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HIV Prevention, Care, and Treatment Among Black Men Who Have Sex with Men (MSM)

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HIV in US Communities of Color

Abstract

Black men who have sex with men (MSM) have been severely affected by HIV burden in the United States. A multitude of epidemiologic, structural, and psychosocial factors has contributed to the disparate HIV incidence and prevalence rates of black MSM. The objective of this chapter is to better understand the prevention, care, and treatment considerations for black MSM. Thus, this chapter examines (1) theoretical approaches to HIV prevention with a specific focus on the role of stigma, marginalization, and structural inequalities in black MSM communities; (2) factors associated with disproportionate HIV infection rates and HIV sexual behavior in black MSM; (3) the role of primary and secondary prevention in black MSM communities; (4) culturally congruent treatment and care in black MSM communities; and (5) psychosocial support and mental health needs in black MSM communities.

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References

  1. Millett GA, Jeffries WL, Peterson JL, et al. Common roots: a contextual review of HIV epidemics in black men who have sex with men across the African diaspora. Lancet (London, England). 2012;380:411–23.

    Article  Google Scholar 

  2. Millett GA, Peterson JL, Flores SA, et al. Comparisons of disparities and risks of HIV infection in black and other men who have sex with men in Canada, UK, and USA: a meta-analysis. Lancet (London, England). 2012;380:341–8.

    Article  Google Scholar 

  3. Pathela P, Jamison K, Braunstein SL, Schillinger JA, Varma JK, Blank S. Incidence and predictors of HIV infection among men who have sex with men attending public sexually transmitted disease clinics, New York City, 2007-2012. AIDS Behav. 2017;21:1444–51.

    Article  PubMed  Google Scholar 

  4. Singh S, Song R, Johnson AS, McCray E, Hall HI. HIV incidence, prevalence, and undiagnosed infections in U.S. men who have sex with men. Ann Intern Med. 2018;168:685–94.

    Article  PubMed  Google Scholar 

  5. Mannheimer SB, Wang L, Wilton L, et al. Infrequent HIV testing and late HIV diagnosis are common among a cohort of black men who have sex with men in 6 US cities. J Acquir Immune Defic Syndr (1999). 2014;67:438–45.

    Article  Google Scholar 

  6. Mayer KH, Wang L, Koblin B, et al. Concomitant socioeconomic, behavioral, and biological factors associated with the disproportionate HIV infection burden among Black men who have sex with men in 6 U.S. cities. PLoS One. 2014;9:e87298.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  7. Adekeye OA, Adesuyi BF, Takon JG. Barriers to healthcare among African immigrants in Georgia, USA. J Immigr Minor Health. 2018;20:188–93.

    Article  PubMed  Google Scholar 

  8. Bogart LM, Wagner GJ, Galvan FH, Landrine H, Klein DJ, Sticklor LA. Perceived discrimination and mental health symptoms among black men with HIV. Cultur Divers Ethnic Minor Psychol. 2011;17:295–302.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Brewer RA, Magnus M, Kuo I, Wang L, Liu TY, Mayer KH. Exploring the relationship between incarceration and HIV among black men who have sex with men in the United States. J Acquir Immune Defic Syndr (1999). 2014;65:218–25.

    Article  Google Scholar 

  10. Cahill S, Taylor SW, Elsesser SA, Mena L, Hickson D, Mayer KH. Stigma, medical mistrust, and perceived racism may affect PrEP awareness and uptake in black compared to white gay and bisexual men in Jackson, Mississippi and Boston, Massachusetts. AIDS Care. 2017;29:1351–8.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Eaton LA, Earnshaw VA, Maksut JL, Thorson KR, Watson RJ, Bauermeister JA. Experiences of stigma and health care engagement among Black MSM newly diagnosed with HIV/STI. J Behav Med. 2018;41:458.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Irvin R, Wilton L, Scott H, et al. A study of perceived racial discrimination in black men who have sex with men (MSM) and its association with healthcare utilization and HIV testing. AIDS Behav. 2014;18:1272–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Lassiter JM. Extracting dirt from water: a strengths-based approach to religion for African American same-gender-loving men. J Relig Health. 2014;53:178–89.

