High rates of HIV/AIDS infections in the black gay male community continue to raise concerns and puzzle health experts and community advocates.

To mark the seventh annual Black HIV/AIDS Awareness Day February 7, community members and health officials held luncheon in San Francisco where they initiated a call to action. Health department staff members Matthew Florence, director of community education and recruitment, and Vincent Fuqua, health educator of the HIV prevention section, facilitated a discussion to create "The HIV/AIDS Contract with Black San Franciscans: A Call to Action."

The call to action is another facet in the campaign to put a face on AIDS in the African American community and for the community to take responsibility and ownership of the disease by stepping out of denial and becoming educated about sexual health.

"Not about HIV," said Stephen Oxendine, an HIV/AIDS consultant and community advisory board member for the HIV research section at the health department. "This is about the mindset of black gay men. [It's a] wellness issue, not a disease state issue. We are approaching the effect, not the cause."

The health department's estimate for 2006 was that 14,205 of the gay men in San Francisco were living with HIV. The city estimates there are 63,577 gay men living in the city.

Health department officials were unable to provide the number of African American men who have sex with men who are living with HIV. The department's 2005 Annual Report on HIV/AIDS Epidemiology stated African American MSM had the highest HIV prevalence rates, at 31.8 percent, followed by whites at 26.3 percent, Latinos at 23.1 percent, and Asians at 10 percent.

Yet the report notes that black gay and bi men tend to have the least risky sex of any racial group. The report said they were less likely to have unprotected anal intercourse with a partner of an unknown or different HIV status. HIV-negative black men are the least likely to bottom without a condom with a partner who is HIV-positive or of unknown status, stated the report.

"We have ideas and people are tying to pursue those ideas," said H. Fisher Raymond, assistant director of the HIV/AIDS statistics section of the health department.

Raymond told the Bay Area Reporter that there is a lot of speculation, but no one has been able to figure out exactly why black gay and bi men continue to be disproportionately affected by the epidemic.

"Black folks aren't any more promiscuous or use fewer condoms," said Andre Robertson, who identifies as heterosexual and is director of prevention at the Black AIDS Coalition and coordinator for the Brother's Alive program.

Robertson believes that one of the reasons for the black community's high HIV/AIDS rates overall is due to a lack of access to healthcare.

"People in general tend to not go very far from where they live," said Robertson, pointing out that the public health system is geographically spread out with long waiting lists for appointments while people with health insurance don't have that same experience regarding health care.

"They don't have access to healthcare. If you don't have access to healthcare you are less likely to take preventative measures to preserve your health and so consequently any health threat that comes along [means] African Americans will be impacted disproportionately simply because of the access issue."

Researchers point out that prejudice and distrust continue to be barriers to accessing healthcare. According to a 2004 report in the Journal of the National Medical Association about race and sexual identity barriers, the perception both within the healthcare system and the black community continued to be a problem. The report noted that cultural sensitivity was lacking in medical facilities. In turn there remained a distrust of doctors and medical facilities from black people's perspective.

Other studies identified that there is "a pattern of ethnic and racial minorities receiving lesser quality of health care than non-minorities, even when they have health insurance" according to the Institute of Medicine's 2002 article "What healthcare consumers need to know about Racial and Ethnic Disparities in Healthcare" published in the National Academy of Sciences.

"People choose to get care where they think they are going to get the most personalized service, warm reception, and a place that affirms who they are," said Perry Lang, executive director of the Black Coalition on AIDS. "I don't think that it really matters where one gets service, it's just important that people get the service to support their health."

"Really, to save our people we have to, as heterosexuals, examine our homophobic baggage," said Robertson. "If you somehow demean or minimize someone else's humanity you minimize your own. I think that goes a long ways to one enfranchising and empowering people reducing the stigma of this disease."

Oxendine was quick to point out that homophobia isn't any different in the black community than it is in any other community.