HIV Among Black Men Who Have Sex with Men (MSM) in the United States: A Review of the Literature

Abstract

In 2006, Millett published a seminal literature review that examined 12 hypotheses to explain the high rates of HIV among black MSM. This paper augments Millett's article by reviewing the recent literature on behavioral, biomedical, structural, social contextual, psychosocial, and social network factors that affect HIV rates among black MSM. We searched three databases: PubMed, Scopus, and Google Scholar. First we searched all articles that included black or African American and MSM and HIV. We then searched the following terms for each area: behavioral (drug use during sex, crack cocaine use, and serosorting); biomedical (circumcision, STDs, and STIs); structural (access to care, HIV care, ART, HAART, patient-provider communication, HIV quality of care); social contextual (stigma, discrimination, internalized homophobia, internalized heterosexism, medical mistrust, social isolation, and incarceration); psychosocial (peer support and mental health); and social network (sexual mixing, partner characteristics, and social networks) factors. We identified 39 articles to include in this review. We found inconclusive evidence that incarceration, stigma, discrimination, social isolation, mental health disparities, or social networks explain the elevated rates of HIV among black MSM. We found evidence that the differences in rates of HIV between black and white MSM may be explained by differences in STIs, undiagnosed seropositivity, access to care and treatment services, and use of HAART. There is an overwhelming need for HIV testing, linkage to care, retention in care, and adherence programs for black MSM.

Development of Year 2020 Goals for the National HIV/AIDS Strategy for the United States

“…Further, we did not construct a similar health disparities goal for unprotected serodiscordant risk behavior both because of measurement challenges as well as indications that for at least some populations there is no evidence of subpopulation differences (e.g., there seems to be little difference in levels of risk behavior among white and black gay men) [20,21].…”

Syndemic Health Disparities and Resilience Processes Related to HIV Transmission Risk among African American/Black Men in South Florida

“…Research shows the negative impact of poverty, racism, and homophobia on health among minority MSM (Díaz et al 2008;Maulsby et al 2014). Others have noted that…”

“…In addition, African American/Black MSM are more likely than other races/ethnicities to be behaviorally bisexual, non-gay identified, and less likely to disclose their sexual orientation and are more likely to be exposed to heterosexist community, family, and religious norms (Balaji, et al 2012;Maulsby, et al 2014;Millett et al 2005). As described in Díaz, Peterson, and Choi (2008), a large body of literature documents structural homophobia within African American communities.…”

“…For these reasons, many African American/Black MSM feel they are unable to disclose their sexual orientation . Such feelings also impact health and medical care, as minority MSM are less likely to disclose samesex behaviors to health care providers (Maulsby et al 2014).…”

“…Thus, the strong presence of African American churches and the significant involvement in them by many African American families have a negative effect on African American/Black MSM mental health and access to support (Miller 2013;Peterson and Jones 2009). Among African American/Black MSM, the lack of social support is associated with experiences of discrimination, financial hardship, and participation in risky sexual situations (Ayala et al 2012), while the presence of social support is associated with reduced substance use and sexual risk behavior (Lauby et al 2012;Maulsby et al 2014). …”