In light of the federal government plan announced in February 2019 to end the HIV epidemic in the U.S., TheBody has created a new series called Eyes on the End. This series will include a snapshot of the HIV epidemic in each of the 48 counties, seven states, and two cities targeted within the plan. These profiles aren’t meant to be the definitive story of the epidemic in each locale, but rather—through sharing some basic statistics and interviews with a few key stakeholders—to provide some context for what’s occurring there, and what it will take to end the epidemic in that area.
The Big Picture: HIV in Dallas County, Texas
With a robust services infrastructure, the city is among 127 worldwide committed to ending their HIV epidemic by 2030—and in order to do this, Dallas must reach the young gay and bisexual men of color whose HIV rates there are highest.
Need-to-Know Stats About HIV in Dallas County, Texas:
Of the more than 16,000 people living with HIV in Dallas in 2017, 82% were men (mostly who have sex with men, or MSM), 43% were Black, 28% were white, and 24% were Latinx. (And these statistics are similar to those for new infections from 2013 to 2017.) The city is 39% Latinx, 31% white, and 23% Black.
Dallas residents living with HIV make up about a quarter of all people living with HIV in Texas.
New diagnoses annually mainly remained in the 700s between 2013 and 2017. Most were in MSM.
This year, Dallas joined the Paris Declaration of 127 cities worldwide that have committed to getting to 90-90-90 (90% of people living with HIV will be diagnosed, 90% of those will be on antiretroviral treatment, and 90% of those will be virally suppressed) by the year 2030.
Successes and Challenges Facing HIV Service Providers in Dallas
We talked to Jalenzski Brown, empowerment programs manager, and JP Cano, prevention services manager, at the HIV- and LGBTQ-serving Resource Center.
Jalenzski Brown: I’ve been in this role for 3.5 years. Before that, I was a program coordinator here, and before that, I volunteered. I oversee a CDC [Centers for Disease Control and Prevention] evidence-based HIV intervention. It involves managing the staff and helping to create social outreach events to raise awareness around HIV and connect community members to resources.
JP Cano: I’ve been in my role 3.5 years and here 11 years. We focus on HIV testing, PrEP [pre-exposure prophylaxis], condom distribution, and our gender-affirming care program.
Tim Murphy: Tell us about Resource Center.
JPC: The agency has been around for more than 30 years, starting pretty much as a small group of people trying to meet the needs of LGBT people in the Dallas area. It’s grown exponentially. It started in 1983 as the Foundation for Human Understanding, with the goal of achieving LGBT recognition and equality. However, with the arrival of the AIDS epidemic, around 1985 it established the AIDS Resource Center, which was our name until seven years ago. Over our history, we’ve combined with other entities, like the Nelson-Tebedo clinic and United Black Ellument. Now we’re the largest LGBT and HIV services agency in north Texas. In July, we launched primary-care services. The annual revenue was $10 million and expenses were $9 million.
TM: What is your staff like?
JPC: It’s about 60 people total, racially mixed and about 90% LGBT. On my team, I have 11 people, several white, two Black, three Hispanic, with three cisgender women, one transgender woman, and one transgender man.
JB: On my team, I have six people including me—all men, Black and white. Nobody is openly HIV positive.
TM: What are your gamut of services?
JB: We see more than 60,000 people each year through services like HIV and STI testing, PrEP navigation, mental health support, dental, primary care for those affected by HIV, insurance payment assistance, the food pantry, and group and youth services. We don’t do housing—we refer out to a few agencies we work closely with—but it’s in the works.
TM: How would you paint the overall HIV picture in Dallas?
JB: The numbers aren’t decreasing much. We’ve gotten better as far as agencies working together to create a more robust services network and have recently re-formed the city’s HIV task force. But the struggle still comes in getting people to actually engage in services. Young people are more sexually fluid, but that doesn’t always mean more sexually responsible, so we still have work to do.
TM: What group is disproportionately affected in Dallas?
JB: Men of color who have sex with men age 35 or under.
JPC: There’s been an increase in HIV rates in Latinx MSM, but African-American MSM still have higher rates.
TM: What is driving the higher rates in those groups?
JB: What I see personally is substance abuse and mental health as well as housing issues. I hear constantly about people having to engage in sex work for survival. Crystal meth, people engaging in “party ‘n’ play” sex parties.
JPC: There are so many other social determinants. We still live in the South, where someone can be fired for being gay. There’s extreme brutality toward transgender women of color. [Ed.: Texas [leads the nation] in murders of transgender women.] The political climate under Trump has led immigrants to not go look for care at hospitals.
