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Depression Along With HIV Can Kill Black Gay Men. Can We Stop It?

Ari Hampton came out to his father when he was 18. It didn’t go well.

Fearing for his life, the gay teen ran away, ending up on the streets of Detroit. To survive, he sold the only thing he had—his body. To deal with the harsh realities of his life and the humiliation of sex work, Hampton turned to drugs and quickly became addicted. In the years that followed, Hampton eventually traded life on the streets for an abusive partner who ended up giving Hampton more than a place to stay and a few stitches: In 2009, just shy of his 21st birthday, Hampton learned that he’d also gotten HIV. evn_journalismaward-insert2015

Neither Hampton’s name nor his snapshots hint at the 26-year-old’s mixed-race heritage, but you can hear his African-American roots in his baritone voice (Barry White’s got nothing on this guy). Listening to his story, though, it’s not hard to imagine why Hampton might struggle with depression.

Americans tend to think of depression as a personal, time-based, event-specific, short-term occurrence. Something specific happens to a person, like they lose a partner, and that makes them immediately (but temporarily) sad. Eventually that person gets over it and moves on.

That isn’t what it’s like for people with clinical depression. Their feelings of despair can come out of nowhere, return daily for months on end, arrive hand in hand with anxiety, and be so consuming that the person can’t function, which is why depression is the leading cause of disability.

“It’s not a trigger of somebody doing something towards me,” Hampton explains. “It’s not a trigger of me being stressed out about life. Sometimes it just happens.”

Black gay men, in particular, are bearing the brunt of these intersecting factors, leading them to experience higher rates of depression as well as increased HIV risks and negative health outcomes.”

It may come out of the blue, but depression doesn’t strike at random. Certain psychosocial factors—like religion, family, or poverty combined with a person’s thoughts and behavior— mean that some of those most at risk of becoming HIV-positive are also at the greatest risk for depression. Black gay men, in particular, are bearing the brunt of these intersecting factors, leading them to experience higher rates of depression as well as increased HIV risks and negative health outcomes, including early death.

Bottom line: Depression along with HIV can kill Black gay men. But why?

Being Black, Gay, and Depressed

“If you’re Black, you’re gay, and you’re HIV-positive, you’ve already got three strikes,” says Antoine Craigwell, founder of the organization Depressed Black Gay Men and the driving force behind “You Are Not Alone,” a documentary that features dramatized re-creations of Black gay men’s experiences with depression. Add depression and “you might as well just dig a hole, crawl into it, and pull the dirt over you, because it’s all over,” he adds.

Depression has been a part of Hampton’s life since he was a teenager, but before that, he recalls, “As a kid I was very optimistic and very sunny.” That disposition didn’t survive the abuse and family discord that marred Hampton’s childhood.

“The physical abuse as a kid happened a lot with my dad,” Hampton says. “And it was one of the biggest reasons that my mom left, so it kind of broke up the family.”

Hampton grew up in Detroit, long after the Motor City’s heyday in the 1960s. The city’s crime rate peaked in 1991—when Hampton was a toddler—and Detroit had the undesirable distinction of being the FBI’s “Most Dangerous City in America.” People fled the city, leaving behind an endless supply of abandoned houses and industrial buildings where drugs, arson and other crimes flourished.

With White flight altering the city’s demographics, Hampton’s skin tone only fueled his growing sense of alienation. “I’m the lightest person in my family,” he explains. “So I basically don’t look like anybody in my community. The majority of the community, most of them don’t think that I am Black. I’ve grown up having two worlds that didn’t want to accept me.”

And that was before Hampton came out as gay. “When I was trying to battle myself, trying to suppress my feelings towards men, I think that’s when [my] depression started,” Hampton admits. “When you have childhood trauma, it breaks down your self-esteem. And I think that voice becomes your [internal] voice. It becomes your subconscious telling you, ‘You’re not good enough.’”

