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

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 morningwhenIwassixyearsold,Iwaswaitingatmyneighborhoodbusstopwhenaboymyagewholivedattheotherendof thestreetcameuptome.“Areyouafag?”heasked.Atthatage,I hadnoideawhatthatmeant.Judgingfromthesmileonhisface, however,and theteasingstaresofsomeof theolderkidsaround us, Isenseditwassomethingbad.

“No,”Isaid,prayingthiswastherightanswer. “Good,”hesaid,“’CauseIdon’t play with play with fags.”

Fromthenon,Iwasdeterminednevertodoanythingthatmight makethatlabelapplytome.Duringrecessinelementaryschool, wesometimes playedagamecalled“smearthe queer,”wherethepersonwhoheldthefootballwas“thequeer.”Idoubtthekidsknew whatqueer meant, atleastnot intheadult sense.Icertainly didnot. ButImadesuretoneverbe“thequeer.”

BythetimeIbecameateenagerandbegantounderstandthe basicsofsex,wordslikequeerandfaghadbeensoequatedwithweaknessand inferiority thatitseemedonlynaturalformetolookdown ongaysandwanttoseparatemyselffromthem—especiallyfrom gaymen.Myparents,conservativeinallmatterssexual,didnot approveofgayrelationships,but theyneverhadmuchtosayonthe subject,incontrast tothe specialcondemnationgaypeople received atthehandsofpreachersIsawontelevisionorreadaboutinnewspapers.Rather,theysimplydumpedhomosexualbehaviorintothe cauldronwithallothersexualactsthattookplaceoutsidetheconfinesoftraditionalmarriageandwasthustobeavoided.Looking back,eveniftheyhadbeenopenlysupportiveofsame-sexrelationships,I’mnotsurethattheycouldhavecounteractedthevicious antigaymessageI washearingallaroundme.

Duringbasketballpracticesandgames,wheneverweplayedpoorly, somecoachesandolderplayerswouldsaythatwewereactinglikefags orsissies,asmotivationtomakeusworkharderandperformbetter. We,inturn,usedthatsamelanguagetotauntourteammatesand opponents. BackthenIusedthosewordsmoretimesthanIcancount. Ineveropenlyridiculedanyoneorharboredanyviolentimpulsestoward kidsIthoughtmightactuallybegay.Isimplyavoidedthem.

Myhomophobiapersistedincollege.Onedayafteragameor practice,ablackteammate,talkingaboutagaysingeroractorhe’d seenontelevision,proclaimedthatifhissoneverstartedtoacteffeminate,hewould“beatitoutofhim.”Withhisquicktemper,there was every reasonto believe that hewas serious.Two or three teammateschimedin,agreeingwithhim.Afewotherslaughedorsmiled. Ishruggedintacitacceptance,asiftryingtobeathomosexuality outofyourownchildmadeasmuchsenseasattackingsomeone who’dharmedyourfamily.OrmaybeIshruggedbecausewe’dall heardsomanystatementslikethisbeforethatithardlyseemedre- markable.Nooneobjectedorseemedtroubledbyhisignorantrant.

Thatsameyear,Iwashavinglunchwithagroupofclassmates, allblackmen, whenwe hadasimilardiscussion.“ThereisnowayI couldhaveagayson,”Allansaid.

“Maybeit’snotinyourcontrol,”hisroommatesaid.“Maybe peoplearebornlikethat.”

“That’scrap,”Allanreplied.“Itain’tnatural.It’sallabouthow youraiseyourkids.Dudesturnoutthatwaywhentheydon’thave astrongmale influence.”

Thenotionthatbeingraisedbyawomanwouldmakeamandesireanothermandoesn’tmakesense,especiallygivenhowmanyblack boysareraisedbysinglemoms,butweallacceptedhisflawedlogic. Hewontheargumentwithastupidanswer.

Myattitudefinally beganto changeduringmedical school where Iworkedwithafewgaydoctorsandmedicalstudents,thefirst peopleI’dknownwellwhowereopenlygay.Irealizedthatinour shared experiencein themedicalfield,ourliveshadalotmoresimilarities thandifferences.Further,mymedicaleducationrevealeda certaincommonalitysharedbyallpeople.Evenif onesexual,racial, orgendergroupgotagivendiseasemorefrequently than another,all ofuswerevulnerabletosickness,injury,and,ultimately,death. FromallIcouldtell,gay people, like everyone else, sometimes dealt withtheseproblemswellandsometimesdidnot.Acrossthespanofa person’slife,wheresomanythings,bothgoodandbad, couldoccur, beinggay(ornot)wasjustonepartof anynarrative.