JB: It’s true. A lot of folks are hesitant to engage with HIV service providers because they don’t trust them with their HIV status or their citizenship status. With people of color, there’s a history of medical mistrust. There’s also defeatism. When you hear that one in two gay Black men will get HIV in their lifetime, you think, “If I get HIV, whatever, there’s a pill I can take and I’ll deal with it.”
TM: How are your efforts with PrEP going?
JPC: In 2017, we started a CDC-approved program with one provider. Now we have two PrEP providers and offer it almost every day. Our goal in 2017 was to do 150 prescriptions for the year, and now we do between 150 and 180 prescriptions a month.
TM: What percentage of those who could benefit from PrEP do you think you’re hitting at this point?
JPC: From our client data here, I think 60% to 70%.
TM: What are the barriers to raising that figure?
JB: I think awareness. When we opened our clinic, it opened up access to PrEP, and we avoided having a waitlist. We do good outreach to most vulnerable populations. But we’ve hit a roadblock this year because of those ads popping up on social media [about a class-action lawsuit against Gilead for side effects related to Truvada, a PrEP drug].
JPC: In our clinic, I think we had two people who seroconverted because they stopped taking PrEP because of those ads.
TM: What do you say about those ads when clients ask about them?
JPC: That they need to talk to their health provider about them.
JB: We do a lot of educational outreach programs, and when that comes up, I’m grateful that my staffers and I have been on PrEP so that we can speak from personal experience to quell those worries. We also remind them that PrEP is not designed for the rest of your life but for [periods when you are at risk]—and that being on PrEP for a year is better than being on HIV meds for the rest of your life.
TM: Where have you had success? What would you like to brag about?
JPC: I think our PrEP program has been very successful and has impacted a lot of individuals, even [playing a role in] lowering the number of HIV diagnoses here.
JB: I’m proud of our CDC evidence-based interventions, including FUSE, for MSM ages 18 to 29, and United Black Ellument (UBE) for Black MSM ages 18 to 29. Then in 2017 we noticed that lots of transgender and gender-nonconforming folks were getting lumped in with MSM, so we adapted to serve them and created GenderBrave, a name that the clients came up with. And each group has their own core group that works with staff to do activities that bring the community together while raising awareness and with the goal of reducing HIV transmission.
TM: What kind of events?
JB: For one, with UBE, we worked with the Dallas Arts District. Every Friday, UBE has a voguing academy. We host kiki balls. We did one at the Dallas Museum of Art this past summer. More than 21,000 people came to the block party, and more than 6,000 went through the museum, a very nontraditional partner [for an HIV event]. We’re constantly thinking of ways to expand and get more people involved.
TM: Where do you feel challenged or stuck?
JPC: People engage more easily than ever now in sexual activities because of the apps, which make it easy for people to put themselves at risk.
JB: Agencies have to do a better job with outreach and social media. We’ve noticed that the clubs aren’t as packed as they used to be. Most folks spend a lot of time at home online and can just get online and party at home versus going out into the community, so it can make reaching people harder.
TM: Do you have a presence on the apps?
JB: Yeah, we’ve had ads and we post a lot. Our volunteers are often using their personal accounts on Jack’d and Grindr [to get out the word about HIV].
TM: What would you do with more money?
JB: More one-on-one life coaching. People seem to want more individualized programming, whereas most of ours is in groups. Also, housing and transportation. My dream is to have a big housing complex full of wraparound services including breakfast, lunch, and dinner.
JPC: I second everything Jalenzski is saying. I think we’re living in an era where prevention is washing away. I’m all about PrEP, but I think it’s taking away from the community-based approach. We’re struggling to keep our empowerment program going because PrEP is taking more work in the field.
TM: So here’s a devil’s advocate question: Some people say that PrEP and other biomedical prevention [such as HIV-positive people being undetectable and hence untransmittable] are the only true ways to end the epidemic, because community-driven interventions just haven’t worked the way biomedical has. Do you agree?
JB: That comes up a lot. You can have all the biomedical intervention you want, but at the end of the day, taking a pill is still a behavior and you still need behavioral interventions. And when you see those ads [for lawsuits against Gilead claiming Truvada is dangerous], you need to counteract that narrative. We still need community-level interventions.
TM: Can you share some stories?
