Keywords

Introduction

The House Ball Community is an underground community that has its roots in the drag balls of Harlem from the 1920s (Bailey, 2013; Chauncey, 1994). The House Ball Community, made up of houses and the elaborate balls they organize and perform in, exists in a number of metropolitan centers across the United States (US) and increasingly in various countries such as Canada, the United Kingdom, Russia, and Sweden. Members of the House Ball Community come predominantly from Black and Latino/a communities of gay, lesbian, bisexual, and transgender (GLBT) youth, with a variety of gender presentations. For example, an entire range of gender and sexual identities are revered and celebrated in the context of ballroom performances and institutionalized within the houses, including butch queens, butch queens up in drag, butches, and femme queens. These social activities and alliances represent safe subaltern spaces for young people to give and receive affirmation for non-heteronormative gender and sexual identities, as well as to take part in a community that celebrates gender fluidity and a cornucopia of sexual desires (Bailey, 2014). Most crucial to HIV prevention is that Ballroom members expand gender and sexual possibilities by taking up multiple articulations and performances of both masculinity and femininity.

The House Ball Community has been largely unknown in the public health literature until relatively recently, when a handful of investigators have begun to publish findings from studies with the population (Alio et al., 2014; Arnold & Bailey, 2009; Bailey, 2009, 2013; Galindo, 2013; Kipke, Kubicek, Supan, Weiss, & Schrager, 2013; Kubicek, et al., 2013; Murrill et al., 2008; Rowan, DeSousa, Randall, White, & Holley, 2014; Wong, Schrager, Holloway, Meyer, & Kipke, 2014; Young et al., 2017). The House Ball Community first appeared in popular media in Jennie Livingston’s documentary Paris is Burning, and, subsequently, in Wolfgang Busch’s documentary How do I look, Madonna’s Vogue, as well as the featuring of the dance group “Vogue Evolution” in “Do you think you can dance.” Although there have been a number of depictions of the House Ball Community within popular media, these mostly cinematic representations fail to capture the full dimensions of the House Ball Community, such as the gender system and the complex kinship structure upon which the community depends. Notwithstanding this exposure in popular media, albeit limited, this community is still relatively unknown in academic circles (Bailey, 2013). The ball event is the central means through which members of the community affirm, celebrate, and constructively critique its fellow members. Houses organize and invite the larger House Ball Community to compete in particular categories listed on flyers or call sheets. Balls are festive affairs, usually held in older dance halls, community centers, bars/clubs, or rented hotel event rooms, in the middle of the night. Recent funding for HIV prevention activities, in conjunction with a policy of test and treat, has started to put the community on the radar in public health circles as departments of health and community-based organizations begin to use balls as a way to capture young men who have sex with men (MSM) and transgender women of color in particular for HIV testing and case detection (van Doorn, 2012).

HIV Prevalence and Cofactors Driving the Epidemic in the House Ball Community

A limited number of studies have also been conducted with the House Ball Community to determine HIV prevalence rates , HIV-related risk activities, as well as potential avenues for intervention (Young et al., 2017). A groundbreaking study, known as the House Ball Survey, was conducted with the NYC House Ball Community in 2004, and utilized venue-based time day sampling as well as biological determinants of HIV status to examine prevalence and risk behavior. This study reported that 17% of participants tested were HIV positive, and 73% of those who were HIV positive were unaware of their HIV positive status (Murrill et al., 2008). This study also reported high levels of HIV-related risk behavior, with 24% of the sample having had more than five sexual partners in the past 12 months, 40% reporting condomless anal intercourse with a male partner within the same time period, and 37% exchanging sex for money, drugs, or shelter in the past 12 months. Murrill et al. also found that 42% of the sample had symptoms of depression, measured by a CES-D (Center for Epidemiologic Studies Depression Scale) score over 16 in the past 7 days, and a majority of the sample had experienced at least one stressful life event in the past 12 months. In a more recent study conducted with the House Ball Community in Los Angeles, California, Kipke et al. used venue-based day time sampling and found an overall rate of 6% self-reported HIV prevalence among the 263 participants in their study, which was much lower than that found in the NYC House Ball Community (Kipke et al., 2013). Kipke et al. also reported high use of alcohol (72%) and other drugs including marijuana (53%), ecstasy (12%), and cocaine (4%) in the past 3 months. More disconcerting, findings indicated that 25% of participants used other drugs in conjunction with sexual activity in the past 3 months. In a study conducted from 2011 to 2012 with the House Ball Community in the San Francisco Bay Area, Arnold et al. found HIV prevalence, measured by self-report, to be 27% in a sample of 274 participants attending ballroom events in the San Francisco Bay Area (Arnold, Sterrett-Hong, Jonas, & Pollack, 2016).

