This Doc Wants to Change How Black Men View PrEP

For Dr. Leo Moore, education is the best way to reduce HIV rates in the black community, and he’s the man to do it. “I’m in a unique position to help this community, because I understand this community, because I grew up in this community, because I even became a black gay man in this community,” he told NBC Out in 2017.

Moore, 31, oversees a program for the Los Angeles County Department of Public Health that educates medical providers about PrEP, a prevention strategy that when taken as prescribed makes it nearly impossible for an HIV-negative person to contract the virus. Moore, the son of a nurse (who he credits for getting him interested in medicine), is at the forefront of an effort to reduce HIV transmissions in Los Angeles by educating residents and health care providers alike. Under Moore’s leadership, the program reached more than 700 clinics in its first six weeks. We asked Dr. Moore to elaborate.

Why do you think prior messaging about prevention, and particularly PrEP, has not reached black men who have sex with men?
Often, at conferences and other meetings, I’ve heard researchers say that black MSM [men who have sex with men] are “hard to reach,” which is an idea that I strongly disagree with. Black MSM are not hard to reach. We as organizations and agencies that serve them have to ensure that we bring them to the table to help us craft the best messages that will resonate, and the best venues to place these messages. When developing these messages, we must also recognize that being a black man who has sex with men is not a monolithic experience. Some black MSM may suffer from internalized homophobia due to multiple factors such as a religious upbringing or hearing homophobic comments expressed by family and friends, which can hinder them from receiving HIV prevention messages aimed at gay men, while others may have grown up in an affirming environment and be more open to receive these messages.

Also, many black MSM don’t identify as gay and therefore may not be in environments such as gay bars or clubs where HIV prevention messaging is traditionally placed. Many of the initial PrEP campaigns focused heavily on men who identify as gay, which limited the reach into the black community. Pretty soon thereafter, we began to see PrEP ads on dating and hookup apps which I think are great platforms for HIV and STD prevention messages as they focus more on sexual behavior and less on sexual orientation. Another reason that messaging may not have reached some black MSM is the lack of focus on the black family in which mothers, sisters, cousins, and other family members who learn about PrEP could then inform black men and each other about PrEP. Given that black women are also disproportionately affected by HIV, this strategy of raising collective knowledge within the black community could benefit both black MSM and black women.

What is it about your messaging that works?
Our team works closely with focus groups and community advisory boards that include black MSM to ensure we are creating messages that will resonate with them. Prior to the launch of our Get PrEP LA campaign, we met with focus groups multiple times to determine the best approach. During these focus groups, participants mentioned that they were tired of seeing intimate photos of men or women in romantic poses. They also felt that images of two men might deter some non-gay identified MSM from interacting with our campaign. Lastly, they wanted to choose a campaign theme that emphasized a person’s “power” to protect themselves and the message that PrEP presented another “choice” of how to do so. They thought superheroes could have widespread appeal because most people grew up with a favorite superhero, or were at least exposed to them.

After creating the campaign, we began promoting it through multiple physical and digital outlets, from bus tails and billboards to social media platforms and hookup apps. We also have a “PrEP Squad” that regularly attends events in areas where communities of color are known to reside. Throughout our campaign, we’ve placed an emphasis on community engagement and are constantly identifying new ways to insert ourselves into mainstream conversations that appeal to black MSM with messages that blend HIV prevention messages and humor and wit.

Simply put, [identifying as] “same-gender loving” is more effective for some black “gay” men because it was created by a black man to specifically affirm the black man’s romantic attraction towards other men. It’s a term that provides an alternative to the Eurocentric terms of same-sex attraction, which don’t take into account Afrocentric experiences and through which many black men still experience prejudice and racism within the lesbian, gay, bisexual, transgender, queer, questioning, intersex, and asexual community. I think the most important thing to recognize is that prejudice and acts of racism within LGBTQQIA spaces can contribute to the failure of messages meant to appeal to the broader gay community among black gay men.

What excites you about your work?
I’m excited by a few things. First, I’m excited we currently have the tools to end the HIV epidemic. With PrEP and Treatment as Prevention [TasP], we can end it. We just have to ensure that communities, specifically black and Latino MSM, heterosexual women, injection drug users, and transgender persons have access to PrEP, HIV treatment, and support services to get them in care and keep them in care. Second, I’m excited by the opportunity my work provides to create new access points for PrEP and HIV treatment for communities of color and vulnerable populations where they can access care at low to no cost. We can’t talk about ending the HIV epidemic without ensuring low-barrier access to essential services and treatment in order to narrow the gap in HIV incidence between these groups and Caucasians. Lastly, that my work allows me to see patients in our county health center and hear their stories first-hand. Regardless of my career trajectory, I always want to remain connected to patients who are accessing services. They keep me informed about the gaps that need to be filled in order to help them reach and maintain optimal health.