Aspects of masculine socialization among Black men who have sex with men (MSM) and potential corresponding influences on high-risk sexual behaviors are explored in this study. Individual interviews were conducted with 29 Black MSM in Atlanta, Georgia. Findings included (1) formative masculine socialization experiences marked by an absence of biological fathers and Black male role models, (2) negative perceptions of “gay” identities and communities, (3) race and racial identification as intersecting influences on masculine and sexual identities, (4) the influences of masculine socialization and beliefs on partner selection and sexual behaviors, and (5) general themes of trust, control, “heat of the moment” sex, and low self-love as primary factors influencing condom use. Implications for future research and HIV prevention efforts targeting Black MSM are discussed.

Objectives. We explored gender role strain (GRS) arising from conflict between homosexuality and cultural conceptions of masculinity among young Black men who have sex with men (MSM). Methods. We conducted a categorical analysis (a qualitative, 3-stage, iterative analysis) of data from studies conducted in 2001 to 2006, which interviewed 35 men aged 18 to 24 years in 3 New York cities and Atlanta, Georgia. Results. Participants described rigid, often antihomosexual expectations of masculinity from their families, peers, and communities. Consistent with GRS, this conflict and pressure to conform to these expectations despite their homosexuality led to psychological distress, efforts to camouflage their homosexuality, and strategies to prove their masculinity. Participants believed this conflict and the associated experience of GRS might increase HIV risk through social isolation, poor self-esteem, reduced access to HIV prevention messages, and limited parental-family involvement in sexuality development and early sexual decision-making. Conclusions. Antihomosexual expectations of masculinity isolate young Black MSM during a developmental stage when interpersonal attachments are critical. GRS may influence sexual risk behavior and HIV risk and be an important target for HIV prevention.

Purpose Young Black men who have sex with men (MSM) have among the highest rates of HIV infection in the US. Although reported rates of unprotected anal intercourse are similar to MSM of other racial/ethnic backgrounds, young Black MSM (YBMSM) aged 15–22 are 5 times more likely than comparably aged white MSM to be HIV-infected. We explored contextual social-environmental factors that may influence how YBMSM assess risk, choose partners, and make decisions about condom use. Methods We analyzed semi-structured interviews with 35 YBMSM (18–24) in New York City, upstate NY, and Atlanta. We used structured analytic coding based on a theoretical scheme that emerged from the data. Results Perception of masculinity was the primary contextual factor influencing partner selection, risk assessment, and condom decision-making. Four primary themes emerged: 1) greater preference for partners perceived as masculine; 2) discomfort with allowing men perceived as feminine to be the insertive partner in anal intercourse; 3) a power dynamic such that partners perceived as more masculine made condom-use decisions within the dyad; and 4) use of potential partners’ perceived masculinity to assess HIV risk. Conclusions Perceived masculinity may play a significant role in HIV risk for YBMSM and may be an important concept to consider in prevention strategies directed towards this population.

Adolescents and young adults, aged 13e24 years, are disproportionately affected by HIV in the United States. Youth with HIV (YHIV) face many psychosocial and structural challenges resulting in poor clinical outcomes including lower rates of medication adherence and higher rates of uncontrolled HIV. The Johns Hopkins Intensive Primary Care clinic, a longstanding HIV care program in Baltimore, Maryland, cares for 76 YHIV (aged 13e24 years). The multidisciplinary team provides accessible, evidenced-based, culturally sensitive, coordinated and comprehensive patient and family-centered HIV primary care. However, the ability to provide these intensive, in-person services was abruptly disrupted by the necessary institutional, state, and national coronavirus disease 2019 (COVID-19) mitigation strategies. As most of our YHIV are from marginalized communities (racial/ethnic, sexual, and gender minorities) with existing health and social inequities that impede successful clinical outcomes and increase HIV disparities, there was heightened concern that COVID-19 would exacerbate these inequities and amplify the known HIV disparities. We chronicle the structural and logistic approaches that our team has taken to proactively address the social determinants of health that will be negatively impacted by the COVID-19 pandemic, while supporting YHIV to maintain medication adherence and viral suppression.

