As a Black MD Working with HIV Patients, I Had to Confront My Own Community's Biases Against Gay People

Personal Health

The following ia an excerpt from the new book  Black Man in a White Coat: A Doctor's Reflections on Race and Medicine  by Damon Tweedy (Picador, 2015): 

One morning when I was six years old, I was waiting at my neighborhood bus stop when a boy my age who lived at the other end of the street came up to me. Are you a fag?” he asked. At that age, I had no idea what that meant. Judging from the smile on his face, however, and the teasing stares of some of the older kids around us, I sensed it was something bad.

“No, I said, praying this was the right answer. Good, he said, Cause I dont play with play with fags.

From then on, I was determined never to do anything that might make that label apply to me. During recess in elementary school, we sometimes played a game called smear the queer, where the person who held the football was the queer. I doubt the kids knew what queer meant, at least not in the adult sense. I certainly did not. But I made sure to never be the queer.

By the time I became a teenager and began to understand the basics of sex, words like queer and fag had been so equated with weakness and inferiority that it seemed only natural for me to look down on gays and want to separate myself from themespecially from gay men. My parents, conservative in all matters sexual, did not approve of gay relationships, but they never had much to say on the subject, in contrast to the special condemnation gay people received at the hands of preachers I saw on television or read about in newspapers. Rather, they simply dumped homosexual behavior into the cauldron with all other sexual acts that took place outside the confines of traditional marriage and was thus to be avoided. Looking back, even if they had been openly supportive of same-sex relationships, Im not sure that they could have counteracted the vicious antigay message I was hearing all around me.

During basketball practices and games, whenever we played poorly, some coaches and older players would say that we were acting like fags or sissies, as motivation to make us work harder and perform better. We, in turn, used that same language to taunt our teammates and opponents. Back then I used those words more times than I can count. I never openly ridiculed anyone or harbored any violent impulses toward kids I thought might actually be gay. I simply avoided them.

My homophobia persisted in college. One day after a game or practice, a black teammate, talking about a gay singer or actor hed seen on television, proclaimed that if his son ever started to act effeminate, he would beat it out of him. With his quick temper, there was every reason to believe that he was serious. Two or three teammates chimed in, agreeing with him. A few others laughed or smiled. I shrugged in tacit acceptance, as if trying to beat homosexuality out of your own child made as much sense as attacking someone whod harmed your family. Or maybe I shrugged because we’d all heard so many statements like this before that it hardly seemed re- markable. No one objected or seemed troubled by his ignorant rant.

That same year, I was having lunch with a group of classmates, all black men, when we had a similar discussion. There is no way I could have a gay son, Allan said.

Maybe its not in your control, his roommate said. Maybe people are born like that.

“Thats crap, Allan replied. It aint natural. Its all about how you raise your kids. Dudes turn out that way when they dont have a strong male influence.

The notion that being raised by a woman would make a man desire another man doesnt make sense, especially given how many black boys are raised by single moms, but we all accepted his flawed logic. He won the argument with a stupid answer.

My attitude finally began to change during medical school where I worked with a few gay doctors and medical students, the first people I’d known well who were openly gay. I realized that in our shared experience in the medical field, our lives had a lot more similarities than differences. Further, my medical education revealed a certain commonality shared by all people. Even if one sexual, racial, or gender group got a given disease more frequently than another, all of us were vulnerable to sickness, injury, and, ultimately, death. From all I could tell, gay people, like everyone else, sometimes dealt with these problems well and sometimes did not. Across the span of a persons life, where so many things, both good and bad, could occur, being gay (or not) was just one part of any narrative.

The medical profession has historically suffered from similar homophobia. Until the early 1970s, homosexuality was regarded as an official psychiatric illness. Dr. Mark Schuster, chief of general pediatrics at Boston Childrens Hospital, has spoken at length about his experiences as a gay Harvard medical student during the 1980s, when some doctors openly discriminated against gay patients and medical students. Schuster once saw a surgeon refuse to operate on a patient whom he suspected of being a lesbian. Later, when Schuster came out to a professor whod previously given high praise to his work, the professor revoked his offer to write Schuster a recommendation for pediatrics training. Shuster reflected that he often found himself in the burdensome position of choosing between being a doctor and being openly gay.