    Article  PubMed  Google Scholar 

  14. Levy ME, Wilton L, Phillips G 2nd, et al. Understanding structural barriers to accessing HIV testing and prevention services among black men who have sex with men (BMSM) in the United States. AIDS Behav. 2014;18:972–96.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Mena L, Crosby RA, Geter A. A novel measure of poverty and its association with elevated sexual risk behavior among young black MSM. Int J STD AIDS. 2017;28:602–7.

    Article  PubMed  Google Scholar 

  16. Miller RL Jr. Legacy denied: African American gay men, AIDS, and the black church. Soc Work. 2007;52:51–61.

    Article  PubMed  Google Scholar 

  17. Nelson LE, Wilton L, Moineddin R, et al. Economic, legal, and social hardships associated with HIV risk among black men who have sex with men in six US cities. J Urban Health. 2016;93:170–88.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Bowleg L, Del Rio-Gonzalez AM, Holt SL, et al. Intersectional epistemologies of ignorance: how behavioral and social science research shapes what we know, think we know, and don’t know about U.S. black men’s sexualities. J Sex Res. 2017;54:577–603.

    Article  PubMed  Google Scholar 

  19. Cohen CJ. The boundaries of blackness: AIDS and the breakdown of black politics. Chicago: University of Chicago Press; 1999.

    Book  Google Scholar 

  20. Bowleg L. Towards a critical health equity research stance: why epistemology and methodology matter more than qualitative methods. Health Educ Behav. 2017;44:677–84.

    Article  PubMed  Google Scholar 

  21. Mullings L, Schulz A. Intersectionality and health: an introduction. New York: Wiley; 2005.

    Google Scholar 

  22. Smedley A, Smedley BD. Race as biology is fiction, racism as a social problem is real: anthropological and historical perspectives on the social construction of race. Am Psychol. 2005;60:16–26.

    Article  PubMed  Google Scholar 

  23. Williams DR, Lawrence J, Davis B. Racism and health: Evidence and needed research. Annu Rev Public Health. 2019; 40:105–125.

    Google Scholar 

  24. Paradies Y, Ben J, Denson N, et al. Racism as a determinant of health: a systematic review and meta-analysis. PLoS One. 2015;10:e0138511.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  25. Williams DR, Cooper LA. Reducing racial inequities in health: using what we already know to take action. Int J Environ Res Public Health. 2019;16:606.

    Article  PubMed Central  Google Scholar 

  26. Bailey M, Mobley IA, Charles N, et al. Open letter to editors of Journal of the National Medical Association from the black feminist health science studies collective. J Natl Med Assoc. 2019;111:573.

    PubMed  Google Scholar 

  27. Thomas SB, Quinn SC. The Tuskegee Syphilis Study, 1932 to 1972: implications for HIV education and AIDS risk education programs in the black community. Am J Public Health. 1991;81:1498–505.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Bogart LM, Dale SK, Christian J, et al. Coping with discrimination among HIV-positive black men who have sex with men. Cult Health Sex. 2017;19:723–37.

    Article  PubMed  Google Scholar 

  29. Magnus M, Franks J, Griffith S, Arnold MP, Goodman K, Wheeler DP. Engaging, recruiting, and retaining black men who have sex with men in research studies: don't underestimate the importance of staffing--lessons learned from HPTN 061, the BROTHERS study. J Public Health Manag Pract. 2014;20:E1–9.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Schulz AJ, Freudenberg N, Daniels J. Intersections of race, class, and gender in public health interventions. In AJ Schulz & L Mullings (Eds.), Gender, race, class, and health: Intersectional approaches. New York: John Wiley & Sons, Inc. 2005;371–93.

    Google Scholar 

  31. Arnold EA, Bailey MM. Constructing home and family: how the ballroom community supports African American GLBTQ youth in the face of HIV/AIDS. J Gay Lesbian Soc Serv. 2009;21:171–88.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Wong JO, Benjamin M, Arnold EA. ‘I want the heart of fierceness to arise within us’: maintaining public space to promote HIV-related health with House Ball Community members in an era of gentrification. Cult Health Sex. 2019;22:444.

