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arly on a balmy morning last October, Cedric Sturdevant began his rounds along the bumpy streets and back roads of Jackson, Miss. If he doesn’t make these rounds, he has learned, many of these patients will not get to the doctor’s appointments, pharmacies, food banks and counseling sessions that can make the difference between life and death. I’m proud of you.” But Marq barely said goodbye as he jumped out of the car in front of a convenience store on an avenue scattered with a pawnshop, a liquor store and several Baptist churches, and he all but admitted he was planning to spend the afternoon smoking weed and looking at Instagram. The South also has the highest numbers of people living with H. An unconscionable number of them are dying: In 2014, according to a new analysis from Duke University, 2,952 people in the Deep South (Alabama, Florida, Georgia, Louisiana, Mississippi, North Carolina, South Carolina, Tennessee and Texas) died with H. “Growing up, I was taught that God was not fixing to forgive a person who was homosexual,” Sturdevant said. in 2005, Sturdevant knew little about the virus and was too depressed and ashamed to tell anyone at first. And yet a series of fateful decisions and omissions, dating back to the discovery of the disease, have led to a present that looks like the past — but only for some. Barbara Lee, the longtime United States representative from Northern California, has signed her name as a sponsor to every piece of major federal H. V./AIDS legislation since she was first elected in 1998. He pointed to stacks of studies over the years, including a groundbreaking, exhaustive 2006 data dive led by Greg Millett that was published in The American Journal of Public Health.

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Now I want to help anyone I can in any type of way. I think it’s part of our responsibility that when someone in our community passes away, we give them the dignity of a place to rest.”On a late, lazy Sunday afternoon in early April, Sturdevant, in cutoff fatigues and a white tank top stained with barbecue sauce stretched over his generous belly, was flipping chicken and rib tips on his grill.

My goal is to not to let anyone judge me or let this disease own me.”The bias that black gay and bisexual men still face poisons the H. He had gathered his family — nearly two dozen sons and daughters, some related by blood, most not — to his house in South Jackson for a family barbecue.

He was headed to a small town 90 miles east of the city to visit Jordon, an H. Sturdevant met the young man in 2009 and took him in; he later helped him deal with his H. His arms were marked with scars from hospital visits and IVs. He smiled slightly when he saw Sturdevant, dimples folding into his hollow cheeks. He wasn’t accustomed to being sick and had tested negative for H. In 2010, the Obama administration unveiled the first National H. V./AIDS Strategy, an ambitious plan that prioritized government research and resources to so-called key populations, including black men and women, gay and bisexual men, transgender women and people living in the South. “What we have been trying to do is ensure that we’re having the greatest effect with the resources we’re provided.”Few believe there is the kind of energy, leadership, money and political will in the current political climate to fix the situation in the community that has fallen through the cracks for so long. The congressional fight over the repeal of the Affordable Care Act, and the president’s declarations that “Obamacare is dead,” have conjured a disastrous return to even more alarming conditions, like waiting lists for medication. medication ballooned to over 9,000 people, mostly poor black and brown men in Southern states.“The key to ending the AIDS epidemic requires people to have either therapeutic or preventive treatments, so repealing the A. “For the most vulnerable, do we end up back in a time when people had only emergency care or no care and were literally dying on the streets? In 2006, I attended the International AIDS Conference in Toronto with a delegation of black journalists, civil rights leaders, government officials, politicians and celebrities, including the singer Sheryl Lee Ralph, Representatives Maxine Waters and Barbara Lee, the Rev. We ask that you bring more people in that need somebody to talk to. That need the understanding.”As the men settled into their seats, Sturdevant asked them to go around and “check in.” Jermerious Buckley, watchful behind black rectangular glasses, with no sign of the makeup and colorful pumps he wore on weekends at Metro, told the group, “I’m doing a whole lot better.” Last year, he said, “Daddy,” as he called Sturdevant, had pulled him back from the dead, after he had shrunk to 85 pounds, his arms covered with Kaposi’s sarcoma lesions, his kidneys failing. News outlets and social-media accounts shared a photo of him in his clerical robe, holding a sign that read: “Marriage is one man and one woman.

With a mandate to “follow the epidemic,” several pharmaceutical companies and philanthropic organizations also started projects to help gay black men, particularly in the Southern states. And experts in the field have grown increasingly worried about the new administration’s commitment to fighting the disease. As recently as 2011, the AIDS Drug Assistance Program state-by-state list of people waiting for H. We don’t know yet, but we have to think about it.”June Gipson, president and chief executive of My Brother’s Keeper, the Jackson nonprofit Cedric Sturdevant works for, believes that the repeal of the Affordable Care Act wouldn’t have an immediate catastrophic effect in her state — but only because things are already so dire. He felt like a “zombie,” he said, too weak and hopeless to bother with his meds. Anything else is a perversion,” next to a horse clad in a white wedding dress. in Jackson lack the support of their families, community and the church, they end up in Grace House, a homeless facility on a sleepy block in the midtown section of the city.