Medication adherence among youth living with HIV (28%–69%) is often insufficient for viral suppression. The psychosocial context of adherence barriers is complex. We sought to qualitatively understand adherence barriers among behaviorally infected and perinatally infected youth and develop an intervention specific to their needs. We conducted in-depth interviews with 30 youth living with HIV (aged 14–24 years) and analyzed transcripts using the constant comparative method. Barriers were influenced by clinical and psychosocial factors. Perinatally infected youth barriers included reactance, complicated regimens, HIV fatigue, and difficulty transitioning to autonomous care. Behaviorally infected youth barriers included HIV-related shame and difficulty initiating medication. Both groups reported low risk perception, medication as a reminder of HIV, and nondisclosure, but described different contexts to these common barriers. Common and unique barriers emerged for behaviorally infected and perinatally infected youth reflecting varying HIV experiences and psychosocial contexts. We developed a customizable intervention addressing identified barriers and their psychosocial antecedents.

Intersectionality is a theoretical framework that suggests that multiple social identities – e.g. race, ethnicity, gender, and sexual orientation – intersect at the individual or micro level of experience and reflects larger social-structural inequities experienced on the macro level. This article uses an intersectionality framework to describe how multiple stigmatized social identities can create unique challenges for Young Black gay and bisexual men (YBGBM) as an example. YBGBM exist at the intersection of multiple stigmatized identities compared to their majority peers. There is limited health-focused research on the intersecting identities of YBGBM. Using the lens of intersectionality to understand challenges to health-related behaviors and threats to health and well-being for YBGBM may reveal key opportunities for prevention and intervention for YBGBM and other gay and bisexual men from other ethnic groups. In this article, we examine the key intersecting identities (race, sexual identity, socioeconomic status, and cultural expectations (such as gender norms/masculinity, religious morality), that exist in YBGBM and how those factors may predispose young men to adverse health outcomes and health inequality.

Objectives HIV disproportionately affects African-American men who have sex with men (MSM). High levels of traumatic stress among African American MSM may be associated with poor health behaviors, including sexual risk, and thus may be a promising target for HIV prevention. We investigated whether one form of traumatic stress, discrimination-related trauma (e.g., physical assault due to race), was associated with unprotected anal intercourse (UAI), especially when compared to non-discrimination-related trauma, among African-American MSM. Methods A convenience sample of 131 HIV-positive African-American MSM receiving antiretroviral treatment completed audio computer-assisted-self-interviews that covered UAI; interpersonal trauma; and whether trauma was due to discrimination based on race/ethnicity, HIV-serostatus, or sexual orientation. Results 60% reported at least one interpersonal trauma; they attributed at least one trauma to being gay (47%), African-American (17%), and/or HIV-positive (9%). In a multivariate regression, experiencing discrimination-related trauma was significantly associated with UAI (AOR=2.4,95%CI=1.0-5.7,p=0.04), whereas experiencing non-discrimination-related trauma was not (AOR=1.3,95%CI=0.6-3.1,p=0.53). Conclusions HIV-positive African-American MSM experience high levels of discrimination-related trauma, a stressor that was associated with greater risk. HIV prevention interventions should consider the potential damaging effects of discrimination in the context of trauma.

Purpose: Young black gay, bisexual, and other MSM (YBMSM) that carry a disproportionate HIV burden in the US Geosocial networking applications (GSN apps) are environments that may increase HIV risk among users. This study explored the acceptability and feasibility of using these apps for HIV/sexually transmitted infection (STI) public health outreach. Design: Semi-structured in-depth qualitative interviews. Setting: A frequently reported GSN app for meeting sex partners by newly diagnosed HIV-infected MSM in Baltimore. Participants: Seventeen YBMSM aged 18 to 24 (mean = 21.5/SD = 1.8) who were logged-on to the GSN app in venues or census tracts in high HIV transmission areas. Methods: Participants completed 60 to 90 minute semi-structured interviews, which were audio-recorded and transcribed. Interview data were analyzed in NVivo10 using categorical analysis and double-coded until consistency was achieved. Results: Participants described GSN apps as acceptable and feasible resources for public health practitioners seeking to access YBMSM to provide HIV/STI treatment and prevention services and resources. Three themes emerged: (1) the need to authenticate public health messages to distinguish from spam; (2) improved access to YBMSM including opportunities to identify and access virtual congregations of youth in non-gay-related spaces; and (3) the importance of avoiding stigmatizing YBMSM when targeting sexual health messages. Conclusion: GSN apps have great potential as tools for identifying and engaging at-risk YBMSM. Additional work is needed to understand limitations of this medium, to develop strategies to engage YBMSM without further stigmatizing them, and to maximize their outreach potential.