    Article  PubMed  Google Scholar 

  33. Ayala G, Bingham T, Kim J, Wheeler DP, Millett GA. Modeling the impact of social discrimination and financial hardship on the sexual risk of HIV among Latino and black men who have sex with men. Am J Public Health. 2012;102(Suppl 2):S242–9.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Choi KH, Han CS, Paul J, Ayala G. Strategies for managing racism and homophobia among U.S. ethnic and racial minority men who have sex with men. AIDS Educ Prev. 2011;23:145–58.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Han CS, Ayala G, Paul JP, Boylan R, Gregorich SE, Choi KH. Stress and coping with racism and their role in sexual risk for HIV among African American, Asian/Pacific islander, and Latino men who have sex with men. Arch Sex Behav. 2015;44:411–20.

    Article  PubMed  Google Scholar 

  36. Rolle CP, Rosenberg ES, Luisi N, et al. Willingness to use pre-exposure prophylaxis among black and white men who have sex with men in Atlanta, Georgia. Int J STD AIDS. 2017;28:849–57.

    Article  PubMed  Google Scholar 

  37. Liu AY, Vittinghoff E, von Felten P, et al. Randomized controlled trial of a mobile health intervention to promote retention and adherence to pre-exposure prophylaxis among young people at risk for human immunodeficiency virus: the EPIC study. Clin Infect Dis. 2018;68:2010.

    Article  PubMed Central  CAS  Google Scholar 

  38. Wheeler DP, Lucas J, Wilton L, et al. Building effective multilevel HIV prevention partnerships with Black men who have sex with men: experience from HPTN 073, a pre-exposure prophylaxis study in three US cities. J Int AIDS Soc. 2018;21(Suppl 7):e25180.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Wheeler DP, Fields SD, Beauchamp G, et al. Pre-exposure prophylaxis initiation and adherence among black men who have sex with men (MSM) in three US cities: results from the HPTN 073 study. J Int AIDS Soc. 2019;22:e25223.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  40. Eisinger RW, Dieffenbach CW, Fauci AS. HIV viral load and transmissibility of HIV infection: undetectable equals untransmittable. JAMA. 2019;321:451–2.

    Article  PubMed  Google Scholar 

  41. Hightow-Weidman L, LeGrand S, Choi SK, Egger J, Hurt CB, Muessig KE. Exploring the HIV continuum of care among young black MSM. PLoS One. 2017;12:e0179688.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  42. Chandler CJ, Sang JM, Bukowski LA, et al. Characterizing the HIV care continuum among a community sample of black men who have sex with men in the United States. AIDS Care. 2019;31:816–20.

    Article  PubMed  Google Scholar 

  43. Clement ME, Johnston BE, Eagle C, et al. Advancing the HIV pre-exposure prophylaxis continuum: a collaboration between a Public Health Department and a Federally Qualified Health Center in the Southern United States. AIDS Patient Care STDs. 2019;33:366.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Friedman MR, Sang JM, Bukowski LA, et al. HIV care continuum disparities among black bisexual men and the mediating effect of psychosocial comorbidities. J Acquir Immune Defic Syndr (1999). 2018;77:451–8.

    Article  Google Scholar 

  45. Nelson LE, McMahon JM, Leblanc NM, et al. Advancing the case for nurse practitioner-based models to accelerate scale-up of HIV pre-exposure prophylaxis. J Clin Nurs. 2019;28:351–61.

    Article  PubMed  Google Scholar 

  46. Poteat T, White J, van Griensven F. The HIV care continuum in black MSM in the USA. The Lancet HIV. 2014;1:e97–8.

    Article  PubMed  Google Scholar 

  47. Irvin R, Vallabhaneni S, Scott H, et al. Examining levels of risk behaviors among black men who have sex with men (MSM) and the association with HIV acquisition. PLoS One. 2015;10:e0118281.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  48. Duncan DT, Hickson DA, Goedel WC, et al. The social context of HIV prevention and care among black men who have sex with men in three U.S. cities: the neighborhoods and networks (N2) cohort study. Int J Environ Res Public Health. 2019;16:E1922.