The data was so persuasive that the federal government began pushing new H. V./AIDS treatment guidelines to health care providers the following year. report in February noted that only 48 percent of black gay and bisexual men effectively suppress the virus with consistent medication, and the numbers are even lower for these men in their late teens and 20s. had progressed to AIDS by the time they learned of their infection — which meant that they were generally very ill by the time they began treatment. “November in New Orleans — y’all wish me luck,” he said. Until recently, Justin Huff, a former Jackson State student, shared a room on the second floor of Grace House’s main facility. “I was throwing up and couldn’t eat anything for a few days; I thought it was from the drinking,” Huff said.

And in 2012, the Food and Drug Administration approved the preventive use of Truvada, in the form of a daily pill to be taken as pre-exposure prophylaxis (commonly called Pr EP). from contracting the virus, based on the results of two large clinical trials; an estimated 80,000 patients have filled prescriptions over the past four years. In 2014, nearly one in five black gay men who had received a diagnosis of H. Only a small percentage of black people use Pr EP to prevent contracting the virus, accounting for only 10 percent of prescriptions; the vast majority of users are white. The group turned toward Benjamin Jennings, who wore a serious expression, with a shock of long hair in dreadlocks flipped to the side. Though currently blocked by federal court and under appeal, the legislation, if allowed to proceed, would allow churches, religious charities and private businesses to deny services in a broad variety of contexts to L. “When I went to the doctor, he was like, if I hadn’t made it in the next two days, I would’ve been dead.”Frightened and overwhelmed, he eventually landed on the doorstep of Grace House.

Thanks to the success of lifesaving antiretroviral medication pioneered 20 years ago and years of research and education, most H. V.-positive people today can lead long, healthy lives. for several key populations, predicted that if current rates continue, one in two African-American gay and bisexual men will be infected with the virus. The South is also home to 21 of the 25 metropolitan areas with the highest H. Sturdevant has shared his story too many times to count, to let young men know that he has been there, too, and to help them understand that they can survive this plague. “I honestly didn’t believe it.” He paused and then added quietly, “It was the worst day of my life.”With effort, Jordon sat up slightly, untangling himself from a jumble of sheets. diagnosis and the illness are so overwhelming that maintaining a new and unfamiliar regimen of medication can be difficult. “Not as often as I should.” When he saw Sturdevant’s glare, he continued, sounding like a little boy. I have to take six pills, now seven, eight, plus a shot —”Sturdevant cut him off. Though not stated explicitly, the language of the report, by omitting race, implied that its “five young men, all active homosexuals,” were white, which they were. treatment and care for those who have no other way to finance their medication. The largest international health initiative in history to fight a single disease, Pepfar is considered a success story by any measure and a crowning achievement of George W. Yet while buckets of money went overseas, domestic funding for H. V./AIDS remained flat, and efforts to fight the disease here were reduced to a poorly coordinated patchwork affair. is only a problem in sub-Saharan Africa, and that message filtered down to the public. globally, the havoc that it wreaked on the domestic epidemic has been long-lasting.”Beginning in the late ’90s, the United States government funneled billions of federal dollars into abstinence-until-marriage programs here and abroad. “Plus, these are the same individuals that are dealing with structural barriers around lack of employment, lack of education and opportunities, transportation and, of course, very, very overt institutional racism.”An elevated viral load in a smaller sexual network (because most people still tend to have sex with people of the same race), amplified by the structural issues that Moore pointed to, also explains why H. But in the first decades of the epidemic, these ideas and explanations had not been widely accepted to explain the growing body of data pointing to fast-rising numbers of H. In fact, the African-American community was largely in denial about the fact that H. The community’s awakening came in 1991, when Magic Johnson tearfully announced, “Because of the H. I was an editor at Essence in 1994 when the magazine’s editor in chief, Susan L. among African-American women by putting Rae Lewis Thornton, a Chicago woman who described herself as “young, educated, drug-free and dying of AIDS,” on the cover. cases and deaths among black women, there was a lack of empirical evidence to clearly explain why the rates were so high. infection among African-American women was a result of a complicated combination of all these factors, as well as the reality that after decades of denial and neglect, the viral load piled up in black communities, making any unprotected sexual encounter with anyone a potential “bridge to infection.” But two decades ago, in the midst of a very scary, fast-growing epidemic, the down-low brother became the AIDS boogeyman. I assure you that none of the brothers on the down low like me are paying the least bit of attention to anything you have to say.”King’s subsequent 2004 book, “On the Down Low: A Journey Into the Lives of Straight Black Men Who Sleep With Men,” appeared on the New York Times best-seller list for a number of weeks and spawned two “Oprah” shows, an episode of “Law & Order S. U.,” a BET documentary, a sequel by King and another book by his ex-wife. On Wednesday evenings once a month, Sturdevant runs an H. V./AIDS support group in a stark conference room near the State Capitol in Jackson.

