What's Happening Here? Some HIV Research Continues to Miss the Mark

The Abbey, a gay bar in West Hollywood

You'd be hard-pressed to find a Lionel Richie song in a gay bar these days, but the lyrics to Richie's classic "Dancing on the Ceiling" ring just as true today as they did in the mid-1980s. "What is happening here?" Richie chants in his popular track. "Something is going on/That's not quite clear ... "

A presentation made at the 20th International AIDS Conference (AIDS 2014)—one that actually featured a photo of male dancers on the ceiling of a gay bar—left me wondering what's going on with HIV-prevention efforts in the social spaces MSM frequent, and what it will take before the research focuses on the most at-risk demographic: young Black MSM.

During his presentation, "Associations Between Gay Community Venue Network Position and HIV Risk and Protective Factors Among Young Men Who Have Sex With Men in Los Angeles County," public health researcher Ian W. Holloway, Ph.D., from the department of social welfare at UCLA's Luskin School of Public Affairs—who worked with Michele D. Kipke, Ph.D., of the pediatrics department at Children's Hospital Los Angeles—stated that their research explored how MSM socialize in gay bars, where they mingle, if drug use is involved and what effect these factors have on HIV risk and prevention. (Go here to watch the presentation on YouTube.)

The study's results showed that when young MSM, ages 18 to 24, frequent gay venues and neighborhoods, they are exposed to an increased level of HIV risk. In other words, while barhopping through neighborhoods such as West Hollywood in Los Angeles, where part of the study took place, they expose themselves to a network of people who are more likely both to have HIV and to be engaged in sexually risky behavior. These risks are heightened by illegal substance use, which some of the men engage in.

Straightforward enough. However, to paraphrase Richie, some of the researchers' other findings are far from clear.

For example, even though young MSM are exposed to increased risk in these establishments, the research shows that they also encounter a few HIV-prevention messages and receive social support. Indeed, Drs. Holloway and Kipke show that the more MSM get involved in gay venues, the less stress they experience as a result of being sexual minorities.

How is it possible that by frequenting gay establishments, MSM are both at higher risk for HIV and supported toward more healthy living?

Drs. Holloway and Kipke conclude that the venues MSM frequent provide few HIV-prevention messages. According to Dr. Holloway, this is a missed opportunity. The good news? There's great potential for improvement. But these findings reveal a life-threatening contradiction facing MSM who socialize in these popular places. They also raise the question of why there aren't better HIV-prevention efforts at popular gay bars.

The researchers say that many of the gay-business owners think that HIV-prevention efforts are a "buzzkill" and bad for business—that bars are in business to sell a good time, not good health. Business owners seem not to be aware that the health of their clientele is crucial to the health of their business.

But economics and social responsibility aside, another crucial element to understanding MSM behaviors was missing from this study. The researchers brushed over a key factor: whether the demographic groups served by the bars they studied represent the actual MSM communities most at risk for HIV.

Although a quarter of the men surveyed were African American—the demographic at greatest risk of acquiring HIV—not all Black MSM frequent predominantly White mainstream bars. Indeed, Dr. Holloway's "dancing on the ceiling" slide revealed a mostly White crowd.

Most likely, the researchers' sample represents only a fraction of the African American MSM experience. And even Black MSM in mainstream clubs may not be exposed to the same channels of risk as White and Latino MSM in those same venues. To thoroughly understand African American MSM social behavior, researchers must study their behavior not only in mainstream venues but in all of the contexts in which they socialize, including establishments in which they are the dominant demographic.

In other words, how we frame studies and where we find study participants is just as important as the data uncovered. Data means little if we are not focusing our research in the right places. South African scientist Salim S. Abdool Karim, M.D., Ph.D., a professor at Columbia University's Mailman School of Public Health, illustrated this concept masterfully in a presentation in which he identified the world's 10 largest HIV epidemics. (The United States ranks ninth, following several sub-Saharan African nations and India.) If we end the epidemic in these 10 countries, he told conference delegates, we will end 61 percent of the world's HIV pandemic.

Similarly, as we attempt to end the U.S. epidemic, we can no longer behave as though HIV is a disease of the masses. Although all MSM are at increased risk of acquiring HIV, the path to understanding how to end this epidemic requires that researchers do more than pick a mainstream venue and then survey as diverse a crowd as possible. Today's efforts must be razor-sharp in their targets. The question becomes not merely "Where do MSM frequently socialize and what risks await them?" but also "Where do African American MSM frequent, and how do the risks they encounter and their behaviors in those contexts affect our overall strategies toward prevention?" Only when we consider that the health of Black MSM is central to the health of all MSM and all of America can we truly make progress in achieving an AIDS-free generation.

Ramon Sahib Johnson is a Ph.D. researcher at the Centre for Cultural Studies at Goldsmiths College, University of London. He writes on topics of race, queerness, technology and group identity.