to24-year-olds interviewed reported that theyhave encountered the campaign. Seventyfivepercent of those who have encounteredit reported seeing the ads and shows at leastthree times. Ninety percent said that the adsmade them think about the seriousness ofHIV/AIDS among African American youthand the need to reduce their risk. Eightythreepercent of respondents reported that, asa result of the programming, they are morelikely to take their sexual relationships seriouslyand 77 percent reported that they arenow more likely to use condoms if they havesex.At the same time, the review pointed toareas where more work is clearly still needed.Only 52 percent of respondents said theyhave talked to their partner about safer sexsince viewing the ads and only 28 percenthave been tested for HIV. Therefore whileyoung people are reporting increased awarenessand changed attitudes toward unsafe sex,not as many are changing their behaviors.Ultimately, popular culture and the medialandscape seems to play an important roleon the front end of the process: cuing youngviewers and listeners either in or out ofdiscussions about healthy lives. But it is noreplacement —positive or negatively—for acomprehensive and aggressive public healthwork that gives youth not just the awareness,but the tools they need to protect themselves.Notes1. Dawson, Michael C. Black Visions: The Roots ofContemporary African-American Political Ideologies.Chicago: University of Chicago Press, 2001. p. 80.2. Motivational Educational Entertainment, ThisIs My Reality: The Price of Sex, An Inside Look at BlackUrban Youth Sexuality and the Role of Media. 2004.3. Classification and Rating Administration of theMotion Picture Association of America. “SubstanceUse in Popular Movie and Music Issue Brief.” 1999.Conducted by Mediascope.4. Wingood, Gina M et al. “A prospective study ofexposure to rap music videos and African Americanfemale adolescents’ health.” American Journal of PublicHealth 93:437-439. 2003. Although the study does notspecify the type of STD contracted, the great majorityof STDs (including HIV) can be avoided with the use ofcondoms.5. Hetherington, S.E., R.M. Harris, R. BakerBausell, K.H. Kavanagh, and D.E. Scott. 1996. “AIDSprevention in high-risk African American women:Behavioral, psychological, and gender issues.” Journal ofSex and Marital Therapy 22:9-21.6. Barongan, Christy and Nagayama Hall, GordonC. The Influence of Misogynous Rap Music on SexualAggression against Women. Psychology of WomenQuarterly 19:195-207. 1995.7. Wade, Bruce and Thomas-Gunner, Cynthia.“Explicit Rap Music Lyrics and Attitudes toward Rape:The Perceived Effects on African American CollegeStudent’s Attitudes.” Challenge: A Journal on AfricanAmerican Men. October 1993.8. Gilliam, Tanji. “Hip Hop and Politics,” memoproduced for Black Youth Project Website, October2005.9. Classification and Rating Administration of theMotion Picture Association of America. “SubstanceUse in Popular Movie and Music Issue Brief.” 1999.Conducted by Mediascope.10. Kaiser Family Foundation, Assessing PublicEducation Programming on HIV/AIDS: A NationalSurvey of African Americans.

52 Reclaiming Our FutureAbout theBlack AIDS InstituteTThe Black AIDS Institute, founded in 1999,is the only HIV/AIDS think tank in theUnited States focused exclusively on Blackpeople. The Institute’s mission is to stop theAIDS pandemic in Black communities byengaging and mobilizing Black institutionsand individuals in efforts to confront HIV.The Institute conducts HIV policy research,interprets public and private sector HIVpolicies, conducts trainings, builds capacity,disseminates information, and providesadvocacy and mobilization from a uniquelyand unapologetically Black point of view.What We Do The Institute develops and disseminatesinformation on HIV/AIDS policy. Our firstmajor publication was the NIA Plan, whichlaunched a national campaign to stop HIV/AIDS in African American communities byformulating and disseminating policy proposalsdeveloped through collaboration withfederal, state and local government agencies;universities; community-based organizations;healthcare providers; opinion shapers and“gatekeepers.” The African American HIV University(AAHU), the Institute’s flagship trainingprogram, is a two-year fellowship programdesigned to increase the quantity and qualityof HIV education in Black communitiesby training and supporting peer educators ofAfrican descent. The International Community Treatmentand Science Workshop is a trainingand mentoring program to help people whoare living with HIV/AIDS or who are workingwith community-based and non-governmentalAIDS organizations to meaningfullyaccess information presented at scientificmeetings. The Drum Beat is the Institute’s Blackmedia project designed to train Black mediaon how to report accurately on HIV/AIDS and tell the stories of those infectedand affected. The Black Media Task Forceon AIDS, a component of the Drum BeatProject, currently has over 800 Black mediamembers. The Institute publishes original editorialmaterials on the Black AIDS epidemic.Our flagship publication is a monthly newsletter,Kujisource, which has a distribution

About the Black AIDS Institute 53of 25,000. Our web site, www.BlackAIDS.org attracts nearly 100,000 hits a month.The Drum Beat newspaper is a semi-annualtabloid with a distribution of 300,000. It isdistributed to Black conventions, barbershops,beauty parlors, bookstores and doctor’soffices. The Institute’s newest publicationis Ledge, a magazine produced by and forBlack college students and distributed on thecampuses of historically Black colleges anduniversities around the country. Heroes in the Struggle, an annual photographictribute to the work of Black warriorsin the fight against AIDS, is currentlytraveling to Black universities, museums andcommunity-based organizations throughoutthe United States, providing information onHIV/AIDS. The Black AIDS Institute and BET inassociation with the Kaiser Family Foundationalso sponsors the Rap-It-Up BlackAIDS Short-Subject Film Competition tohighlight the issue of AIDS and HIV infectionwithin the African American community.The 2004 Rap-It-Up winner, first-timefilmmaker Tracy Taylor has been nominatedfor an NAACP Image Award. Taylor’s film,Walking on Sunshine, aired on BET and willbe screened at film festivals throughout theyear.Rap-It-Up is designed to provide a voiceand visual outlet for the thousands of AfricanAmericans living with or caring for thosewith HIV and AIDS, and/or fighting AIDS inBlack communities. By showcasing examplesof heroism from within Black communities,we can galvanize African Americans torefocus and recommit to overcoming thisepidemic. The Institute provides technical assistanceto traditional African American institutions,elected officials and churches who areinterested in developing effective HIV/AIDSprograms, and to AIDS organizations whowould like to work more effectively with traditionalAfrican American institutions.Finally, nearly 30,000 people participatedin AIDS updates, town hall meetings or communityorganizing forums sponsored by theInstitute last year.