Surgeon and writer Pauline Chen recounted a similar version of medical antigay bias in a 2012 New York Times article, in which a supervising physician during her training chastised a group of young doctors for prescribing a homosexual dose of medication, meaning one too weak to properly treat the patients problem. During my own surgery rotation in the late 1990s, the senior surgeon, frustrated with his junior colleagues efforts, told him that he was operating like a fag. In each case, powerful people were using homosexuality as a proxy for weakness and incompetence.

By the time I met my own HIV-infected patients George and Monica, Id grown up enough during medical school to begin moving past this sort of bias, at least enough to recognize it when I saw it and to take care never to perpetuate it through my words or actions. As a black man, hating gay people simply didnt add up. How could I get upset about being discriminated against because of my race while ignoring, or worse yet, being a part of, prejudice that others faced?

But many blacks see it differently. In the era of HIV/AIDS, much has been said and written about homophobia within our community. Black people are often described as the most homophobic racial group in America. There is some data to support this contention. In 2008, black voters supported Californias Proposition 8 renouncing marriage rights for gay couples at higher levels than all other racial groups. A 2013 Pew Research Center poll showed that while half of whites supported same-sex marriage, just over a third of black respondents felt similarly.

Based on the comments of public figures, as well as private discussions Ive been part of over the years, its clear that many black people reject a link between the civil rights struggles of the 1950s and 1960s and the contemporary legal efforts on behalf of gay people. Barack Obama framed the issue during a 2008 presidential campaign speech, which took place at Ebenezer Baptist Church in Atlanta, Dr. Martin Luther King Jr.s church. If we are honest with ourselves, Obama said, well acknowledge that our own community has not always been as true to Kings vision of a beloved community. We have scorned our gay brothers and sisters instead of embracing them. It was fitting that Obamas comments took place where they did, as black churches are widely seen as a main source in shaping the communitys antagonistic attitude toward gays. In some of the black churches Ive attended, the antigay sentiment has ranged from tacit disapproval to outright denunciation. For every Reverend Calvin Butts in Harlem and Reverend Dennis Wiley in Washington, D.C., both supporters of gay rights and acceptance, there are many more clergy who take the opposite stance.

In recent years, a handful of gay black celebrities have spoken on the issue. In a 2011 interview with the New York Times, CNN anchor Don Lemon asserted that being gay is about the worst thing you can be in black culture. Youre taught you have to be a man; you have to be masculine. In the black community, they think you can pray the gay away. Lee Daniels, director of the movies Precious and The Butler offered a similar perspective, saying: “Black men cant come out. Why? Because you simply cant do it. Your family says it. Your church says it. Your teachers say it. Your parents say it. Your friends say it. Your work says it.

To be sure, certain white churches, public figures, and political organizations can be equally virulent, if not worse, in their condemnation of gays. Hispanic and Asian cultures also possess their own share of homophobia. But when it comes to how these beliefs intersect with health, blacks are the group least able to afford such attitudes. In 2010, the Centers for Disease Control and Prevention reported that gay and bisexual black men, despite being a much smaller group than white gay and bisexual men, accounted for approximately the same number of new HIV infections; in 2011, this black group surpassed their white counterparts. Among the many causes of higher HIV/AIDS rates among black people, homophobia and the resulting sexual secrecy clearly play an important role. The time has come for the black community to confront some of its prejudices toward gay people.


Excerpt from Black Man in a White Coat by Damon Tweedy, chapter 7 "The Color of HIV/AIDS." Black Man in a White Coat copyright © 2015 by Damon Tweedy. First hardcover edition published Sept. 8, 2015, by Picador. All rights reserved.

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