Because transgender members assume an important role in the community, including occupying positions of leadership in many houses, they must be considered in any discussion of HIV prevalence in the House Ball Community. Several investigators have reported high rates of exchange sex among gay men and transgender members of the House Ball Community. Sanchez, Finlayson, Murrill, Guilin, and Dean (2010) examined the NYC House Ball Community survey data looking specifically at exchange sex, stigmatization, stressful life events and high risk related behavior and comparing findings between MSM and transgender female respondents (Sanchez et al., 2010). Transgender members were especially vulnerable, with findings indicating significantly higher rates of exchange sex, 7% compared to 39%, respectively. In a study conducted among male-to-female (MTF) transgender House Ball Community participants in New York, Hwahng and Nuttbrock found that engaging in sex work along with drug use as a way to cope with sex work, was a “rite of passage” for many young MTF transgender people entering the scene (Hwahng & Nuttbrock, 2007). Sex work, in many cases survival sex, was employed to help pay for basic necessities such as food, clothing, and shelter, as well as body modification through silicone injections, surgery, and hormones. Hwahng and Nuttbrock point out that it was difficult for their transgender informants to find other forms of employment in the formal economy due to gender and sexual discrimination. Importantly, the authors examined the salience of belonging within particular ethnocultural communities, and how marginalization plays out for communities positioned differently within the larger graded power structure within the US context. Several investigators, including Hwahng and Nuttbrock, have recommended the development of prevention strategies to improve public acceptance of gender variation and increasing opportunities for transgender and gay youth of color in the more traditional workforce.

Much of the research on young MSM and transgender women of color has found that they are difficult to engage in care, and these findings that have been supported in studies with House Ball Community participants. Holloway et al. (2012) indicated that while services exist for young MSM, House Ball Community members did not access service programs in the Los Angeles study (Holloway et al., 2012). Although 80% of the sample reported testing for HIV, only 26% used HIV prevention programs. In a literature review, Phillips, Peterson, Binson, Hidalgo, and Magnus (2011) identified several opportunities within the structure of the House Ball Community to engage with participants to encourage more regular testing, prevention activities, and treatment adherence, citing programs such as the House of Latex program conducted by the Gay Men’s Health Crisis (GMHC) in New York City as a model for successful engagement with the House Ball Community (Phillips et al., 2011). Painter, Ngalame, Lucas, Lauby, and Herbst (2010) described working with People of Color in Crisis (POCC), a community-based organization (CBO) in Brooklyn, New York, to engage with the New York City-based House Ball Community to recruit young MSM of color for their Many Men, Many Voices (3MV) program when recruitment initially lagged (Painter et al., 2010). POCC worked with house leaders to recruit and retain participants, tapping into the membership networks of House Ball Communities . Eventually 338 men were enrolled in their evaluation of 3MV , one of the only HIV prevention interventions that has been found to significantly reduce HIV-related risk behavior among Black MSM (Wilton et al., 2009).

Some social scientists have been more critical of the recent reliance on the House Ball Community to engage young people in HIV prevention strategies . Van Doorn (2012) conducted ethnographic research with the House Ball Community in Baltimore as “Test and Treat” became the new paradigm for HIV prevention (van Doorn, 2012). Van Doorn argued that using the “affective labor performed by members of the House Ball Community attracts a host of optimistic investments in collective and individual prosperity that have yet to be realized.” In what he calls the “labour of cruel optimism,” van Doorn contends that while employing members of the House Ball Community to help bring in their peers for HIV testing and treatment serves public health, the larger systemic production of inequality will not change, because the language of viral containment depoliticizes the struggle against HIV. While testing assists the Department of Health in achieving their numbers and creates a professional workforce among disenfranchised communities, health, as articulated by van Doorn, is too narrowly defined and does not address the root causes of HIV and other syndemics affecting the House Ball Community. Homelessness, crime, racism, and homophobia remain more immediate threats to the health and well-being of young people involved in the House Ball Community (van Doorn, 2012). Other social scientists suggest that in addition to the aforementioned factors, racial discrimination, incarceration, poverty, and overall social dispossession are also primary drivers of high HIV prevalence among African American GLBT individuals (Harris, 2010; Lemelle, 2010; Watkins-Hayes, Patterson, & Armour, 2011)—who constitute the majority of the membership of House Ball Communities. Although perhaps unintended, the abandonment of HIV negative men, with a refocus of federal resources on treatment adherence and medical care, leaves these more immediate causes of inequality and poor health among members of the House Ball Community in place.