That fueled a downward spiral. “Not liking what I saw in the mirror…I stopped eating and ended up forming this very unhealthy relationship with food,” he says. “I would binge and purge all the time. That progressed into taking cigarettes and burning myself.”

By high school, Hampton learned his best friend was not only gay too but “a cutter,” someone who cuts himself for psychological relief.

“We discovered each other’s dark secrets,” Hampton recalls. “And we were like, ‘No more.’ We formed this bond and made sure that we weren’t doing these unhealthy habits.”

Hampton’s anxiety about coming out intensified after his father moved them to Florida. “The family on my dad’s side they weren’t too accepting,” Hampton says. “As the majority of [them are] African-American or Native American, they didn’t accept that type of ‘lifestyle.’” His father’s abuse made things worse.

“I knew the only way I could come out of the closet was at a time when it was OK for me to get away from the house,” Hampton says. As his high school graduation neared, he finally got up the nerve and came out in a letter to his father.

“He called me and was like, ‘I accept you and everything is cool.’ Then I came home and, immediately, the physical abuse started. The last straw was him putting a knife to my chest and explaining how he could get away with murder and plead insanity.”

That’s when Hampton ran away and “got into some really bad things…I turned to drugs and struggled with addiction and struggled with just trying to survive on the street. I ended up doing sex work and stuff like that. It was very tough.”

Unfortunately, Hampton’s experiences aren’t unique. LGBT youth make up 40 percent of the homeless kids in the U.S., and more than half experienced abuse at home, while 68 percent cited family rejection as a factor in their homelessness. Family rejection, stigma around nonconforming gender expression, and “minority stress” (the prejudice, stigma, and discrimination encountered by minorities, including LGBT people) have also been shown to increase mental health problems and suicide rates.

Here’s where the numbers tell the story: Gay and bisexual men are twice as likely as straight men to experience anxiety or depression in their lifetime. Among those who are also Black, a full 33 percent suffer from depression, in part because of the impact of other factors like poverty, discrimination, and mass incarceration in addition to homophobia.

The biggest contributors to depression in Black gay men, Craigwell says, are issues around “sex, sexuality and sexual identity; the role of the church; contracting HIV; being out as a Black gay man; and sexual abuse.”

A 2003 study noted the prevalence of childhood sexual abuse among of gay and bisexual men at risk of becoming HIV-positive. Other health problems common among the group included substance abuse, intimate partner violence and depression, all of which have a compounding impact on each other (an occurrence known as a “syndemic” in public health jargon). For example, gay men who had suffered childhood sexual trauma were more likely to experience partner violence and depression.

Elsewhere, depressed people were shown to be more likely to have substance abuse issues and engage in survival sex (sex for money or housing) as well as sex while under the influence of alcohol or drugs.

Depression Compounds HIV Risks

With greater odds of being depressed come a greater probability of becoming HIV-positive.

Craigwell sees becoming HIV-positive as an expression of Black gay male depression: “The stigma, the discrimination, and the homophobia from the community causes an individual to descend into depression where he no longer cares about himself and he contracts HIV as a passive form of suicide.”

Research backs him up. “People with serious mental illness are particularly vulnerable to HIV infection as a result of the higher prevalence among this group of a variety of factors, including poverty, homelessness, high-risk sexual activities, drug abuse, sexual abuse and social marginalization,” says a report from the U.S. Department of Health and Human Services Health Resources and Services Administration.

Some of the seminal research showing mental illness could have a negative impact on HIV health outcomes has come from Jane Leserman, an expert in psychoneuroimmunology (the study of the relationship between psychological and neurological issues and immune system factors).

In the early 1990s, Leserman noticed that some people with HIV were surviving their infections, while “other people immediately fell ill and developed AIDS,” she tells Plus. To find out why, she launched a 14-year longitudinal study, which showed that people with “more cumulative stress and more cumulative depression” tended to more quickly convert to AIDS, die, or see a dramatic and dangerous drop in T cells.

