A Qualitative Study: The Journey to Self-Acceptance of Sexual Identity among Young, Black MSM in the South

Abstract

HIV disparities among Young, Black men who have sex with men (YBMSM) persist despite concerted efforts to increase uptake of prevention tools like HIV pre-exposure prophylaxis (PrEP). We conducted in-depth interviews with 25 YBMSM (aged 18-29 years old) to understand factors contributing to PrEP access in Birmingham, Alabama. We identified that one major barrier to PrEP uptake was intersectional stigma related to their multiple identities and contributed to lack of feeling able to accept their sexual identities. Facilitators of validation and acceptance of sexual identity were strong social support networks, which participants reported consisted of, not only other gay and bisexual Black men, but also Black women, an unexplored social support group among YBMSM networks. However, participants felt that internal, perceived and experienced homophobia were exacerbated in Southern, Black communities due to perceived values surrounding masculinity, which were reinforced by religious doctrine. Looking forward, public health officials will need to add additional resources to support interventions that have meso-level impact to effectively change social norms as a critical determinant of individual-level prevention practices within this at-risk group and their social networks.

Keywords:

• HIV
• prexposure prophylaxis
• sexual identity

Conflicts of interests

Latesha Elopre is currently a consulted on the following continuing medication activities: “Building HIV Treatment Capacity in the Family Medicine Clinic,” provided by the North Carolina Academy of Family Physicians and Med-IQ, sponsored by Gilead as well as the Clinical Care Options’ HIV Now Program, entitled “Overcoming Barriers to PrEP Uptake in the United States” also funded by Gilead.

Acknowledgements

The authors gratefully acknowledge the staff of the University of Alabama at Birmingham’s Research and Informatics Service Center for their valuable assistance with study recruitment and especially thank Eddie Jackson and Tammy Thomas for conducting interviews. We also would like to acknowledge AIDS Alabama and Birmingham AIDS Outreach for their help with development of key study materials and aid in recruitment.

Additional information

Funding

This study was funded by the University of Alabama at Birmingham’s Center for AIDS Research P30 AI027767. Latesha Elopre is currently funded through NIH/NIMH 1K23MH112417-01 and the Robert Wood Johnson Harold Amos fellowship.