JUNE | 2019 | BLACK, GAY & GIFTED

THE PEOPLE’S CHAMP

Manny Pacquaio, Muhammad Ali and Dwayne “The Rock” Johnson have all been known or referred to as “The People’s Champ”. The title is one that’s earned more than its given, and those who wear it are believed to have clearly and undoubtedly proven themselves as being some of the greatest people alive. They are known to give back, to dedicate their talents to causes that help to sustain or improve their communities, and they’re pretty good at giving people something to believe in.

While Pacquaio, the spirit of the late great Ali, and Johnson didn’t return any of our inquires about being featured for June, we are fortunate enough to have found someone just as admirable--The Dr. David Malebranche. We’re not sure as to whether or not he’s ever set foot inside of a single ring in his life, but we’re beyond certain he’s proven himself worthy of the title, and are humbled to have the opportunity to feature him.

Whether he’s conducting research on the racial, gender, age, and cultural factors that influence the health of black men regarding sexual risk behaviors and HIV testing, or exploring the ways in which notions of masculinity among black MSM influence sexual behavior, decision making, and risk of HIV, rest assured that he’s always doing something that’s going to benefit the SGL community. From the looks of things, he’s not showing any signs of stopping. Dr. Malebranche has lent his experience and his voice to the cause, the cause of educating both patients and peers alike on HIV, behavioral patterns, and most importantly patient care.

We’re thirty-eight years into the HIV epidemic, and there’s still a lot of misinformation going around. The only thing rivaling the misinformation is the lack of information about HIV, the virus that causes AIDS. When asked about whether or not he’s ever surprised at the amount of stigma associated with the virus, questions about transmission, and levels of education, Dr. Malebranche says he’s not surprised.

“I think those of us who have worked in the field for a while are just surrounding ourselves with the "choir" who also knows a lot about sexual health and HIV. So we are tricked into thinking that everyone is like this. Not at all.” His belief is that those working within the field of HIV prevention, education, and health should continuously reinforce messages as if they’ve never been heard. “And even if we get tired of saying it, we can't let this stop us from educating and advocating, because the information is needed!”

According to this report released from the CDC, HIV infections declined among some populations, but increased among others. While HIV infections remained stable among black gay and bisexual men, they increased 30 percent among Latino gay and bisexual men, and by about 65 percent among both black and Latino gay and bisexual males ages 25 to 34. What’s interesting is that this same report illustrates a 30 percent decrease in HIV infections among black gay and bisexual males ages 13 to 24- which is a total win. The report boasts about the effectiveness of prevention efforts in New York and D.C, but, it lacks information on how much of this information has made its way to rural America. To this Dr. Malebranche says, “Rural areas aren't getting this information as much as they should, and also we have to remember that with each new generation, we can't get frustrated if they don't demonstrate knowledge immediately.”

In 2016, the Prevention Access Campaign, a health equality initiative with the goal of ending HIV and the stigma associated with it, launched the Undetectable equals untransmittable (U=U) initiative. Many have expressed their concerns about the initiative which is built upon a mound, if not a mountain, of scientific information supporting that someone who is HIV positive with an undetectable viral load cannot transmit the virus to their partners. Detractors of the initiative suggest that it offers false hope, but Dr. Malebranche sees things differently.

“I think it's tremendously empowering to anyone living with HIV, and since, from the studies, it represents the best mode of preventing HIV transmission, it helps reduce stigma and can open conversations about condom use, closeness, sexual health, etc” However excited he may be about U=U, Malebranche’s only concern is that “it tends to put the onus on the sexual partner living with HIV to be the responsible one and "convince" someone not living with HIV that it's ok to have have sex with them. Most sex is consensual with both parties, so while U = U empowers people with HIV, both parties need to have these honest conversations on both ends about sexual health... not just the HIV+ partner reassuring everyone else that they are ok to have sex with.”

Since we were fortunate enough to have the good doctor’s attention, we wanted to get his take on those who simply refuse to use condoms. Many of us have heard the “ it doesn’t feel natural” rationale behind this, and many more of us are familiar with the “raw is law” subculture that exists among and across all sexual orientations, so...we just had to ask.

“I encourage all my patients and everyone else to enjoy the sex they enjoy, whether with condoms, without, or a fluid trip of sometimes with and sometimes not. People are going to have sex without condoms, over all the continuum of sexual orientations and gender/sexual identities.” There are other reasons that people don’t use condoms. Some lack the ability to access them, don’t know how to properly use them and might feel insulted when asked to use them as the request comes with the assumption that one of the two (or more, we’re not judging) sexual partners may not be “clean”. David understands all of this.

“It's natural, feels better, and for many people it signifies closeness, intimacy, and trust. My job is to encourage you to live the best sexual life you want to and can, but come and see me for routine screening. This doesn't have to be an "either/or" scenario - you can have good sex AND be responsible with getting check ups, etc. I don't see my job as being the "condom" police - I see it as encouraging folks to have good sex, educating them about what's out there and what risks are associated with certain behaviors, and then having open, honest, and nonjudgmental discussions about what they like and how often to come in for check ups.” Listen, why can’t more doctors be this nonjudgmental?

