‘Why aren’t you on PrEP? You’re a gay man’: reification of HIV ‘risk’ influences perception and behaviour of young sexual minority men and medical providers

BACKGROUND Increased HIV pre-exposure prophylaxis (PrEP) initiation is urgently needed to substantially decrease the incidence among Black sexual minority men (BSMM). However, BSMM are less likely than other groups to accept a clinician’s recommendation to initiate PrEP and uptake remains suboptimal. Peers and smartphone apps are popular HIV prevention-intervention mechanisms that are typically used independently. Few studies have combined these strategies into a multi-component intervention to increase PrEP initiation for BSMM. OBJECTIVE This study refined an intervention using a smartphone app and a peer change agent (PCA) to increase HIV risk perceptions (HRP) and PrEP initiation among BSMM. METHODS Data were obtained from 12 focus groups and one in-depth interview among BSMM from Baltimore, MD, between October 2019 and May 2020 (N=39). Groups were stratified by age group: 18-24, 25-34, and 35 and older. Facilitators probed on attitudes towards the app, working with a PCA, and preferences for PCA characteristics. RESULTS Most self-identified as homosexual, gay, or same gender-loving (68%), were employed (69%), single (66%), and interested in self-monitoring sexual behaviors (68.4%). Overall, participants had low HRP and suggested that self-monitoring sexual behaviors could trigger internalized stigma. An acceptable PCA should be a “possible self” for BSMM to aspire. CONCLUSIONS Future research should explore the impact of implementing this strategy on HRP and PrEP initiation among BSMM.

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Intersectional Effects of Sexual Orientation Concealment, Internalized Homophobia, and Gender Expression on Sexual Identity and HIV Risk Among Sexual Minority Men of Color

Journal of the Association of Nurses in AIDS Care ◽

10.1097/jnc.0000000000000274 ◽

2021 ◽

Vol Publish Ahead of Print ◽

Author(s):

S. Raquel Ramos ◽

David T. Lardier ◽

Ijeoma Opara ◽

Rodman E. Turpin ◽

Donte T. Boyd ◽

...

Keyword(s):

Sexual Orientation ◽

Sexual Identity ◽

Hiv Risk ◽

Sexual Minority ◽

Internalized Homophobia ◽

Sexual Minority Men ◽

Gender Expression ◽

Men Of Color ◽

Minority Men ◽

And Gender

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The Role of Gay-Related Stigma in HIV-Risk Behavior Among Sexual Minority Men in Europe

AIDS and Behavior ◽

10.1007/s10461-018-2306-z ◽

2018 ◽

Vol 23 (3) ◽

pp. 684-694 ◽

Cited By ~ 5

Author(s):

Corina Leluţiu-Weinberger ◽

H. Jonathon Rendina ◽

Massimo Mirandola ◽

Lorenzo Gios ◽

Cinta Folch ◽

...

Keyword(s):

Risk Behavior ◽

Hiv Risk ◽

Sexual Minority ◽

Hiv Risk Behavior ◽

Sexual Minority Men ◽

Related Stigma ◽

Minority Men

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Risk From Within: Intraminority Gay Community Stress and Sexual Risk-Taking Among Sexual Minority Men

Annals of Behavioral Medicine ◽

10.1093/abm/kaaa014 ◽

2020 ◽

Vol 54 (9) ◽

pp. 703-712

Author(s):

Charles L Burton ◽

Kirsty A Clark ◽

John E Pachankis

Keyword(s):

Risk Behaviors ◽

Hiv Risk ◽

Sexual Minority ◽

Risk Taking ◽

Hiv Risk Behaviors ◽

Sexual Minority Men ◽

Gay Community ◽

Minority Men ◽

Community Stress ◽

Online Group

Abstract Background Sexual minority men remain highly impacted by the human immunodeficiency virus (HIV) with social stress being a clear predictor of their risk for infection. The past several decades of stress research regarding sexual minority men’s HIV-risk behaviors has almost exclusively focused on the influence of stress emanating from outside the gay community (e.g., stigma-related stress, or minority stress, such as heterosexist discrimination). However, recent evidence suggests that sexual minority men also face stress from within their own communities. Purpose We sought to examine whether stress from within the gay community, or intraminority gay community stress, might influence sexual minority men’s risk behaviors, including HIV-risk behaviors, over-and-above more commonly examined stressors affecting this risk. Methods We tested whether intraminority gay community stress was associated with sexual minority men’s HIV-risk behaviors in a large national survey of sexual minority men (Study 1), and experimentally tested intraminority gay community stress’s impact on behavioral risk-taking and attitudes toward condom use (Study 2). Results Self-reported exposure to intraminority gay community stress was positively associated with HIV-risk behaviors when accounting for the effects of several commonly examined minority stressors and general life stress (Study 1). Participants who were rejected from an online group of other sexual minority men evidenced greater risk-taking in a subsequent task and reported fewer benefits of condom use than participants who were accepted by the online group, when accounting for state affect (Study 2). Conclusions Sexual minority men’s experiences of stress and rejection stemming from their own community may be an important and overlooked predictor of HIV infection and transmission.