    Article  PubMed  Google Scholar 

  49. Duncan DT, Park SH, Hambrick HR, et al. Characterizing geosocial-networking app use among young black men who have sex with men: a multi-city cross-sectional survey in the southern United States. JMIR Mhealth Uhealth. 2018;6:e10316.

    Article  PubMed  PubMed Central  Google Scholar 

  50. Franks J, Hirsch-Moverman Y, Loquere AS Jr, et al. Sex, PrEP, and stigma: experiences with HIV pre-exposure prophylaxis among New York City MSM participating in the HPTN 067/ADAPT study. AIDS Behav. 2018;22:1139–49.

    Article  PubMed  Google Scholar 

  51. Williams JK, Wilton L, Magnus M, et al. Relation of childhood sexual abuse, intimate partner violence, and depression to risk factors for HIV among black men who have sex with men in 6 US cities. Am J Public Health. 2015;105:2473–81.

    Article  PubMed  PubMed Central  Google Scholar 

  52. Hotton A, Quinn K, Schneider J, Voisin D. Exposure to community violence and substance use among black men who have sex with men: examining the role of psychological distress and criminal justice involvement. AIDS Care. 2018;31:1–9.

    Google Scholar 

  53. Fields SD, Malebranche D, Feist-Price S. Childhood sexual abuse in black men who have sex with men: results from three qualitative studies. Cultur Divers Ethnic Minor Psychol. 2008;14:385–90.

    Article  PubMed  Google Scholar 

  54. Wilton L, Koblin B, Nandi V, et al. Correlates of Seroadaptation strategies among black men who have sex with men (MSM) in 4 US cities. AIDS Behav. 2015;19:2333–46.

    Article  PubMed  PubMed Central  Google Scholar 

  55. Dyer TP, Regan R, Wilton L, et al. Differences in substance use, psychosocial characteristics and HIV-related sexual risk behavior between black men who have sex with men only (BMSMO) and black men who have sex with men and women (BMSMW) in six US cities. J Urban Health. 2013;90:1181–93.

    Article  PubMed  PubMed Central  Google Scholar 

  56. Dyer TV, Khan MR, Regan R, et al. Differential patterns of risk and vulnerability suggest the need for novel prevention strategies for black bisexual men in the HPTN 061 study. J Acquir Immune Defic Syndr (1999). 2018;78:491–8.

    Article  Google Scholar 

  57. Dyer TV, Khan MR, Sandoval M, et al. Drug use and sexual HIV transmission risk among men who have sex with men and women (MSMW), men who have sex with men only (MSMO), and men who have sex with women only (MSWO) and the female partners of MSMW and MSWO: a network perspective. AIDS Behav. 2017;21:3590–8.

    Article  PubMed  PubMed Central  Google Scholar 

  58. Wilton L. Correlates of substance use in relation to sexual behavior in black gay and bisexual men: implications for HIV prevention. J Black Psychol. 2008;34:70–93.

    Article  Google Scholar 

  59. Harris OO. Survival now versus survival later: immediate and delayed HIV risk assessment among young Jamaican men who have transactional sex with men. Cult Health Sex. 2018;21:1–15.

    Google Scholar 

  60. Ojikutu BO, Bogart LM, Mayer KH, Stopka TJ, Sullivan PS, Ransome Y. Spatial access and willingness to use pre-exposure prophylaxis among black/African American individuals in the United States: cross-sectional survey. JMIR Public Health Surveill. 2019;5:e12405.

    Article  PubMed  PubMed Central  Google Scholar 

  61. Ojikutu BO, Mazzola E, Fullem A, et al. HIV testing among black and Hispanic immigrants in the United States. AIDS Patient Care STDs. 2016;30:307–14.

    Article  PubMed  PubMed Central  Google Scholar 

  62. Rodriguez MM, Madera SR, Diaz NV. Stigma and homophobia: persistent challenges for HIV prevention among young MSM in Puerto Rico. Rev Let Cienc. 2013;26:50–9.