In cities like New York and San Francisco, once ground zero for the AIDS epidemic, the virus is no longer a death sentence, and rates of infection have plummeted. Last year, the Centers for Disease Control and Prevention, using the first comprehensive national estimates of lifetime risk of H. That compares with a lifetime risk of one in 99 for all Americans and one in 11 for white gay and bisexual men. If gay and bisexual African-American men made up a country, its rate would surpass that of this impoverished African nation — and all other nations. He also knows that many black gay and bisexual men have been rejected and discarded, and has wrapped his arms around as many as he can grab hold of, treating them like family. He feeds them, sometimes houses them, but mostly listens to them. Sturdevant asked how he was doing, and he cataloged a laundry list of what he called his “old man” ailments. But there were two more documented cases, not mentioned in the notice, and these sixth and seventh cases were black — one of them a gay African-American, the other a heterosexual Haitian. Michael Gottlieb, the lead author of the report and a renowned physician specializing in H. V./AIDS, treated Rock Hudson before he died of AIDS complications in 1985 and still practices in Los Angeles. through a blood transfusion in the ’80s, this federal program provides funding for H. “When we saw that the epidemic was out of proportion in the black community, we started calling for a domestic Pepfar that would bring new resources to the effort, create clear and ambitious objectives and rebuild health care infrastructure around the country,” Lee said. for 14 years and a senior policy adviser for the Obama administration’s White House Office of National AIDS Policy, put it more candidly. Though the Bush administration did wonderful work in combating H. In place of effective sex education, these programs often discouraged condom use while teaching abstinence as the only way to prevent the spread of AIDS — even as well-regarded research established that this kind of sex education does not lower the risk of contracting H. Taylor, insisted that we shine a light on the disturbing increase of H. I had been writing about AIDS in the black community since the mid-’80s but had never seen anything like the coordinated efforts that started in the late ’90s, when civil rights groups, politicians, clergy, fraternities and sororities and celebrities stepped up to encourage testing and distribute prevention information. and other agencies offered plenty of alarming statistics confirming the high and growing numbers of H. Experts in academia and government researchers tried to unravel a knotted tangle of factors: Women were contracting the virus from bisexual men; higher rates of sexually transmitted infections among black women facilitated the spread of H. V.; socioeconomic issues drove up the rates of all disease. Ta-Nehisi Coates jumped into the fray in a 2007 essay for Slate that questioned why the myth of the “on-the-down-low brother” refused to die, referencing a controversial 2003 cover story in this magazine by a white writer who went into the scene to uncover closeted black men who lead double lives. diagnoses among African-American women plummeted 42 percent, though the number of new infections remains unconscionably high — 16 times as high as that of white women. The meetings end promptly at p.m., so the dozen or so young men can race home to watch “Empire.” Sturdevant began October’s gathering with a prayer.

It has been found to be up to 99 percent effective in preventing people who have not been infected with H. But these measures have not extended to most black gay and bisexual men. Many black gay and bisexual men either can’t afford Pr EP or don’t know about it — they may not see a doctor regularly at all, and many medical providers haven’t even heard of Pr EP. When he said it was his first time there, everyone clapped. “I couldn’t believe I was living in a shelter,” said Huff, who is now couch-surfing, applying for jobs at fast-food outlets and retail shops and attending Sturdevant’s support group, determined to stay healthy. Off and on, I got tired of living, because all I was doing was basically dying trying to stay alive.”Behind Grace House is a small, quiet makeshift graveyard that holds the cremated remains of 35 or so residents whose families did not pick up their bodies after they died.

Turning things around would mean expanding testing and providing affordable treatment for those who are positive — to stop sickness and dying and also to block transmission of the virus. during their lifetime, but it’s also been a clarion call for all of us to improve on what we’re doing,” said Dr. “I was diagnosed July 8 of this year, and my goal is to learn everything that I can about this thing,” said Jennings, 21, talking in a tumble of words as he pulled at his cropped T-shirt. Thank God — I am so lucky to have her in my life.” He paused, looking into the faces of the men around the table and speaking more slowly. Ceramic angels, pieces of glasswork and other mementos left by friends in memory of the deceased dot the patch of earth at the base of a pecan tree.

V.-prevention programs, messages or research impossible for U. Watson’s face was still as a stone; as he snapped his neck to the side, his waist-length dreadlocks whipped around his head.

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