Leserman says no one has yet been able to pinpoint the “biological mechanism” behind that interplay. “It could be that trauma and stress has a direct impact on our immunological response,” she says. “[Or] it could be that people who have more trauma and stress have poorer health habits and maybe neglect eating properly or taking care of themselves.”

Leserman later found similar negative outcomes among those who had experienced trauma, including “having parents die at a young age, having alcoholic parents, having depressed parents, having violence in the home,” or having experienced sexual or physical abuse.

Childhood trauma, whether it’s sexual or physical in nature, casts a long shadow, Leserman says: “There are tons of studies that show that people who grow up with childhood trauma end up [with] more medical conditions…they looked worse on every measure we had. Whether it was functioning poorly in the world, whether it was chronic pain, doctor visits or hospitalizations.”

People of color are both more likely to have survived trauma and to experience a syndemic factor that “magnifies the vulnerability of a population to serious health conditions such as HIV/AIDS” or depression, researchers noted in a 2003 study. Syndemic factors also include living below the poverty line, which a more recent study found makes people nearly 2.5 times more likely to have depression than those living at or above the poverty level.

Like Hampton, Bryan C. Jones is a Black gay man who has experienced that magnifying effect firsthand, but you’d never know it. As gregarious as they come, Jones laughs and jokes frequently in every conversation. Sitting across from him you’d never suspect he battles depression. But the 55-year-old, who lives with depression and HIV, grew up in poverty, in “the heart of the ghetto” in Ohio, and ticks many of the risk categories.

When he was “very young, like 3, 4 years old,” Jones was sexually molested, an experience that may have played a role in his later struggles with depression and substance abuse. Substance abuse often goes hand in hand with depression, and HIV-positive gay and bisexual men have a 42 percent chance of abusing alcohol or drugs in their lifetime.

Drugs helped Hampton and men like him survive life on the streets.

“In regards to homeless youth, [crystal meth] really is a survival drug,” Mike Rizzo, a manager of addiction and recovery services at the Los Angeles LGBT Center, told Healthline. “It helps them stay awake all night so they are safer on the streets. It staves off hunger and thirst.”

Other gay men may turn to drugs and alcohol to self-medicate their depression or combat the feelings of shame some “poz” people feel when they first learn of their HIV diagnosis.

“It was hard for me to swallow,” Hampton admits. “Because I knew what I knew about HIV.” While living in Florida, Hampton had volunteered with an HIV service organization. “I knew how to protect myself,” he says. So, it was especially upsetting when he discovered he was “poz.” “Now here I am living with it. I ended up relapsing back into drugs.”

Jones says he still deals with his own substance abuse issues, although to him, “it doesn’t necessarily have to be a narcotic substance. Dealing with people who are only in your presence to see what they can get out of you? That’s a substance. [We] don’t talk about the reality of how we seek out sex to bring us out of our depression, to make us feel like we’re loved, like we belong. Until we start having these open and honest conversations about substance abuse, sex addiction, and how all that is tied to our depression, we’re never going to be able to [get] any real treatment.”

Like sex addiction, intimate partner violence is an uncomfortable topic, and yet another psychosocial factor that disproportionately impacts gay men of color. Research suggests that gay and bisexual men experience intimate partner violence at significantly higher rates than heterosexual men. Social pressures, which researchers in one study defined as “homophobic discrimination, internalized homophobia, and heterosexism” were found to “significantly increase” reports of gay intimate partner violence.

Hampton says intimate partner violence gave him HIV. An argument over his partner cheating “got physical,” and “because of the physical fight and me hitting him in his mouth, he started bleeding really profusely. Then he ended up taking out a chunk of my chin [with his teeth]. And I ended up acquiring HIV through that rare blood-to-blood transmission.”

Like many men in these situations, Hampton found his report of domestic violence met with indifference.  “When the incident happened,” he says, the police came out, “and they basically told me, ‘There’s nothing that we can do.’ And they were like, ‘You’re a man, why didn’t you fight back?’”

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