Winston Husbands, Senior Scientist at the OHTN
Understanding And Addressing The Structural Determinants Of HIV Vulnerabilities Of Heterosexual Young Black Men Living In Toronto
I had this idea that we have been laboring under this cascade of structural violence, and then somebody came along and said no forget about that cascade let’s do this other cascade because this other cascade will get you where you want to go, and I was thinking how can that cascade get us where we were if this other cascade was important, but we just abandon it because another cascade came along, then how is this other cascade going to get us where we want to go? But I was also struck about here we are talking about this other cascade when I say we I mean the black communities in which I circulate, some other people come along and say well let’s do this other cascade instead, and I’m thinking how is that other cascade gonna work if those of us who’ve been talking about this other cascade are not also involved in those discussions about the new cascade?
So that is when I came up with this idea about the cascade of Structural Violence. So of course, and there are a few people that I would like to thank for helping me think through this. So this is the usual view of the cascade that you know, 90 percent of the people who are living with HIV would be tested and then of those, 90 percent will be on treatment, and 90 percent of those will then achieve viral suppression, which means that if this is possible then we could end HIV, or at least end it as we know it. So as as far as I was able to gather using data from 2015 that has been published by the OHTN, this is what the cascade looks like in Ontario. So it looks looks pretty good, right. OK so in thinking about this other cascade I was also you know thinking about we have this cascade of things that fell on us, so then I remember, I actually I only remember this through Denzel Washington’s performance in the movie, and he was so moving and I said but wait did Malcolm actually say that or did Spike Lee just make it up? So I actually went and looked for the actual quote, you know, and Denzel didn’t actually say it like this because of course he’s an actor and he had to make it more dramatic, but you know “We Didn’t Land On Plymouth Rock, Plymouth Rock Landed On Us”.
So that’s the cascade that we were dealing with, this cascade of Violence, these things fell on that fell on us. So you know and in thinking about this I asked myself three questions, and I don’t have the answers for them, but maybe you’ll help me answer them today. First of all. Can we write this cascade to a beneficial outcome while being massively affected by structural violence? And the second question is, Does the cascade actually say anything about structural violence? and my third question is, Does the cascade specify targets for addressing structural violence?, because as you see the cascade, the engagement cascade that we are familiar with, it has targets that you know 90 percent of people should know their status and 90 percent of those should be on treatment and 90 percent of those should achieve viral suppression and so on. So that’s where my final statement my final question comes from. Came from. Now normally we think of you know structural violence, so I call this instead of using the familiar term disparities, I look at these things as markers of structural violence.
So here we are about you know HIV diagnosis in Ontario and you can see how black communities are sort of massively affected by HIV. For Canada as a whole, here once again it’s a similar picture. Actually as far as I know, you know I believe that Aboriginal women also accounted for 35 percent of all the reported cases in in 2016 among women. So that would mean that black women and Aboriginal women would together account for like 70 percent and you know that’s a massive. That’s a massive thing we should we should all be sort of scratching our heads about how to deal with that but you know HIV is just what we see when we work in HIV, this is what we know, this is what we see, these data about testing and prevalence and all these things, but we have to peel back these layers just to sort of think about, well what it is that we are really talking about here? Because obviously this is just the the endpoint of something.
So I try to peel back the layers and look at income you know, look at the massive disparities in income. A quarter of African Canadians have low income nationally compared to just 12 percent of the people who are 12 percent for the country as a whole, that is including everybody. And then you know there’s a way in which we can understand this, if you’re from the Caribbean or from the South that you know the prison has replaced the plantation. So we’re still in this, we’re still in this thing. It’s just that instead of being on the plantation as my forefathers were being back up until the 1830s now we’re sort of somewhere else, but really in a sense even though we’ve achieved something materially in comparison to the other people around us, we’re still sort of back where we were. And this kind of thing makes good copy in the news of course, writing about black men you know who violate white women. So let’s be clear this is all about black men and white women, it’s not about you know these stories.
And this is a familiar narrative as well. One of the interesting things about HIV is that HIV has resurrected discourses which we thought we had gone past. So these discourses about black men and women, and their sexuality, and their sexual behaviors these were discourses that you know maybe in the 1970s or the 1980s even, people thought that this was something of the past, but these discourses now have come back with the way we understand HIV. But there’s always new technologies of course to deal with the problems that we face, but the issue is that many times these new technologies leave us where we are so the disparity remains. You know everybody gets better off to some extent but certain communities still remain where they were. And that is the problem with new technology. So a nod to my man LaRon, this is a paper that came out recently. Maybe you can’t see it but you should read it. You should read the paper, not read it here.
A recipe for increasing racial and gender disparities in HIV infection: A critical analysis of the Canadian guidelines on pre-exposure prophylactics and non-occupational post exposure prophylaxis responsiveness to HIV epidemics among women and black communities. It’s a long title but you’ll get the picture. Anyway, thanks to my man Laurent who led this. So this is my last slide I’m going to stop here. You know what these data tell us is one thing but how this gets translated into into our everyday reality is in terms of the common-sense ways in which people interpret what they see. So how do people interpret the fact that you know black men or black people account for 10 percent of the prison population in federal institutions but black people are only three percent of Canada’s population? So how do we explain the high prevalence of HIV among black communities for example so the numbers say one thing and then people attempt to interpret these numbers you know in a way that fits a certain picture that they have?
In my work with HIV and heterosexual black men, these are some of the things that I’ve come across, some of the ways in which people want to understand black men, and these are ideas in fact are even disseminated amongst researchers themselves. So you read some of the research articles and this is where we are. So I’m going to stop here. So what I’ve done, I haven’t solved anything, but I hope I’ve given you a question to think about the cascade. A moment to pause and think about what it is we’re talking about and where are we going to go with this. And at the end of the day, because my fear is that at the end of the day, decision makers will declare victory over HIV, somebody will say well the cascade tells us that we are done. But there will be some of us left, there will be some communities left that are still struggling with HIV but when the decision makers decide that we are done then it means that the resources also go elsewhere. And we are left to struggle with this on our own. So this is not my issue, but this should be an issue around which we are organizing. And this is the only way I think that we’re going to get this message heard thank you. [applause]