Reconciling Epidemiology and Social Justice in the Public Health Discourse Around the Sexual Networks of Black Men Who Have Sex With Men

Several studies have implicated the sexual networks of Black men who have sex with men (MSM) as facilitating disproportionally high rates of new HIV infections within this community. Although structural disparities place these networks at heightened risk for infection, HIV prevention science continues to describe networks as the cause for HIV disparities, rather than an effect of structures that pattern infection. We explore the historical relationship between public health and Black MSM, arguing that the current articulation of Black MSM networks is too often incomplete and counterproductive. Public health can offer a counternarrative that reconciles epidemiology with the social justice that informs our discipline, and that is required for an effective response to the epidemic among Black MSM

Sexual Scripts and Sexual Risk Behaviors Among Black Heterosexual Men: Development of the Sexual Scripts Scale

Sexual scripts are widely shared gender and culture-specific guides for sexual behavior with important implications for HIV prevention. Although several qualitative studies document how sexual scripts may influence sexual risk behaviors, quantitative investigations of sexual scripts in the context of sexual risk are rare. This mixed methods study involved the qualitative development and quantitative testing of the Sexual Scripts Scale (SSS). Study 1 included qualitative semi-structured interviews with 30 Black heterosexual men about sexual experiences with main and casual sex partners to develop the SSS. Study 2 included a quantitative test of the SSS with 526 predominantly low-income Black heterosexual men. A factor analysis of the SSS resulted in a 34-item, seven-factor solution that explained 68% of the variance. The subscales and coefficient alphas were: Romantic Intimacy Scripts (α = .86), Condom Scripts (α = .82), Alcohol Scripts (α = .83), Sexual Initiation Scripts (α = .79), Media Sexual Socialization Scripts (α = .84), Marijuana Scripts (α = .85), and Sexual Experimentation Scripts (α = .84). Among men who reported a main partner (n = 401), higher Alcohol Scripts, Media Sexual Socialization Scripts, and Marijuana Scripts scores, and lower Condom Scripts scores were related to more sexual risk behavior. Among men who reported at least one casual partner (n = 238), higher Romantic Intimacy Scripts, Sexual Initiation Scripts, and Media Sexual Socialization Scripts, and lower Condom Scripts scores were related to higher sexual risk. The SSS may have considerable utility for future research on Black heterosexual men’s HIV risk

Black Men who Have Sex with Men and the HIV Epidemic: Next Steps for Public Health

Black men who have sex with men (BMSM) are disproportionately affected by HIV/AIDS in the United States. The Young Men's Survey estimates an HIV incidence rate of 14.7% among BMSM in 6 US cities, compared with 2.5% and 3.5% among White and Hispanic men who have sex with men (MSM), respectively.[1] Yet the disparity is not explained by higher rates of unprotected anal and oral sex. There are 4 possible explanations, which are not mutually exclusive: (1) bias in assessment of risk behaviors, (2) increased prevalence of HIV among sexual contacts, (3) increased infectiousness among sexual partners, and (4) increased physiological susceptibility to HIV. By exploring these possibilities more deeply, we can increase our understanding of the apparent disparity between behavioral risks and outcomes while at the same time improving the design and implementation of prevention programs that address the specific needs of BMSM.https://ajph.aphapublications.org/doi/full/10.2105/AJPH.93.6.86

Black Men who Have Sex with Men and the HIV Epidemic: Next Steps for Public Health (Editorial)

Black men who have sex with men (BMSM) are disproportionately affected by HIV/AIDS in the United States. The Young Men's Survey estimates an HIV incidence rate of 14.7% among BMSM in 6 US cities, compared with 2.5% and 3.5% among White and Hispanic men who have sex with men (MSM), respectively.[1] Yet the disparity is not explained by higher rates of unprotected anal and oral sex. There are 4 possible explanations, which are not mutually exclusive: (1) bias in assessment of risk behaviors, (2) increased prevalence of HIV among sexual contacts, (3) increased infectiousness among sexual partners, and (4) increased physiological susceptibility to HIV. By exploring these possibilities more deeply, we can increase our understanding of the apparent disparity between behavioral risks and outcomes while at the same time improving the design and implementation of prevention programs that address the specific needs of BMSM.https://ajph.aphapublications.org/doi/full/10.2105/AJPH.93.6.86

“It's an Uphill Battle Everyday”: Intersectionality, Low-Income Black Heterosexual Men, and Implications for HIV Prevention Research and Interventions

This interview study, the initial qualitative phase of a larger mixed methods HIV prevention study focused on Black heterosexual men, used intersectionality as a theoretical framework to explore: (1) How a sample of Black heterosexual men describe and experience the multiple intersections of race, gender, and SES; and (2) How these descriptions reflected interlocking systems of social inequality for Black men at the social-structural level. Participants were 30 predominantly low-income self-identified Black heterosexual men between the ages of 18 and 44. Analyses highlighted four themes that demonstrate how participants' individual-level experiences as Black men reflect macro social-structural inequality: (1) racial discrimination and microaggressions; (2) unemployment; (3) incarceration; and (4) police surveillance and harassment. We discuss the study's findings within the context of social-structural factors that disproportionately and adversely impact Black men. We also highlight the implications of the intersectionality perspective for HIV prevention research and interventions for Black heterosexual men

Racial discrimination, social support, and sexual HIV risk among Black heterosexual men

Numerous studies document the adverse impact of racial discrimination on African Americans’ health outcomes, but few have focused on HIV risk. We examined the relationship between racial discrimination and sexual risk in a sample of 526 Black heterosexual men and tested the hypothesis that social support would moderate this relationship. Participants in the predominantly low-income urban sample ranged in age from 18 to 45. High social support had a buffering impact on the relationship between racial discrimination and sexual risk. Among men reporting high racial discrimination, those with more social support reported less sexual risk than men with low social support. Men who reported high racial discrimination and low social support reported more sexual risk than men in any of the other groups. The study highlights social support as an important but understudied protective factor that may reduce sexual risk for Black heterosexual men who report high levels of racial discrimination

Neighborhood Context and Black Heterosexual Men’s Sexual HIV Risk Behaviors

The effects of neighborhood context on sexual risk behavior are understudied, particularly for Black heterosexual men who do not inject drugs or report heavy drug use. Evidence of a generalized HIV epidemic (>1 %) among Black heterosexuals in low-income urban U.S. communities underscores the importance of examining the effects of neighborhood context on Black heterosexual men's sexual risk, however. We used structural equation modeling to test the pathways between neighborhood context (neighborhood disorder, personal violence, neighborhood threats), depression, substance use, and sexual risk behavior. Participants were 526 self-identified Black heterosexual men, ages 18-45, recruited via randomized venue-based probability sampling in Philadelphia, PA. Analyses of model fit statistics from Mplus indicated statistically significant direct pathways between neighborhood context, depression, substance use, and sexual risk behavior. The total indirect effect of neighborhood context on sexual risk behavior through substance use was also significant. The study's results highlight a need for more research on neighborhood context and sexual HIV risk, and for multilevel interventions to address the effects of negative neighborhood context on Black heterosexual men's sexual HIV risk