Researchers have also pointed to the need to address HIV-related stigma operating within the House Ball Community, a particularly intractable issue since achieving ballroom status is one of the key organizing principles of the community (Arnold et al., 2012; Bailey, 2013, Galindo, 2013). Using qualitative interviews with 20 members of the House Ball Community in New York City, Galindo (2013) reported that the hierarchical structure of the community, and its emphasis on competition, in conjunction with HIV-related stigma, could impede efforts for HIV prevention among HIV positive members (Galindo, 2013). Galindo points out that HIV-related stigma leads to a loss of moral experience among those in House Ball Community identified as HIV positive, losing ball status as well as a loss of social and emotional support for community members. Thus, Galindo’s participants reported carefully guarding their HIV positive serostatus for fear of undermining their standing in the community as individuals and house members. Similarly, Arnold et al. found that HIV-related stigma created barriers for engaging in HIV prevention activities, based on 67 in-depth interviews with House Ball Community members in the San Francisco Bay Area (Arnold, Williams, Blount, & Pierceson, 2012). HIV-related stigma undermined disclosure, testing, and seeking support for living with HIV. Consistent with Galindo’s findings, HIV status was rarely disclosed to sexual partners or friends, partly due to the fact that many members engaged in sex work to support themselves. Although support existed for HIV testing from house mothers, members took pains not to seek out testing in front of other house siblings should a positive diagnosis be made and the information used against them. HIV treatment adherence was impacted due to an unwillingness to take medications regularly and attend HIV clinics for fear of being outed with their HIV status.

In order to ground recommendations for promoting HIV prevention and treatment with the House Ball Community, it is necessary to describe two core dimensions of the community: the gender system and the balls/houses.

The House Ball Community : Gender System

The gender system , the kinship structure (houses), and ball events (particularly prevention balls) are three inextricable core dimensions of the House Ball Community and these components are important considerations for developing more effective HIV prevention strategies for this community. First, what members refer to as the “gender system” is a collection of gender and sexual subjectivities that extend beyond the binary/ternary categories in dominant society such as male/female, man/woman and gay/lesbian/bisexual, and straight (Bailey, 2011). This system is the basis of all House Ball Community subjectivities, familial roles, and the competitive performance categories at ball events. In this system, categories of sex, gender, and sexuality are linked but not always conflated.Footnote 1

To be clear, the genders and sexualities found in the House Ball Community are subjectivities, insofar as members identify and fashion themselves by and through the convergent notions of sex, gender and sexuality within the community and as those meanings are imposed on them by society (Bailey, 2011). Thus, House Ball Community members do not reject dominant gender norms entirely, nor do they desire doing so; rather, by revealing and exploiting the unstable and fluid nature of socially produced and performed gender categories, members forge more creative and expansive ways of living their gender and sexual lives. Ultimately, as Enoch Page and Matt U. Richardson (Page & Richardson, 2010) suggest, queer gender subjectivities reflect the multitude of experiences of creatively non-conforming gender identities, sexualities, and bodily configurations, both anatomic and performative (Page & Richardson, 2010). The gender system in the House Ball Community consists of six categories, which we delineate here with brief descriptionsFootnote 2:

  1. 1.

    Butch Queens up in Drag (gay men who perform in drag but do not take hormones and do not live as women).

  2. 2.

    Femme Queens (transgender women or MTF at various stages of gender transition involving hormonal or surgical processes, such as breast implants).

  3. 3.

    Butches (transgender men or FTM at various stages of gender transition involving hormonal therapy, breast wrapping or removal, etc., or masculine lesbians or females appearing as men irrespective of sexuality).

  4. 4.

    Women (cisgender women who are lesbian or straight identified or queer).

  5. 5.

    Men/Trade (cisgender men who are usually very masculine, and straight identified or non-gay identified).

  6. 6.

    Butch Queens (cisgender men who live and identify as gay or bisexual men and who can be masculine, hyper-masculine—performing thug masculinity—or very feminine).