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Profiles of HIV Risk, Sexual Power, and Decision-Making among Sexual Minority Men of Color Who Engage in Transactional Sex: A Latent Profile Analysis

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18094961 ◽

2021 ◽

Vol 18 (9) ◽

pp. 4961

Author(s):

S. Raquel Ramos ◽

David T. Lardier ◽

Donte T. Boyd ◽

José I. Gutierrez ◽

Eliana Carasso ◽

...

Keyword(s):

Decision Making ◽

Hiv Risk ◽

Sexual Minority ◽

Profile Analysis ◽

Sexual Relationship ◽

Transactional Sex ◽

Sexual Minority Men ◽

Men Of Color ◽

Minority Men ◽

Sexual Power

Though the transmission of HIV is preventable, there were still 37,968 new documented cases in the United States in 2018. HIV incidence is disproportionate in sexual minority men of color. The purpose of this study was to examine sexual relationship power risk profiles to identify distinct subgroups within the profiles who carry the highest HIV risk. Latent class profile analysis was used to identify subgroups of sexual minority men of color at the highest risk for contracting HIV based on their sexual power profiles. Among 322 sexual minority men, we identified four latent profiles. Profile 1: Low transactional sex and high power (n = 133; 14.3%); Profile 2: Transactional sex, high decision-making in sexual relationships, and low control in sexual relationship (n = 99; 30.7%); Profile 3: Low transactional sex, low decision-making, and moderate control (n = 43; 13.4%); Profile 4: High transactional sex and low power (n = 47; 14.6%). LPA was useful to identify distinct subgroups based on measures of sexual risk and relationship sexual power. Findings carry significant implications for developing tailored strategies to increase HIV knowledge and related HIV prevention and risk reduction services for sexual minority men of color who engage in transactional sex.

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Understanding the complexities of HIV risk among sexual minority men in a global context

European Journal of Public Health ◽

10.1093/eurpub/ckz186.527 ◽

2019 ◽

Vol 29 (Supplement_4) ◽

Author(s):

K Stojanovski ◽

E J King

Keyword(s):

Risk Factors ◽

Complex Systems ◽

Hiv Risk ◽

Sexual Minority ◽

Socioecological Model ◽

Sexual Minority Men ◽

Individual Level ◽

Complex Systems Theory ◽

Multiple Levels ◽

Minority Men

Abstract Background Complex systems theory recognizes the intricacy of health issues and inequities, which permits the study of interrelationships across multiple levels of the socioecological model. We interrogated the research to identify upstream and downstream factors, their intersections, and recursive processes to develop a visualization of HIV risk among sexual minority men. Methods Using global HIV literature drawn from diverse disciplines and geographies, we elucidated HIV risk factors through a complex systems theory approach. We used thematic analysis to categorize HIV risk factors into different levels of the socioecological model, such as policies, community risk factors, individual behaviors, etc. We also identified the relationships between these risk factors to assess how they shaped HIV risk. The analyses were used to inform the connections between the various factors that lead to HIV risk in order to develop a visualization of the complex system, for which Stella Architecture was used. Results The thematic analysis of the literature and complex systems visualization portrays that HIV risk arises from a complex interplay of recursive and reinforcing factors ranging from policies, community factors, healthcare systems, and interpersonal relationships leading to manipulations in individual-level behaviors that put sexual minority men at risk for HIV. This visual representation indicates that HIV risk cannot simply be thought of as an individual-level factor nor simply related to sexual behaviors. Rather, HIV risk arises from upstream societal forces such as stigma, poor mental health, and health systems that relate to a multitude of downstream factors that socially pattern sexual minority men’s HIV risk. Conclusions The risk of HIV among sexual minority men stems from numerous intersecting factors across multiple levels of the socioecological model indicating the need to improve structural- and community-oriented approaches to address HIV. Key messages HIV risk arises from multiple social determinants. HIV preventions need to encompass multi-level interventions to fully address HIV risk.

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