"The skill is using your big head over your little head": what black heterosexual men say they know, want, and need to prevent HIV

Black heterosexual college men's masculinity dimensions, protective behavioral intentions, and sexual risk behaviors

OBJECTIVE

To examine the associations of dimensions of masculinity-respect/toughness and anti-femininity/hypersexuality-with sexual risk behaviors and protective behavioral intentions and the effects of awareness of anti-Blackness.

PARTICIPANTS

127 Black heterosexual men were recruited from four Historically Black Colleges and Universities and one Minority Serving Institution in the South.

METHODS

Students completed an online survey as part of a pilot study to assess the sexual health needs of Black college students.

RESULTS

Our results indicated that respect/toughness and anti-femininity/hypersexuality were significant correlates of protective behavioral intentions. After accounting for awareness of anti-Blackness and age, anti-femininity/hypersexuality was a significant correlate of sexual risk behaviors.

CONCLUSIONS

Our study highlights the complex multi-dimensional construct of masculinity and how forms of anti-Blackness continue to influence HIV vulnerability. Therefore, there is a need to include structural factors within research to better understand behaviors among Black college men and incorporate dimensions of masculinity that promote healthy sexual behaviors in interventions and programming.

Engaging Young Black Males in Sexual and Reproductive Health Care: A Review of the Literature

Young Black males (YBM) ages 18 to 24 years are more at risk of contracting sexually transmitted infections (STIs) and have a substantially greater need for sexual reproductive health (SRH) services than other groups. Despite this significant need, the extant literature does not provide a comprehensive picture of how YBM seek preventive care services (e.g., STI testing). Therefore, the purpose of this review is to address YBM’s SRH access and use of STI/HIV testing and screening in this population, with a specific emphasis on young heterosexual Black males, by identifying barriers and facilitators of engaging with SRH care. An electronic search was performed using Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycInfo, PubMed, and Scopus online databases. Keywords were adapted to each database and included variations of “Black males,” “sexual reproductive healthcare services,” “youth (18-24 years old),” and “healthcare access and utilization.” Studies from the review reported that barriers to engaging in SRH care included lack of health insurance, ideas of masculinity that conflict with SRH care, stigma related to accessing services, and lack of knowledge regarding available services and care options. The top facilitators for utilizing SRH care were engagement on behalf of health clinics, confidence gained from social support, access to quality health care in one’s community, and trust in the health care system and providers. This review contributes to the current state of the science and is important to the improvement of high-quality services for this population, including respect, choice in care, confidentially, and compassion.

HIV Prevention Among Cisgender Men Who have Sex with Transgender Women

Cisgender men who have sex with transgender women face elevated risk for HIV, yet are understudied in prevention research. We conducted in-depth interviews with 19 men who have sex with transgender women in Baltimore, Maryland and Atlanta, Georgia to explore perspectives on HIV prevention. Participants used several strategies to reduce HIV risk: condoms, frequent HIV testing, communication about HIV status with partners, and limiting the types of sex acts performed. While condom use was inconsistent, it was preferred over pre-exposure prophylaxis, in part due to medical distrust. HIV self-testing was generally viewed unfavorably. Although most participants were referred to the study by their transgender women partners, they recommended reaching other men who have sex with transgender women in bars, nightclubs, online, and through social media. HIV prevention interventions should be inclusive of the needs and experiences of men who have sex with transgender women.

Masculinity and HIV: Dimensions of Masculine Norms that Contribute to Men's HIV-Related Sexual Behaviors

Numerous studies have documented a relationship between masculine norms and men's HIV-related sexual behaviors, but intervening upon this relationship requires a nuanced understanding of the specific aspects of masculine norms that shape men's sexual behaviors. We integrate theories on masculinities with empirical HIV research to identify specific dimensions of masculine norms that influence men's HIV-related sexual behaviors. We identify three major dimensions of masculine norms that shape men's sexual behavior: (1) uncontrollable male sex drive, (2) capacity to perform sexually, and (3) power over others. While the existing literature does help explain the relationship between masculine norms and men's sexual behaviors several gaps remain including: a recognition of context-specific masculinities, an interrogation of the positive influences of masculinity, adoption of an intersectional approach, assessment of changes in norms and behaviors over time, and rigorous evaluations of gender-transformative approaches. Addressing these gaps in future research may optimize prevention efforts.

Careful Conversations and Careful Sex: HIV Posttesting Experiences Among African American Men in Rural Florida

PURPOSE

In the United States, black/African American (black) men bear the greatest burden of human immunodeficiency virus (HIV), accounting for 42% of new HIV infections in 2012 despite being 6% of the population. In Florida, heterosexual HIV transmission has increased among black men. Few studies have examined HIV testing experiences for black heterosexual men (BHM) in the rural South. This study describes the post-HIV-testing trial experiences of BHM in rural Florida.

METHODS

We conducted 12 focus groups (4-7 participants per group) in 3 rural Florida counties with BHM who participated in a larger randomized HIV testing trial. Interviews were professionally transcribed and data were analyzed using NVivo 10. The qualitative analysis was informed by the strengths perspective (ie, emphasis on abilities rather than risks) and used a thematic analytical approach.

RESULTS

Sixty-seven men participated (median age 41.5 years); 39 (58%) earned a monthly income of less than $500, 38 (57%) attained education through high school or higher, 37 (55%) were unmarried, and 40 (60%) reported practicing monogamy; all who tested for HIV were negative for HIV. We identified 3 main themes based on self-reported actions: (1) risk reduction (eg, more consistent condom use, fewer sex partners), (2) sexual health communications with sex partners (eg, negotiating HIV testing with sex partners, getting to know partners better), and (3) health communications with peers and family (eg, disclosing test results, encouraging others to get tested).

CONCLUSIONS

Among BHM, being in this HIV testing study facilitated increased protective behaviors and communications for HIV prevention. Interventions for BHM in rural areas warrant incorporating these strategies to encourage routine HIV testing.

Condom refusal and young Black men: the influence of pleasure, sexual partners, and friends

The study investigated pleasure-related, partner-related, and social normative correlates of recent condom refusal in young Black men (YBM). A cross-sectional study of YBM (N = 561) attending clinics treating sexually transmitted diseases in three cities was conducted. Mean age was 19.6 years (SD = 1.87). Nearly one of every two young men (46.8 %) indicated recent refusal to use a condom after a request from their partner. Significant findings included the following: partner-related beliefs "I feel closer to my partner without a condom" (OR = 2.52, 95 % confidence interval (CI) = 1.65-3.83) and "condoms make sex hurt for the female partner" (OR = 1.69, 95 % CI = 1.14-2.52), a scale measure of pleasure-related beliefs (OR = 2.58, 95 % CI = 1.73-3.84), and a scale measure of negative social beliefs associated with condom usage (OR = 1.05, 95 % CI = 1.00-1.10). Interventions addressing pleasure-related, partner-related, and social normative beliefs as barriers to condom use are warranted for YBM.