JPC: We had a client, a Latinx MSM in his early 20s. In July, we diagnosed him with HIV and syphilis and then tried to set up more appointments with him, but he never came back. Today he was brought in by an older white man, we think his boyfriend. We found out he’s actually had HIV for three or four years and hasn’t had any treatment at all. He said he forgot and also had some problems with transportation. So we talked to him for 30 minutes trying to get [the importance of being treated] into his brain and gain his trust. He’s now doing treatment for syphilis and is supposed to come back tomorrow and we can connect him to services. We tried to make him understand that [if he doesn’t get treated], he’s going to end up in the hospital.
JB: I’ve had that situation even with personal friends who blocked me because they didn’t want to deal with their health. That’s why it’s so important to have groups like GenderBrave that do peer mirroring.
TM: How has this work shaped you personally?
JB: My spiritual mission in life is to find peace, love, and happiness in my own experience and to help those around me do the same. I was always inspired by Resource Center, and when I had the opportunity to work for them, after volunteering in this work, it felt like a natural expansion of my purpose. And in doing so I have learned so much about myself and grown in capacity, wisdom, tools, and resources.
TM: What do you guys think is the missing link when we talk so much about higher rates of HIV among young gay men of color? What is not being said?
JB: Allowing Black people to just be. Oftentimes, Black people are told how they should be, like, “Don’t laugh that loud.” That’s the biggest thing that keeps people away from services or institutions.
TM: And specifically for Black MSM?
JB: I think it’s the intersection of identities. Not only is the Black community often homophobic, but when you step outside, you’re also being policed. It creates a very isolated place and a defeatist mentality for Black MSM.
JPC: As a Mexican immigrant who came here 15 years ago, I have a passion for the work we do and for my own self-worth. It can be about the simplest things, like seeing a client who remembers you after several years—that can make your week.
Positive POV: Chad
We talked with Chad [last name withheld], 23, a phlebotomist from Dallas, who was diagnosed with HIV in 2015.
Chad: I grew up in Cedar Hill, Texas, outside Dallas. As a kid, I was pretty sociable and friendly. I did ROTC in high school and was in student council. In college, I was coming back from Christmas break and one of my best friends said, “Do you wanna make $60 getting HIV-tested and filling out a questionnaire for young gay Black men?” I said sure, because I’d had an active sexual life. I had an idea that I could get HIV—but hearing my positive diagnosis out loud was still a shock. So I called my dad, and his reaction was, “I told you so,” because he’s a very strict Christian and a preacher.
He knew I was gay—when I was in middle school, someone from the church told him. I had to go through several courses of conversion therapy. The first one he sent me to was a preacher friend of his, but I had an attitude with him, so then he sent me to a psychiatrist who is based in Christianity. Her first question to me was, “Do you want to change?” I said no, and she said, “If you don’t want to change, I can’t make you change.” Then, being a rebellious teen, I just had more wild sex in response to my dad trying to convert me—and then in college I really let loose.
My stepmom works in the HIV department of the Dallas County department of health—but she didn’t have the best view of [being gay] either. Her reaction to my diagnosis also was, “This is what happens to you from this lifestyle.”
TM: When your dad replied with “I told you so,” how did that make you feel?
Chad: Alone. Like I had no one I could talk to about it. Once I was in treatment, my stepmom did ask if I was doing OK and healthy.
So anyway, that day of the diagnosis, I left the place crying, and the friend I’d gone to the clinic with told me that he was also HIV positive. He hadn’t told me before. Then he told me about different resources, like getting my meds at the Parkland Amelia Court Clinic. I went on meds right away—but I was very on and off about taking them, because I wasn’t good about picking up my prescriptions. I was in college, but then I dropped out and was homeless. I moved in with a guy, but he kicked me out a week later. I couchsurfed or lived on the street. I got addicted to crystal meth and lived with my dealer. I tried to get into Job Corps, but they ended up kicking me out because of my drug use. So this was my life for a couple of years.
Parkland referred me to Resource Center, and they referred me to their United Black Ellument (UBE) program. I first started going there in 2016—that’s when I first met Jalenzski. At first I was really nervous, but they were really friendly and helpful and gave me a lot of resources to help me out with finding a place to stay. They had a fully stocked kitchen, so I went in there and got something to eat. I was very grateful and appreciative. Then a few more people came in and started talking about HIV and about PrEP, which I’d never heard of before. I was newly diagnosed, so I didn’t say too much, just listened.
So I started working on and off for UBE, going with them to different community outreach events and gay pride events. At the end of the summer, there was a big pool party. Everyone who’s anyone in Dallas came out. It was fun. We were inviting people to come get tested and to experience UBE.
TM: Did the experience of being with UBE change you?
