As a Black femme, anti-racist educator, and sex educator, February is a time of community. It’s Black History Month, with February 7th being National Black HIV/AIDS Awareness Day, and the 14th-18th being Sexual and Reproductive Health Awareness Week. It’s easy to get swept up in the perceived urgency to act or make statements without being intentional. This year, I’m thinking more critically about what these moments for awareness mean in the grander goal of liberation and equity. The more I reflect, the more I believe we’re continuously approaching these events and health advocacy incorrectly, especially for the Black community.
Photo: Delilah Kamuhanda
In the words of the infamous queen RuPaul, "Why it gotta be Black?" Health, like everything else, is impacted by race, racism, and culture. Simply put, health is different for Black folks. Not in the eugenicist, racial pseudo-science way – that’s false and dehumanizing. Health is different in a socio-cultural way. How communities of colour define health diverges from Euro-centric definitions. We tend to discuss health in communal ways, less focused on the individual. A survey from The Black Health Alliance in Toronto asked respondents what health meant to them. The way they spoke about health included connection to community, safe spaces free of discrimination, food security, and access to health and social care and much more. Being healthy goes beyond being free of illness or disease – it includes factors like community, socio-economic status, connections, and support. Further, Black and Indigenous people in Canada are consistently more vulnerable to sexually transmitted and blood-borne infections (STBBIs) with more barriers restricting their access to appropriate care due to racism and colonialism. For example, Black Canadian youth reported that racism was a key barrier to accessing sexual health services; this demographic also had the lowest sexual health clinic attendance.
Public health initiatives often involve awareness campaigns or frameworks that focus on the individual. Like, start PrEP today and protect yourself against HIV! Or, there's a rise in *insert infection or STBBI here* so use condoms and get tested! I’m guilty of creating such campaign content myself. However, this messaging makes public health strategies about the individual. And that doesn't always appeal to or encourage urgency for everyone, especially those that don't think of health in such terms. Moreover, these awareness campaigns rarely factor in social and economic barriers to care. For example, a lack of secure housing, no (consistent) access to phones or the Internet, lack of transportation, and inability to schedule appointments due to lack of funds or flexible employment. The way racism impacts economic status, employment, housing etc., it becomes clear that racialized folks experience multiple marginalized identities and may not benefit from these common strategies.
When we try to appeal to everyone, we miss on appealing to those most vulnerable. For example, if you see “prep” trending and think PrEP (an HIV prevention medication) and not meal prep and #gymbros, then you may be aware that the messaging that appeals to us is influenced by our identities and values. If we want to talk about sexual health with Black folks, we need to speak about health in terms that apply to the Black community. Furthermore, we need to pursue efforts that address access issues and deliver quality healthcare to marginalized communities.
When we try to appeal to everyone, we miss on appealing to those most vulnerable.
Although I like to think of sexual health as the cool, fun cousin in the health sector, it still has problematic roots and current practices that harm Black folks and other people of colour. Healthcare and non-profit work is often composed of people or projects that operate on the idea that they know what is best for folks that cannot help themselves. This belief is the basis of white saviourism. White saviourism and white guilt prohibit people in education or health fields from understanding why anyone would be reluctant or uninterested in receiving their "help." This is where a lot of sex ed gets its start. To understand mistrust of healthcare in Black communities is to understand the extensive history of medical racism.
Healthcare and health promotion – like any practice or institution – are entrenched in racism and bias. Physicians in North America exploited enslaved Black people and other POC, even using them for painful and tedious experimentation to develop medical practices and instruments, like in the case of J Marion Sims. Myths of Black people as fertile, hypersexual, and feeling less pain were used to excuse his vile medical practice, and are often still used to dismiss fears around high death rates for Black folks in pregnancy and labour. Sexuality and reproductive ability have been used as tools of oppression in enslavement and colonization. In the United States, people believed to be promiscuous or have sexually transmitted infections could be imprisoned for "sexual immorality". These arrests could lead to very invasive medical examinations and even experimentation. From the early 1900s until the 1960s, “suspicious” women and gender non-conforming folks could be imprisoned, tested for STIs, sterilized, and brutalized by healthcare practitioners and the police, and most people detained were people of colour and/or working class. And then there’s the infamous Tuskegee syphilis experiment, a decades-long, non-consensual study on Black men by doctors and government officials who believed Black people were physically and mentally inferior, and that late-stage syphilis would have different impacts on their cognitive abilities. Even when penicillin became widely available, they weren’t informed of their STBBI status or offered treatment. These men went blind, suffered cognitive impacts, and passed the infection on to their partners.
