Perceptions Towards Condom Use, Sexual Activity, and HIV Disclosure among HIV-Positive African American Men Who Have Sex with Men: Implications for Heterosexual Transmission

Abstract

Disproportionately high HIV/AIDS rates and frequent non-gay identification (NGI) among African American men who have sex with men or with both men and women (MSM/W) highlight the importance of understanding how HIV-positive African American MSM/W perceive safer sex, experience living with HIV, and decide to disclose their HIV status. Thirty predominately seropositive and non-gay identifying African American MSM/W in Los Angeles participated in three semi-structured focus group interviews, and a constant comparison method was used to analyze responses regarding condom use, sexual activity after an HIV diagnosis, and HIV serostatus disclosure. Condom use themes included its protective role against disease and pregnancy, acceptability concerns pertaining to aesthetic factors and effectiveness, and situational influences such as exchange sex, substance use, and suspicions from female partners. Themes regarding the impact of HIV on sexual activity included rejection, decreased partner seeking, and isolation. Serostatus disclosure themes included disclosure to selective partners and personal responsibility. Comprehensive HIV risk-reduction strategies that build social support networks, condom self-efficacy, communication skills, and a sense of collective responsibility among NGI African American MSM/W while addressing HIV stigma in the African American community as a whole are suggested.

Behaviorally Bisexual Men and their Risk Behaviors with Men and Women

“…[10][11][12][13][14][15] In addition, studies show that MSMW who do not disclose are less likely to use condoms with women 16 and more likely than men who have sex with women only (MSW) to engage in anal sex, a more efficient route of HIV transmission than other types of sex, 17,18 with women. 10,19 The use of illicit drugs among MSMW may further heighten their risk of transmitting or contracting HIV by facilitating high-risk sex encounters. Most of the literature regarding drug use among MSM focuses on men who openly identify as gay or bisexual.…”

Intentional Abstinence Among Homeless and Unstably Housed Persons Living with HIV/AIDS

“…Some research with HIVpositive women has also suggested that some may avoid sex due to fear of being charged with a criminal act (K. Williams and Y. Mizuno, 2008, Personal communication). In a sample of HIV-positive, bisexually active African American men, issues around ongoing sexual activity included fear of (or actually experiencing) rejection from partners or social isolation resulting from disclosing their HIV status and reduced sexual desire (Harawa et al 2006).…”

Formation of Personal HIV Disclosure Policies among HIV-Positive Men Who Have Sex with Men

“…Seropositive disclosure is often inconsistent [36][37][38][39][40][41] ; varies by partner type (with less disclosure to casual sex partners than to steady partners) 36,39,40,[42][43][44] ; is inversely related to the number of sex partners 37 ; and is less likely to occur if the sexual partner's serostatus is negative or unknown rather than positive. 45 A review of 23 empirical studies through 2004 failed to establish a consistent relationship between disclosure and safer sex.…”