Background Although HIV infections are documented among all race and sexual risk groups, black men who have sex with men (BMSM) are the most affected by HIV in the US. Currently, there is considerable emphasis on the implementation and use of biomedical HIV prevention to slow the HIV epidemic among this group; however, use of biomedical prevention requires engagement in routine medical care – a necessity that has not been met. Methods In order to better understand this shortcoming, we surveyed 544 BMSM (in 2012) to assess how health care related stigma, global medical mistrust, and personal trust in health care provider relate to engaging in medical care. We used generalized linear modeling and mediation analyses to assess data (completed in 2013). Results Twenty nine percent of participants reported experiencing race/sexual orientation stigma from heath care providers and 48% reported feelings of mistrust towards medical establishments. In generalized linear modeling we found that, among HIV negative BMSM, those who experienced greater stigma and global medical mistrust had longer gaps in time since last medical exam. Furthermore, global medical mistrust mediated the relationship between stigma and engagement in care. Among HIV positive BMSM, experiencing stigma from health care providers was also associated with longer gaps in time since last HIV care appointment. Conclusions Interventions that support the development of greater awareness around the sexual health needs of BMSM are desperately needed. Failure to address psychosocial deterrents will stymie progress made in biomedical prevention and, ultimately, cripple our ability to implement these technologies.

In the United States, rates of HIV infection are highest among black men who have sex with men (BMSM). Preexposure prophylaxis (PrEP) is a highly effective form of HIV prevention, but the uptake of this strategy has been slow since FDA approval in 2012, and it is unknown whether information about PrEP is reaching BMSM. Four hundred and thirty-six BMSM in Atlanta, GA were surveyed from January 2012 (6 months prior to PrEP approval) to March 2014 (20 months after approval). Analyses revealed no association between date of survey assessment and awareness of PrEP (20.5% were aware of PrEP before approval and 23.4% were aware after approval; OR = 0.99 [0.98-1.02], p = 0.952). In a multivariate model, BMSM unaware of PrEP reported lower rates of HIV testing knowledge, fewer experiences with HIV testing, and higher rates of transactional sex than BMSM who were aware of PrEP. Our findings suggest that there is limited understanding of PrEP and that there is considerable groundwork that needs to be achieved in order to reap the full benefits of PrEP. The current findings call attention to the need to both prioritize and better understand how to strengthen the bridge between medical advances and community uptake.

The HIV epidemic among Black men and transgender women who have sex with men (BMTW) demands an urgent public health response. HIV point prevalence among this population ranges from 25%–43% - a rate far exceeding any other group. Pre-exposure prophylaxis (PrEP) for HIV prevention is a very promising prevention tool, however, its full potential to slow the epidemic has yet to be realized. For the current study, random time-location sampling at Black Gay Pride Events was used to collect data from N=1,274 BMTW, from five US cities, reporting HIV negative/unknown status. In-field HIV testing was also provided to participants. Participants were assessed on awareness and use of PrEP, health care factors, HIV testing history, psychosocial variables, and sex behaviors. About one-third of participants were aware of PrEP (39%), and a small percentage of participants were users of PrEP (4.6%). In multivariable analyses, being in a relationship, testing for HIV in the past six months, and others being aware of one’s sexuality were positively associated with PrEP awareness. Higher levels of internalized homophobia and greater numbers of female sex partners were positively associated with PrEP use, while education and condom use were negatively associated. Based on study findings, messaging and uptake of PrEP needs greater expansion and requires novel approaches for scale-up. Improving linkage to HIV testing services is likely critical for engaging BMTW with PrEP. The potential for PrEP to slow the HIV epidemic is high, however, we must strengthen efforts to ensure universal availability and uptake.

OBJECTIVES In the US, Black men who have sex with men (BMSM) are disproportionately affected by HIV/AIDS. Pre-exposure prophylaxis (PrEP) holds tremendous promise for curbing the HIV/AIDS epidemic among these men. However, many psycho-social components must be addressed in order to effectively implement this prevention tool among BMSM. METHODS We assessed PrEP knowledge and use, health care access experiences, race-based medical mistrust, sexual partners and behaviors, and drug and alcohol use among 699 men attending a community event in the southeastern US. We used generalized linear modeling to assess factors associated with their willingness to use PrEP. RESULTS Three hundred ninety-eight men reported being BMSM and HIV negative status. Among these men, 60% reported being willing to use PrEP. Lack of being comfortable with talking to a health care provider about having sex with men, not having discussed having sex with a man with a health care provider, race-based medical mistrust, and alcohol consumption and substance use were all identified as barriers to willingness to use PrEP. Sexual risk taking, including number of sex partners and STI diagnosis, was not associated with willingness to use PrEP. CONCLUSIONS Findings from the current paper demonstrate the importance of acknowledging the role of various psycho-social factors in the uptake of PrEP. It is imperative that we prioritize research into better understanding these barriers as the failure to do so will impede the tremendous potential of this prevention technology.

BackgroundMen who have sex with men (MSM), particularly MSM who identify as African-American or Black (BMSM), are the sociodemographic group that is most heavily burdened by the human immunodeficiency virus (HIV) epidemic in the United States. To meet national HIV testing goals, there must be a greater emphasis on novel ways to promote and deliver HIV testing to MSM. Obstacles to standard, clinic-based HIV testing include concerns about stigmatization or recognition at in-person testing sites, as well as the inability to access a testing site due to logistical barriers.ObjectiveThis study examined the feasibility of self-administered, at-home HIV testing with Web-based peer counseling to MSM by using an interactive video chatting method. The aims of this study were to (1) determine whether individuals would participate in at-home HIV testing with video chat–based test counseling with a peer counselor, (2) address logistical barriers to HIV testing that individuals who report risk for HIV transmission may experience, and (3) reduce anticipated HIV stigma, a primary psychosocial barrier to HIV testing.  MethodsIn response to the gap in HIV testing, a pilot study was developed and implemented via mailed, at-home HIV test kits, accompanied by HIV counseling with a peer counselor via video chat. A total of 20 MSM were enrolled in this test of concept study, 80% of whom identified as BMSM.ResultsAll participants reported that at-home HIV testing with a peer counseling via video chat was a satisfying experience. The majority of participants (13/18, 72%) said they would prefer for their next HIV testing and counseling experience to be at home with Web-based video chat peer counseling, as opposed to testing in an office or clinic setting. Participants were less likely to report logistical and emotional barriers to HIV testing at the 6-week and 3-month follow-ups.ConclusionsThe results of this study suggest that self-administered HIV testing with Web-based peer counseling is feasible and that MSM find it to be a satisfactory means by which they can access their test results. This study can serve as a general guideline for future, larger-scale studies of Web-based HIV test counseling for MSM.