The gender system is integral to the House Ball Community’s performative gender and sexual identities, kinship structure, and ball events. Regarding the former, each member of the community identifies as or is assigned one of the six categories in the gender system. Because gender performance is central to self-identification and can imply a whole range of sexual identities in the House Ball Community, the system reflects how the members define themselves largely based on the categories they walk/perform. It is important to note that some of the categories in the system are strictly gender categories, such as Femme Queens (Bailey, 2011). Hence, Femme Queens can be heterosexual, lesbian, bisexual, and queer, etc. Another example is the category “Women,” consisting of cisgender women (with few exceptions), demarcates gender, while implying a range of sexualities (Schilt & Westbrook, 2009). Those in the Women category are primarily heterosexual, feminine lesbians, or queer. However, other categories in the House Ball Community conflate gender and sexuality; for example, the Butch Queen, who is at once a cisgender man and gay. This gender system does not totally break from hegemonic norms of sex, gender, and sexuality, but it offers more gender and sexual identities to adopt and express than are available to members in larger society.

The House Ball Community: House Structure and Ball Events

The second core dimension of the House Ball Community is houses—the kinship structure. The gender system defines the roles that members serve in the house. Houses are socially, rather than biologically, configured kinship structures. Although houses are primarily social configurations, at times, they serve as literal homes or gathering places for their members (Arnold & Bailey, 2009). Houses are typically named after haute couture designers, but some are named after mottos and symbols that express qualities and attributes with which the leaders want a house to be associated. These alternative families are led by “mothers” and “fathers,” house parents who provide guidance for their “children” of various ages, races/ethnicities, genders, and sexualities.

The most conspicuous function of houses is organizing and competing in ball events. The gender system and kin labor system create a close-knit community and this community expresses its essence at these events. House parents recruit, socialize, and prepare their protégés to compete successfully in performative identity and performance categories. When one “walks a ball,” the participant competes in the categories that coincide with their gender identity within the House Ball Community. For instance, a Femme Queen can only “walk” (perform) in categories that are listed under the Femme Queen heading. These intensely competitive performances at the ball events are a part of communal gender practice that occurs and is enhanced within the Black GLBT affirming spaces that House Ball Community members produce.

In the House Ball scene, competitive categories abound, for example, “realness” categories such as “schoolboy realness,” call for a performance in which participants are judged on how effectively they act, dress, and walk, in ways that are indistinguishable from any other working class man or woman in everyday society, as in the case of schoolboy or schoolgirl realness, a working class young man or woman going to school.Footnote 3 Participants compete vigorously against one another on behalf of their respective houses, and, at times, as individuals, in which case they are “free agents,” or “007s.” The ball event is the central means through which members of the community affirm, celebrate, and constructively critique its fellow members. Thus, the gender system—gender and sexual identities—and the ball events combined with the social relations that underpin and exist within the houses (both within and outside the ball space) are mutually constitutive and, taken together, make up the social world of the House Ball Community. Most importantly, these dimensions constituted the spaces in which effective HIV/AIDS prevention and social support for both HIV negative and positive members can be developed and implemented.

Avenues for Intervention

Based on ethnographic work in both the Detroit and San Francisco Bay Area House Ball Communities, Arnold and Bailey (2009) were the first published investigators to discuss the importance of house structures and gender roles within the House Ball Community in informing HIV-related interventions for MSM and transgender youth of color (Arnold & Bailey, 2009). Our study of the Ballroom community documented several forms of intravention (Friedman et al., 2004), or forms of intervention or strategies that occur organically within community settings, and the importance of the gender system, houses, and balls in organizing these practices. Since houses are metaphorical homes for Black gay youth, they are prime configurations for providing various forms of support for HIV prevention. As a house mother and HIV prevention worker in Detroit explained, “The structure of the Ballroom community already allows for prevention work, you know, just in the fact that someone can say to you, ‘Now you know you need to wear a condom’ and it be from someone that you have built that trust factor with. People in the community do prevention work all of the time.” We offered recommendations for community-based organizations to make use of existing social structures within the community and the salient concepts of home and family, to provide HIV-related services and support. We argued that HIV prevention interventions necessarily required a more culturally appropriate, nuanced approach to reaching Black youth at risk.

