“To Me, Everybody Is infected”: Understanding Narratives about HIV Risk among HIV-negative Black Men Who Have Sex with Men in the Deep South

ABSTRACT

For black MSM living in the Deep South, the intersection of sexuality, race, and geography impacts HIV risk substantially. Between July and September 2016, we conducted a qualitative study among HIV-negative black MSM in five southern cities in the US with elevated HIV prevalence. Analysis included assessment of interrater reliability, cluster analysis, and descriptive statistics. We enrolled 99 black MSM (mean age: 33.6; SD = 12.8; range: 17–68 years). Four overarching themes emerged: harboring fear of HIV and the internalization of HIV stigma; scrutinizing potential partners to assess riskiness and HIV status; embracing distance and isolation from those perceived as a threat to HIV status; and exhibiting self-efficacy toward HIV prevention and utilizing risk reduction strategies. Future HIV prevention efforts may benefit by balancing risk and deficit based strategies with those that emphasize resilience, address disenfranchisement via structural interventions, and assess and treat inherent trauma(s).

KEYWORDS:

• HIV/AIDS
• African-American
• black
• MSM
• risk reduction
• resiliency
• protective factors

Acknowledgments

The authors would like to acknowledge iQual Study staff from the Centers for Disease Control and Prevention, Research Support Services, Inc., IMPAQ International, LLC, and Emory University for their hard work and dedication on this project. We would also like to thank our collaborators in Miami, FL (Empower U, Inc., Pridelines Youth Services, Care Resource, Borinquen Medical Center, and Family AIDS Coalition, Inc.), New Orleans, LA (Brotherhood, Inc., CrescentCare Health – NO/AIDS Task Force, Tulane Drop-In Clinic for Homeless Youth, and the Louisiana Department of Health and Hospitals), Baton Rouge, LA (Baton Rouge Black Alcoholism Council Metro Health Program), Jackson, MS (My Brother’s Keeper, University of Mississippi Medical Center, Mississippi Department of Health, Crossroads Clinic, and Open Arms Healthcare Center), and Atlanta, GA (Lost-n-Found Youth, Someone Cares, Inc. SisterLove, Inc., Positive Impact Health Centers, AID Atlanta, Stand, Inc., the Phillip Rush Center, and the Greater Piney Grove Baptist Church Health Ministry) for their assistance with outreach and recruitment for this study.

Disclosure statement

No potential conflict of interest was reported by the authors.

Disclaimer

The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention

Notes

1. The Deep South is defined as a nine-state region that includes Alabama, Florida, Georgia, Louisiana, Mississippi, North Carolina, South Carolina, Tennessee, and Texas.

2. Mississippi House Bill 1523, a religious liberty bill officially known as “The Protecting Freedom of Conscience from Government Discrimination Act.”

3. I just know that living in New Orleans, we have high transmission rates. There’s a CDC study that came out. It said that in a couple years, like, half of all black, gay men are projected to be HIV positive, so it’s kind of hard from me not to just associate the two. It’s not like a moral judgment. It’s just knowing the stats.—35 years old, New Orleans, LA.

Additional information

Funding

Centers for Disease Control and Prevention contract to Research Support Services, Inc.: [200-2013-57341-2].