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

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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.

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Acknowledgements

This study was funded by Universitywide AIDS Research Program (AL04-CDREW-840) and the UCLA-Drew Project Export (NIH 1P20MD001148-01). The authors would like to thank the collaborating community-based organizations and their staff members for input into the study design, assistance with recruitment, and use of their facilities. These include The AmASSI Health and Cultural Center (Cleo Manago), JWCH Institute, Inc. (Sergio Avina), and Palms Residential Care Facility (Tony Wafford and Kevin Pickett). We also acknowledge William Cunningham, MD, MPH, of UCLA for his input into the development of the proposal and study designdesign and Siri Sat Nam for facilitating the focus groups.

Institutional Review Board approval was received from the University of California, Los Angeles. Office for the Protection of Research Subjects.

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Correspondence to John K. Williams MD.

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Harawa is with the Charles B. Drew University of Medicine and Sciences, University of California, Los Angeles, CA, USA. Williams is with the Semel Institute of Neuroscience & Human Behavior, Suite C8-871C, 760 Westwood Plaza, Los Angeles, CA 90024-1759, USA. Williams and Ramamurthi are with the Department of Psychiatry & Biobehavioral Sciences, University of California, Los Angeles, CA, USA; Bingham is with the Los Angeles Department of Health Services, HIV Epidemiology Program, Los Angeles, CA, USA.

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Harawa, N.T., Williams, J.K., Ramamurthi, H.C. et al. Perceptions Towards Condom Use, Sexual Activity, and HIV Disclosure among HIV-Positive African American Men Who Have Sex with Men: Implications for Heterosexual Transmission. JURH 83, 682–694 (2006). https://doi.org/10.1007/s11524-006-9067-0

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