Dr. Malebranche sees condom use as more of a personal choice than a social norm or mores, and is more concerned with people being knowledgable about the risks associated with condomless sex. “ ...you can choose what level of risk you are comfortable with regarding sex. Oral sex carries some risk for STIs, but is not risky for HIV - most are comfortable with that. Others will take the risk of anal sex and HIV/other STIs that some are not comfortable with... it depends on you. I have education and expertise around all of that - my job is to help guide you through your decisions, but ultimately they are your decisions.”

Dr. Malebranche’s non judgemental approach as a medical provider is one of the reasons we’ve declared him the people’s champ, because far too many of us tend to tap dance on eggshells when it comes to seeing our doctors for whatever we’re seeing them for. According to Dr. Malebranche, the surest way to avoid doing this is to find a provider with whom you meld with.

“The best providers can be professional and give you advice and recommendations based on our education and training, but package it in a way like we would with a family member, loved one, or friend. Providers should be asking questions of you and show general concern for your well being. They should not be put off by you being empowered about your health care, asking questions, or suggesting alternatives to what they think is the best course of action. While providers know the medical stuff best - you know your body better than anyone. Any provider that doesn't respect that reality when dealing with you can kick rocks”

Dr. Malebranche has been very active in promoting PrEP and PEP, two of the most tangible action steps in the fight against HIV. PrEP, which is short for pre-exposure prophylaxis, is provides a shield, of sorts for those who are HIV negative. It comes in pill form and can be taken once a day before and severely reduces their risk of contracting HIV.

PEP, or post-exposure prophylaxis, is a prevention tool that comes in pill form that is given to those who are HIV negative after they’ve come into contact with HIV. It reduces their risk of HIV infection, but only if used within 72 hours of exposure.  Both PrEP and PEP have taken HIV prevention to a new level, but some of those who are interested in it have found its not so easy to get. If this is you, then worry not because Dr. Malebranche has some news for you!

“Gilead, the company who makes Truvada, has patient assistance programs that can help in both situations.” Also goodrx.com is a good option. Medicare and Medicaid do pay for Truvada, but for Medicaid it depends on the state. All of them depend on income qualifications, but even with that caveat, one should be able to get PrEP regardless of insurance status, with little or no copay. Also goodrx.com is a good option. Medicare and Medicaid do pay for Truvada, but for Medicaid it depends on the state. All of them depend on income qualifications, but even with that caveat, one should be able to get PrEP regardless of insurance status, with little or no copay.” According to Dr. Malebranche, the best part of his job is being able to participate in initiatives that focus on the health of Black SGL men.

“We are typically ignored unless the media wants to tell us how fucked up we are” he says, “Few programs are affirming to Black SGL men, and my work with Revolutionary Health and the Counter Narrative Project fills my soul. Working with great people Working with great people like Charles Stephens, Johnnie Kornegay III, Alvin Agarrat, Robbyn Kistler, Trina Scott, Tina Hoff, Keith Green, Leo Moore, Rashaad Burgess, Terrence Moore, Damon Johnson, Marvell Terry, Daniel Driffin, Omoro Omoighe, Demetre Daskalakis, Leandro Mena, and others is such a blessing and really demonstrates how it really takes a village to tackle issues of sexual health and HIV in Black communities. The folks I am blessed to work with are such warriors and have a similar work ethic as myself, so it makes doing what we do much easier, despite the long hours and challenging circumstances.”

As of late, Dr. Malebranche has been lending his expertise to GTA’s #askthehivdoc, a campaign focused on answering questions people have about HIV/AIDS prevention, treatment and testing. Campaigns such as these are important as they use social media as a means to spread information that might not be reaching the people it needs to.

“...it's been an honor to be part of #askthehivdoc with the Kaiser Family Foundation, the Black AIDS Institute, and the Greater Than AIDS Campaign. To me what's powerful about these initiatives is that they reach people through social media with short educational videos that folks can look at on their time and as often as they want. They also focus on common questions people have, and can reach people who may live in areas of the country without many resources AND for those who are scared or intimidated by navigating medical spaces. Doing this kind of work and the weekly live YouTube videos we do with the Counter Narrative Project and Revolutionary Health make what I do very enjoyable.”

David often cites his father, who is a retired general surgeon, as the inspiration for his decision to pursue a career in medicine. According to the good doctor, witnessing how poorly some patients were being treated by medical staff fueled him to both do and be better. The presence of that passion remains ever clear as he offers his advice to practitioners who might have lost their way.

“I think it’s the most important aspect of being a provider- it’s having cultural humility and realizing your job is to listen and not to impose your cultural journey on your patients. Most providers aren’t good at doing that.” David considers himself as being blessed to have parents who raised him to be considerate while interacting with others. His belief that being on the “other side” is an important component to providing service was shaped by two experiences, the first of which took place waaaaay back in 1997 during a residency in New York.