These issues aren’t relics of the past. Harriet Washington's Medical Apartheid reveals that consent in experimentation is blurred and exploited in impoverished or BIPOC communities. A 2021 report issued claims from Black and Indigenous women in Quebec coerced into tubal ligation. This is an issue of medical racism that systemically and seriously impacts Indigenous people globally – in Canada, coverage of this has increased since a 2018 report of cases in Saskatchewan. History shows us that sexual health hasn’t always been fun and progressive. Hesitance is warranted when marginalized people interact with the healthcare system, as it’s rooted in the past and present exploitation of BIPOC, disabled folks, and sex workers in the healthcare system. If your parents, grandparents, aunts, and uncles spoke to you about being treated like a lab rat or being dehumanized and dismissed by powerful people tasked with caring for you, what trust would you have in people of that profession? Our jobs are not to belittle but to work on becoming trustworthy spaces and allies.
History shows us that sexual health hasn’t always been fun and progressive. Hesitance is warranted when marginalized people interact with the healthcare system, as it’s rooted in the past and present exploitation of BIPOC, disabled folks, and sex workers in the healthcare system.
We need holistic approaches that uphold people's autonomy to define their own health. Our solutions and paths forward need to be anti-racist or else they won’t be culturally appropriate or sustainable. Anti-racist action in sexual and reproductive health can look like: assessing how barriers to healthcare access may be impacted by race/racism, evaluating the status quo and how it impacts sex/sexuality, or diversifying skin tones and identities shown in messaging, examples, and videos.
Black HIV/AIDS Awareness Day takes place every year on February 7. Health disparities and inequity are integral to understanding the need for such a day, and the time to apply these anti-racist analyses and practices is now. In the 1980s, during the HIV/AIDS crisis, communities of colour were greatly impacted and had less access to treatment. Until FX's Pose, most of the imagery around HIV/AIDS was of white gay men. From the screen to real life, our understandings and responses to HIV are white-washed. When we neglect this differential racist impact, we cannot respond in culturally appropriate and impactful ways. This year we can discuss the intersectionality of Black HIV+ folks. How are their experiences shaped by racism, ableism, xenophobia, or other systemic forms of oppression? On the other hand, how may their culture impact their views on health and self-care? Across North America we are seeing higher HIV diagnoses among Black women and femmes – how is this impacted by misogynoir (sexism towards Black women and femmes)?
Educators, healthcare providers, and policymakers: This is a day to reflect on your responsibilities and what you must work on. For example, do you hold any beliefs about health, symptoms, or behaviours that are rooted in racism? One example is the belief that Black skin is thicker, meaning people believe that we feel less pain. A 2016 study surveyed first- and second-year medical students, and found that about half of them believed this myth. How does your work amplify Black voices or reflect our lived experiences? How can your place of work become a safe space for Black folks?
This work necessitates efforts year-round, but perhaps this Black HIV/AIDS Awareness Day and Black History Month can serve as a starting point for these conversations. It’s important to remember that your anti-racist journey depends on your privilege, role, community needs and talents. If you’re wondering how to integrate anti-racism into sexual health, here are a few tips to help you begin that journey:
- Familiarize yourself with intersectionality
- Understand barriers for newcomers
- Acknowledge and understand your privilege
- Prioritize cultural safety
- Incorporate reconciliation and anti-racism into your strategic plans, missions, or visions as both a guiding principle and accountability measure
By Delilah Kamuhanda
This post is adapted from Delilah’s Summit 2022 in-person workshop on Anti-Racist Sexual Health. Click here for a short video interview we did with Delilah on her Summit experience.