More recently, Kubicek, McNeeley, Holloway, Weiss, and Kipke (2012) have put forth a resiliency model that could also strengthen HIV prevention programming with the House Ball Community (Kubicek et al., 2012). Based on the data collected with the House Ball Community in Los Angeles, this model taps into culturally appropriate themes around competition and resilience. “Resiliency” in this articulation includes four manifestations—shamelessness, social creativity, volunteerism, and social support. Shameless, in this case, correlates with a sense of pride and celebration of oneself in the context of Ball competitions, and serves as a counterpoint to internalized homophobia. Social creativity is deployed to counter a lack of social support that young people encounter in their communities of origin, thus the House Ball Community becomes a source of support, with the affiliation with fictive kin within houses. Volunteerism is a reaction to violence, victimization, and homophobia, and takes the form of house parents giving back to their communities. Finally, social support, which counters unhealthy relationships and loneliness, is observed in the sense of camaraderie participants described at the Balls and within their houses.

Prevention Houses

It is important to bring into focus the ways in which HIV prevention support is developed and facilitated within the inextricable relationship between balls and the community-fashioned kinship system in the House Ball Community. This linkage constitutes what House Ball Community members refer to as prevention houses. A prevention house may have either a formal or an informal relationship with a community-based organization. Besides organizing prevention balls, which is explained below, a core mission of a prevention house is to develop and implement strategies for the prevention of HIV and other sexually transmitted infections by fostering open and informed discussions about sex and advocating “safer sex” practices. Prevention houses also provide social support for those members who are HIV positive, which is a critical aspect of the HIV prevention and treatment dyad. Generally, in theory, the prevention house is a safe and supportive space, providing social and, at times, material support and care that House Ball Community members, both HIV negative and positive, often do not get from their families of origin nor elsewhere among the larger Black GLBT community , particularly youth.

House mothers and house fathers in particular provide daily parental guidance for House Ball Community members regarding intimate/romantic relationships, sex, gender and sexual identities, health, hormonal therapy , and body presentation, among other issues. Yet, in prevention houses, HIV prevention is another crucial role that house parents assume as leaders of houses. We refer to their unique role as prevention parenting. In the Detroit chapter of The House of Prestige , for example, the late Noir Prestige, a Butch Queen, explained how prevention parenting works in houses: “Even in the traditional sense, if I’m supposed to be the matriarch or the patriarch of the family, the head, if I see one of my kids is just out there being a whore, then it’s my duty to go, ‘Are you protecting yourself?’” This aspect of parenting—nurturing and caring for the members—is typically undertaken by house mothers, indeed HIV prevention parenting is mostly a house mother endeavor (Arnold & Bailey, 2009; Bailey, 2013). Prevention parenting is especially important for Femme Queens who are taking hormones. Because members of the House Ball Community have limited or no access to safe hormone injections, some Femme Queen mothers ensure their kids use clean needles, and they draw from their own experience or knowledge they have gained to guide their children through their hormonal therapy (Bailey, 2013). In many cases, Femme Queen house mothers can keep their kids from getting hormone shots through shady and unsafe sources on the street.

House parents also were in positions to challenge HIV-related stigma and gossip that could occur in the House Ball Community, should a house member’s status be disclosed. They understood the meaning associated with living as an HIV positive person within the community, and offered support in a culturally appropriate way that also recognized the complex realities of the lives of their children. Says one Bay Area house father, “You may lose your livelihood if someone finds out you’re HIV positive…there’s a lot of competition for [sex work] clients, for status, for looks, for this, for that…street survival is that if you find someone has got it you’re going to use that information to your advantage… And so no I don’t blame the kids for not disclosing. I give them props if they go get tested. I give them props if they seek treatment.” Within the houses, members consult with their parents and their house siblings on issues that, either by choice or by necessity, they cannot discuss with their biological parents. This is not always an issue related to fear of exclusion or retribution; rather, it is often just more feasible and practical to rely on one’s house parents in the House Ball Community who generally have more knowledge and experience with issues confronting marginalized Black GLBT people and communities.

Prevention Balls

Aside from HIV-related prevention and support within the houses, HIV prevention education takes place at “Prevention Balls,” which were typically sponsored by HIV prevention programs, often held in CBOs, and featured categories specifically developed with a safer sex or HIV-related theme in mind. Prevention balls are designed to educate community members about healthy sexual practices and to promote sexual responsibility, through the competitive performances at the balls. By incorporating safer sex awareness and practice, the balls themselves are a means of intervention for House Ball Community members. Having young people “walk” the runway displaying their knowledge of HIV transmission, showcasing safer sex paraphernalia, and, in some cases, actually wearing this paraphernalia in front of the crowd allows these norms to not only be disseminated throughout the community, but allows for the practice and expectations of safer sex to be inscribed on the bodies of those who compete in the balls. One of the most famous prevention houses is GMHC’s The House of Latex in New York City. For almost 20 years, GMHC has organized The House of Latex ball, one of the most popular HIV/AIDS prevention balls in the country, drawing between 2500 and 3000 audience members/participants. Prevention balls are designed to educate House Ball Community members about healthy sexual practices and awareness, through the competitive performances at the balls.