”I stuck myself with a needle while sewing up an IV on a hospital patient living with HIV who had a T cell count of 50 and viral load of 500,000. I had to go on post exposure prophylaxis with AZT, 3TC, and crixivan for a month. The side effects with those meds were so crazy it taught me that the people taking those meds daily as their lives depended on it were WARRIORS and that we should never call folks "noncompliant" when they can't take their meds. Side effects can be no joke.”  Dr. Malebrance says that he was diagnosed with HIV ten years later while he was in the middle of his academic career and that he gained even more of an appreciation for his patients as a result.

Malebranche’s second set of experiences came as the result of having had multiple back surgeries, fractured ribs, sprained ankles and a recent fainting episode as well. “When you have to navigate a crazy US medical system as a patient yourself, you become much more compassionate and understanding for the challenges our patients face every day, and hopefully less judgmental when they get frustrated  or fall short.” These combined instances solidified his belief that medical staff members should experience things from the patient side of things to “ see what bullshit folks have to put up with- that way they won’t be so quick to judge them when they don’t show up for appointments, don’t follow up, don’t take their meds or give up sometimes.”

We wanted to induct Dr. Malebranche into our humble annal of Black, Gay and Gifted features because he really cares. Yes, there are doctors out there who care, but there aren’t many who go above and beyond the way he does. We can guarantee that if you watch him closely enough you’ll see exactly what we’re talking about. Another reason we wanted to feature David was because our social media issue is set to focus on the ways that social media platforms impact and effect us. Dr. Malebranche's work with #askthehivdoc and the Counter Narrative Project illustrate the ways that he selfishly shares his knowledge with others within the SGL community through the use of social media.

June 27th is National HIV testing days, which means that you’ll hopefully have had marked your calendar to get tested. “Getting tested is one of the most important decisions you can make for your sexual health. Regardless of the result, know that you will be ok and that you will live a long life and be able to enjoy your sexual health, mental health, and overall health regardless of what the test says. It also will give you freedom and empowerment to tell your own sexual health narrative, instead of letting others do it for you.”

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We don’t tend to think about the things that make our champions tick; about the understated characteristics that are probably the most overstated when they are alone, or their guiltiest of pleasures. We’ve all got them, and Dr. Malebranche is no different. “I'm an introvert at heart, so I do take a lot of time to myself. I enjoy traveling, domestic and internationally, a big movie buff (especially horror and Marvel), working out, running, biking, and writing. I also spend quieter moments with good friends and family - not a big party goer or club head anymore, but a nice lounge or restaurant with people I love is always a good time.”

He admits that his most recent vice playing the slots because it gives him the opportunity to sit in front of a machine without thinking about anything, and because the prospect of winning a little money calms him. “ I’ve been somewhat more lucky than most on slots, so I don’t lose my shirt and house on it” he says. As a form of self care, Dr. Malebranche says he’s recently started going back to therapy because “taking care of that part of me is paramount!” Its pretty safe to say that David, like many of us has a hidden set of guilty pleasures, but they don’t include Taylor Swift as he’s not a fan of her mediocrity or her Mayochella. “She’s been copying and Columbusising Black style for years and it's never good.” However he does admit to enjoying Zaxby’s, Family Guy and chocolate.

As far as to what we can expect from the people’s champ in the future, our best bet is to look at what he’s doing now as an indicator of things to come. While his primary work with the Morehouse School of Medicine will continue its focus around student health, he’s spending a little time working on ways to improve upon the services that are available to students. “ Revolutionary Health is growing and expanding daily, and we plan on doing more innovative and timely programming that highlights all the aspects of our health as Black SGL men.”

Dr. Malebranche is also working on providing provider educational initiatives that will focus on the importance of prescribing PrEP and providing better clinical experiences for Black and LGBTQ patients as well. “Last, but certainly not least,” he says, “ I’m trying to sit my ass down and write more.” David has had a few narratives floating around his head that he’d like to get out into the world. “All of this stuff excites me as its all work I’m tremendously passionate about.”

In a world that, according to Dr. Malebranche, needs more love, he suggests that we all model loving behavior on an individual basis through our interactions with others. “ One thing I have learned is that people are always watching and paying attention. If you are an asshole and treat people poorly, folks will see that, and it lets them know it’s okay to act like that. It’s not.” Dr. Malebranche’s belief is that being loving, understanding and nonjudgmental goes a long way in putting good energy into the universe. “That shit is contagious, and a more than powerful buffer against all the toxic shit and negative energy that is spewed out by people in this world on a daily basis.”

Dr. Malebranche is an example of what happens when an unstoppable force of experience charges head on into an immovable object of passion. He is probably one of THE most dedicated practitioners of his kind on Earth. He is relatable, humble and always willing to lend his skills to causes that effect change. He’s the kind of doctor anyone would want, and the kind who gives as openly as he lives.  Malebranche may not share Pacquaio’s eight-division world champion title, or be an eight time WWE championship winner, but he’s still out here doing the people’s work, and winning the people’s heart as holds his claim to fame as the people’s doctor.