    Google Scholar 

  63. Malebranche DJ, Gvetadze R, Millett GA, Sutton MY. The relationship between gender role conflict and condom use among black MSM. AIDS Behav. 2012;16:2051–61.

    Article  PubMed  Google Scholar 

  64. Wilton L. Characteristics and correlates of lifetime suicidal thoughts and attempts among young black men who have sex with men (MSM) and transgender women. J Black Psychol. 2018;4:273–90.

    Article  Google Scholar 

  65. Services USDoHaH. Mental health: culture, race, and ethnicity—a supplement to mental health: a report of the surgeon general. Rockville: US Department of Health and Human Services; 2001.

    Google Scholar 

  66. Sun CJ, Nall JL, Rhodes SD. Perceptions of needs, assets, and priorities among black men who have sex with men with HIV: community-driven actions and impacts of a participatory photovoice process. Am J Mens Health. 2019;13:1557988318804901.

    PubMed  Google Scholar 

  67. Mays VM, Jones AL, Cochran SD, Taylor RJ, Rafferty J, Jackson JS. Chronicity and mental health service utilization for anxiety, mood, and substance use disorders among black men in the United States; ethnicity and nativity differences. Basel: Healthcare; 2018. p. 6.

    Google Scholar 

  68. Malebranche DJ, Peterson JL, Fullilove RE, Stackhouse RW. Race and sexual identity: perceptions about medical culture and healthcare among black men who have sex with men. J Natl Med Assoc. 2004;96:97–107.

    PubMed  PubMed Central  Google Scholar 

  69. Wheeler DP. Exploring HIV prevention needs for nongay-identified black and African American men who have sex with men: a qualitative exploration. Sex Transm Dis. 2006;33:S11–6.

    Article  PubMed  Google Scholar 

  70. Williams JK, Wyatt GE, Rivkin I, Ramamurthi HC, Li X, Liu H. Risk reduction for HIV-positive African American and Latino men with histories of childhood sexual abuse. Arch Sex Behav. 2008;37:763–72.

    Article  PubMed  PubMed Central  Google Scholar 

  71. Meyer IH. Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: conceptual issues and research evidence. Psychol Bull. 2003;129:674–97.

    Article  PubMed  PubMed Central  Google Scholar 

  72. la Roi C, Meyer IH, Frost DM. Differences in sexual identity dimensions between bisexual and other sexual minority individuals: implications for minority stress and mental health. Am J Orthopsychiatry. 2019;89:40–51.

    Article  PubMed  Google Scholar 

  73. Meyer IH. Identity, stress, and resilience in lesbians, gay men, and bisexuals of color. Couns Psychol. 2010;38:1–9.

    Google Scholar 

  74. Meyer IH. Does an improved social environment for sexual and gender minorities have implications for a new minority stress research agenda? Psychol Sex Rev. 2016;7:81–90.

    PubMed  PubMed Central  Google Scholar 

  75. Choi KH, Paul J, Ayala G, Boylan R, Gregorich SE. Experiences of discrimination and their impact on the mental health among African American, Asian and Pacific islander, and Latino men who have sex with men. Am J Public Health. 2013;103:868–74.

    Article  PubMed  PubMed Central  Google Scholar 

  76. Sang JM, Matthews DD, Meanley SP, Eaton LA, Stall RD. Assessing HIV stigma on prevention strategies for black men who have sex with men in the United States. AIDS Behav. 2018;22(12):3879–86.

    Article  PubMed  Google Scholar 

  77. Wheeler DP. Working with positive men: HIV prevention with black men who have sex with men. AIDS Educ Prev. 2005;17:102–15.

    Article  PubMed  Google Scholar 

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Wilton, L. (2021). HIV Prevention, Care, and Treatment Among Black Men Who Have Sex with Men (MSM). In: Ojikutu, B., Stone, V. (eds) HIV in US Communities of Color. Springer, Cham. https://doi.org/10.1007/978-3-030-48744-7_4

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