Chad: It opened my eyes to wanting to be in the health care field, sexual health. It gave me more knowledge to be comfortable enough today to talk openly and knowledgeably about HIV—and to protect my boyfriend from it. I met him at UBE. We’ve been together about nine months now. He’s HIV negative. We’re in the process of getting him on PrEP at Resource Center. Now I’m taking my meds steadily and I’m undetectable, so we’re having sex without condoms.
TM: What made the difference for you with your meds?
Chad: Having more access to the Parkland Clinic and also this other program called AIN, Access and Information Network. I don’t drive. I have the biggest fear of driving. So now I get my drugs mailed to me.
Dealing with HIV, I’ve learned that there’s a lot of self-actualization and self-realization I had to go through. I was not loving myself, which is why I was not taking my meds actively. I went to [addiction] rehab and I was in a special unit for people with HIV, and they were saying that when you have HIV and are also doing drugs, you’re not taking care of yourself or your body—you’re trying to diminish it. It wasn’t until I met my boyfriend that I started loving myself more, because now, to love him, I have to take care of me.
Every now and then I smoke weed and drink, but I can manage those things. I got off crystal because when I was doing that, I was at my lowest point, out there living this hypersexual lifestyle that was really, honestly and truly, dangerous. I thank the Lord I’m still here today. I didn’t want that lifestyle anymore, not taking my HIV meds. My immunity dropped so low that I got pneumonia while I was high on a binge, walking around in the rain, and I had to be in the hospital for two or three days. Rehab helped me get to the root of why I was doing crystal. It all centered around sex. I wasn’t really trying to get high, but to take my sexual activity to the next level, trying to mask the real demons I had about having no money, no job, being out there giving myself up for money. I asked myself, is this the lifestyle I really want to live? I went to college for nursing. How can I go from a medical professional to a crackhead?
TM: So how did you get out of that rut?
Chad: One day, I was sitting at a bus stop contemplating suicide. I thought, this is my rock bottom—I can’t live like this anymore. So I ended up calling my dad after two years of not speaking to him and told him that I was homeless and on drugs and that I needed help. That’s when he and my stepmom really pushed through, and my mom got me into the Homeward Bound rehab, a 60-day program. Most of the people in the HIV unit with me were gay, but the other units were friendly to us. The place accepted my gayness.
So I’m working as a phlebotomist now. I got my phlebotomy license in Job Corps. I’m trying to find a living situation. I just got a new ID, and I’m working with the Resource Center and Parkland, signing up for different HIV housing opportunities. My boyfriend and I are both on the street right now. We’re trying to work as much as we can. Hopefully by next week when we both get paid, we’ll be able to find an apartment.
TM: What’s your goal for the next five years?
Chad: By next month, I’m going to be back in school. My aunt, an educator, signed me up for a dental academy. I’m going to become a dental assistant. After that, I want to get my education in human sexuality and psychology and then become a sex and relationship coach. In four years’ time, I can get my license and be a therapist.
TM: What do you think needs to happen to stop continuing HIV infections in young gay and bi men of color like yourself in the Dallas area?
Chad: More openness and conversation. Hookup culture can be fun if you do it smart and lay everything on the table. You’re not there just to have a good time by yourself. You have to deal with a whole other person and have open dialogue. Sometimes people are ignorant. I know lots of guys who still have a ’90s mentality about HIV and think it’s the gay killer disease.
TM: When you were diagnosed in 2015, PrEP had been FDA-approved and technically available for three years. Do you wish someone had done a better job spreading the word about it?
Chad: Definitely. I graduated from high school in 2015, so somewhere in those four years I probably had a sex-ed class, and that would have been a cool thing to talk about, like, “HIV is a thing, but there is a preventive measure …” But instead, I think they talked about abstinence. [Ed.: A battle is underway] in Texas to make schools teach sex ed that is up-to-date and comprehensive rather than focusing on abstinence.]
TM: Do you think Dallas is doing a good job working toward ending the HIV epidemic?
Chad: There’s a lot of resources and help you can get.
TM: But you have to know about it, yes?
Chad: Working with Resource Center now, I see them out in the streets. And I know the Parkland Clinic is doing their part, too. But I think it’s a situation where you can lead a horse to water, but you can’t make him drink. You can push the information out there all you want, but if a certain demographic is not inclined to hear it, it’s gonna be really tough.
But I do see Dallas making progress. I don’t see many people thinking that HIV is a death sentence anymore, and a lot of gay Black men know about PrEP now. On [the hookup apps] Jack’d and Grindr, they say that they’re on it. But I feel like a lot more could be on it.