Themedicalprofessionhashistoricallysufferedfromsimilar homophobia.Untiltheearly1970s, homosexualitywasregardedasan officialpsychiatric illness.Dr.MarkSchuster,chiefofgeneralpediatricsatBostonChildren’sHospital,hasspokenatlengthabouthis experiencesasagayHarvardmedical studentduringthe1980s,when somedoctorsopenlydiscriminatedagainstgaypatientsandmedicalstudents.Schusteroncesawasurgeonrefusetooperateonapatientwhomhesuspectedofbeingalesbian.Later,whenSchuster cameouttoaprofessorwho’dpreviouslygivenhighpraisetohis work,theprofessor revokedhis offer towriteSchusterarecommendationforpediatricstraining.Shusterreflectedthatheoftenfound himselfintheburdensomepositionofchoosingbetweenbeinga doctorandbeingopenlygay.

SurgeonandwriterPaulineChenrecountedasimilarversion ofmedicalantigaybiasina2012NewYorkTimesarticle,inwhich a supervisingphysicianduringhertrainingchastisedagroupofyoungdoctorsforprescribinga“homosexualdose”ofmedication,meaning onetooweaktoproperlytreat thepatient’sproblem.Duringmyown surgeryrotationinthelate1990s,theseniorsurgeon,frustratedwith hisjunior colleague’s efforts,told himthathe was“operating likea fag.”Ineach case,powerfulpeoplewereusinghomosexualityasa proxyforweakness andincompetence.

BythetimeImet my own HIV-infected patients GeorgeandMonica,I’dgrownupenough duringmedical school tobegin moving pastthissortofbias, at least enoughtorecognizeitwhenIsawitandtotakecarenevertoperpetuateitthroughmywordsoractions.Asablackman,hatinggay peoplesimplydidn’taddup.HowcouldIgetupsetaboutbeingdiscriminatedagainstbecauseofmyracewhileignoring,orworse yet, beingapartof,prejudicethatothersfaced?

But many blacks see it differently. In the era of HIV/AIDS,much hasbeensaidandwrittenabouthomophobiawithinourcommunity.BlackpeopleareoftendescribedasthemosthomophobicracialgroupinAmerica.There is somedatatosupportthiscontention. In2008,blackvoterssupportedCalifornia’sProposition8renouncingmarriagerightsforgaycouplesathigherlevelsthanallother racialgroups.A2013PewResearchCenterpollshowedthatwhile halfofwhitessupportedsame-sexmarriage,just overathirdof black respondentsfeltsimilarly.

Basedonthecommentsofpublicfigures, aswell asprivatediscussionsI’vebeenpartofovertheyears,it’sclearthatmanyblack peoplerejectalinkbetweenthecivilrightsstrugglesofthe1950s and1960sandthecontemporarylegaleffortsonbehalfofgay people.BarackObamaframedtheissueduringa2008presidential campaignspeech,whichtookplaceatEbenezerBaptistChurchin Atlanta,Dr.MartinLutherKingJr.’schurch.“Ifwearehonestwith ourselves,”Obamasaid,“we’llacknowledgethatourowncommunityhasnotalwaysbeen astruetoKing’svisionofabelovedcommunity.Wehavescornedourgaybrothersandsistersinsteadof embracingthem.”ItwasfittingthatObama’scommentstookplace where theydid, asblackchurches are widelyseen asamainsource inshapingthecommunity’santagonisticattitudetowardgays.In someoftheblackchurchesI’veattended,theantigaysentimenthas rangedfromtacitdisapprovaltooutrightdenunciation.Forevery ReverendCalvinButtsinHarlemandReverendDennisWileyin Washington,D.C.,bothsupportersofgayrightsandacceptance, therearemanymoreclergywhotaketheoppositestance.

Inrecentyears,ahandfulofgayblackcelebritieshavespoken ontheissue.Ina2011interviewwiththeNewYorkTimes,CNN anchorDonLemonassertedthatbeinggayis“abouttheworstthing youcanbeinblackculture.You’retaughtyouhavetobeaman; youhavetobemasculine.Intheblackcommunity,theythinkyou canpraythegayaway.”LeeDaniels,directorofthemoviesPrecious andTheButlerofferedasimilarperspective,saying:“Blackmencan’t comeout.Why?Because you simplycan’tdoit.Yourfamilysaysit. Your churchsaysit.Yourteacherssayit.Yourparentssayit.Your friendssayit.Yourworksaysit.”

Tobesure,certainwhitechurches,publicfigures,andpolitical organizationscanbeequallyvirulent,ifnot worse,intheircondemnationofgays.HispanicandAsian culturesalso possesstheirownshare ofhomophobia.Butwhenitcomestohowthesebeliefsintersectwith health,blacksarethegroupleastable toafford such attitudes.In2010, theCentersforDiseaseControlandPreventionreportedthatgayand bisexualblackmen,despitebeingamuchsmallergroupthanwhite gay andbisexualmen,accountedforapproximatelythesamenumber ofnewHIV infections; in 2011,thisblackgroup surpassedtheir white counterparts.AmongthemanycausesofhigherHIV/AIDSrates amongblackpeople,homophobiaandtheresultingsexualsecrecy clearlyplayanimportantrole.Thetimehascomefortheblackcommunitytoconfrontsomeofitsprejudicestowardgaypeople.