Contributions of Qualitative Research in Informing HIV/AIDS Interventions Targeting Black MSM in the United States

Abstract

This article presents a systematic review of qualitative studies focusing on the Human Immunodeficiency Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS) among Black men who have sex with men (BMSM) in the United States. We reviewed studies that were published between 1980-2014. Qualitative methods employed in the studies reviewed include: in-depth interviews, focus groups, participant observation, and ethnography. We searched the following databases: PubMed, PsychINFO, JSTOR, ERIC, Sociological Abstracts, and Google Scholar for relevant articles using the following broad terms: “Black men” and/or “BMSM,” and “qualitative” and/or “ethnography.” Seventy studies were included in this review. The key themes observed across studies were: (1) heterogeneity, (2) layered stigma and intersectionality, (3) risk behaviors, (4) mental health, (5) resilience, and (6) community engagement. The review suggests that sexual behavior and HIV-status disclosure, sexual risk-taking, substance use, and psychological well-being were contextually situated. Interventions occurring at multiple levels and within multiple contexts are needed to reduce stigma within the Black community. Similarly, structural interventions targeting religious groups, schools, and health care systems are needed to improve the health outcomes among BMSM. Community engagement and using community-based participatory research methods may facilitate the development and implementation of culturally appropriate HIV/AIDS interventions targeting BMSM.

The Intersection of Sociocultural Factors and Health-Related Behavior in Lesbian, Gay, Bisexual, and Transgender Youth

“…Qualitative studies of YBGBM and adult Black MSM have consistently described internalization of homo-negative messages among study participants, the negative impact on psychological well-being, and the mechanism by which these ill effects can lead to increased HIV risk [30, 74]. …”

“…Black gay, bisexual and other men who have sex with men often describe social isolation and lack of social support from Black communities and, in qualitative studies, have consistently reported the absence of organized communities and opportunities to connect with and support one another, citing homophobia and secrecy around same-sex behaviors as contributing factors [74]. …”

“It's Almost Like a Crab-in-a-Barrel Situation”: Stigma, Social Support, and Engagement in Care Among Black Men Living With HIV

“…Similarly, Black men living with HIV may experience racism outside the Black community (Hirschfield & Piquero, 2010), which can be associated with ART nonadherence among Black PLWH (Bogart et al, 2015). Black gay, bisexual, and other MSM may experience social isolation and lack of social support from Black communities and consistently report the absence of organized communities and opportunities to connect with one another (Fields, Morgan, & Sanders, 2016; P. A. Wilson et al, 2016b).…”

‘Ballroom itself can either make you or break you’ – Black GBT Youths’ psychosocial development in the House Ball Community

“…These experiences of alienation and/or rejection of Black GBT youths’ sexuality or perceived femininity often come from multiple sources, including family and peer groups, the religious communities to which they belong, and the health care institutions they access (Wilson, Valera, Martos, et al 2015). Dickson-Gomez and colleagues (2014) conducted a qualitative study on constructed families among BMSM and found that many BMSM formed alternative family relationships with friends or in “houses” due to the biological families’ rejection of their sexual behaviour and/or identity.…”

“…For example, a study examining experiences of marginalization and migration amongst gay male adolescents living with HIV found that several youth reported loss of childhood friends (Bruce & Harper & ATN, 2011). Furthermore, there is growing body of research which suggests that such experiences are mutually occurring and interact with the developmental experiences of gay male adolescents to produce health disparities related to sexual behaviour and HIV status disclosure, sexual risk taking, substance use, and psychological well-being (Wilson et al, 2015; Bruce, Harper, & ATN, 2011). Efforts therefore need to focus on a new way of understanding and working with such adolescents in the context of larger systems (Lerner & Galambos, 1998), outside of the traditional individual and family units.…”