It is worth reiterating here that the Ballroom community is a place in which Black GLBT youth, especially, look for guidance, nurturing, care, and support. Given the absence of youth voices on community-based organization staffs and boards, the House Ball Community embrace of Black GLBT youth is essential to HIV prevention and social support for HIV positive youth. According to House Ball Community members and HIV prevention workers, the members are getting younger and younger. “These ‘kids,’ literally, are more prone to high-risk sexual behavior,” said Tino, a Butch Queen. He further suggested that, “A lot of people who are involved in the community are dealing with being put out of the home ‘cause of their parents and maybe they are out at an early age and they get involved with sex and substance abuse at an early age.” At the time of the interview, Tino was an HIV prevention and treatment advocate at The Horizons Project and a member of The House of Prestige in Detroit. Consequently, for young Black GLBT youth, the House Ball Community becomes a space that counters the social conditions that produce these risk factors. As Tino observes:

The main reason why I got involved in Ballroom was to deal with my own biases and misinformation by observing. But also to connect with people who were infected that others in the scene didn’t know. I was able to connect with people at the balls. During a Ninja ball, I ran into a guy who was HIV positive who had missed his appointment. I encouraged him to come to his appointment to follow up on his health. He came but still has problems with adherence with his appointments. He is 18 years old and probably hasn’t come to grips with it and is afraid.

Since balls have major drawing power, they offer a space in which to engage younger members in unique ways. People such as Tino’s client will not go to a community-based organization to access treatment resources, nor is he able to discuss his status with his biological family. But the young HIV positive man participates in balls, and he may or may not be a member of a house. House Ball Community prevention workers such as Tino encourage their clients to take better care of their overall health and to remember to take their HIV medication. Especially for Black GLBT youth in urban spaces like Detroit and the San Francisco Bay Area, depressed social conditions for them contribute to diminished health and increases their likelihood of infecting someone else. Tino’s movement between the House Ball Community and HIV prevention is evidence of his understanding of the magnitude of the problem of HIV infection rates among Black GLBT youth. These critical issues should be considered in any prevention program.

Research Priorities with the House Ball Community

Given the complexity of the House Ball Community, and the need to position any quantitative findings within the intricate social and contextual realities of the lives of community members, we recommend that investigators develop interdisciplinary research teams that use both qualitative and quantitative approaches (Creswell & Plano Clark, 2007). Scholars who have the ability to collaborate with multidisciplinary teams, which should include social scientists such as sociologists, anthropologists, human geographers, and gender, sexuality and cultural theorists, will be especially relevant to furthering research agendas with the House Ball Community.

Likewise, research that utilizes a community-based participatory research paradigm and involves members of the community must be prioritized (Minkler & Wallerstein, 2008). This can take many forms, including consulting members of a community advisory board, hiring and training House Ball Community members to participate in the research process, or partnering with ballroom alliances and houses to design research studies and interpret findings. Finally, researchers should acknowledge, take seriously, and draw from forms of intravention already taking place within House Ball Communities. Recognizing the ingenuity of this community will be crucial in developing programmatic strategies for reducing HIV prevalence among House Ball Communities in particular and larger Black GLBT communities in general.

Conclusions

Although the House Ball Community offers great promise for reaching Black GLBT youth with HIV-related information, support, and interventions, it is also a very dynamic and somewhat ever-changing community. The economic resources that House Ball Community leaders can access are limited and constrained, and many members engage in informal and unstable work and experience periods of unemployment. Thus, linkages to more formal services, employment programs, job training, housing, and other economic resources offered through community-based organizations and social service agencies would be of great benefit to House Ball Community members, and must not be overlooked in the recent “Test and Treat” paradigm. Indeed, it is essential that members of the House Ball Community who are both HIV positive and negative to come together to advocate for public forms of funding to continue to cover substance use treatment programs, mental health services, housing, and job training, and educational opportunities to benefit the community. Community-based organizations should also make sure that house parents, particularly house fathers, are informed about broader programs to increase well-being and economic opportunities for young HIV positive people involved in the House Ball Community, as well as offering them support for continuing to promote lower risk behavior and treatment adherence.