Introduction

Black adolescents and young adults are disproportionately affected by HIV, accounting for more than half of all new HIV infections among persons 13–24 years old [1]. Young, Black men who have sex with men (YBMSM) have been particularly hard hit by the epidemic in recent years, with an HIV incidence rate nearly three times that of young White or Hispanic MSM [1]. This increased risk of HIV exposure among YBMSM is attributable to complex factors at multiple levels of the social environment. Arguably, one of the most widely identified macro-level determinants of HIV risk among youth and adolescents is the manifestation of social and cultural norms in stigma [2]. Coined by sociologist Erving Goffman, stigma is the social identification of an individual or group of individuals based on physical, behavioral, or social traits, which may result in marginalization or discrimination [3] and is often understood to be a symptom and byproduct of social and structural inequality [4–6]. Homonegativity, or the stigma associated with homosexuality, is of particular importance in understanding HIV disparities. Although research on the association between stigma and increased HIV risk is in its infancy [7], a focus on stigma to understand HIV disparities is strongly supported by the broader social determinants of health literature [8, 9].

Experiences of homonegativity may be exacerbated for young Black men, as some work has suggested that Black individuals may be more significantly affected by homonegativity [10]. Importantly, among YBMSM ages 16–21, nearly 90 % believe their parents would respond unfavorably to knowing they were gay or bisexual [11], and fewer than 2 % of Black MSM report being open about their sexual identity at all times [12]. Homonegativity may prevent some YBMSM from seeking HIV testing, prevention interventions, and treatment services [1]. Furthermore, homonegativity may make it difficult for some YBMSM to be open about their same-sex relationships, increasing stress and limiting social support, and subsequently increasing risk for HIV via increased sexual and drug-related risk behaviors [13].

The homonegativity experienced by Black MSM may be partially attributable to the culture of the Black Church. Black male identities are closely linked to a sense of belonging to the Black community due to a painful, shared racial history and experiences of racism [14], and membership in the Black community often coincides with membership in the Black Church. The Black Church has provided social and support services to the Black community for centuries, played an integral role in mobilizing communities during the Civil Rights era, and continues to be a strong advocate for social and political change [15]. The historical relevance of the Church, along with its broader social importance, makes Church doctrine and teachings especially influential. Furthermore, Black Americans are among the most religiously committed in the United States, with nearly 80 % reporting that religion plays an important part in their lives [16]. For many, the importance of the Black Church extends beyond the individual, as it is deeply intertwined with family and community life [17]. Yet, the Black Church is often cited as a primary source of homonegativity in the Black community [18], adding an additional complex structure to navigate for YBMSM [19]. As a result, the Church’s biblical interpretations and generally conservative teachings on sexuality and homosexuality have contributed to significant homonegativity [20]. Although leaving one’s religious institution may be an effective coping mechanism for faith-based homonegativity, doing so may be especially difficult for Black MSM, for whom the Church has significant social and cultural importance [21]. As a result, many Black LGBT individuals remain involved in the Church despite the homonegativity and often simultaneously receive great personal benefit from the connection with the Black faith community [22]. Yet, research indicates that Black churches have a lasting and significant effect on the self-worth of YBMSM, provoking significant psychological discomfort related to religious teachings around the condemnation and sinfulness of homosexuality [23].

The Black Church has also been cited as influential in defining masculinity for Black men via its culture of homonegativity [24]. Masculinity is a social construct that involves the negotiation of traditional gender role norms such as sexual prowess, physical dominance, aggression, and anti-femininity. For Black men, these gender norms have been identified as ways for men disempowered by racism to demonstrate power and assert some authority and control [25], and flamboyant and feminine behaviors are seen as undermining this power.

Thus, YBMSM are often dealing with compounding negative effects as a result of the need to navigate multiple marginalized identities and layers of societal oppression (i.e. race and sexual orientation) [26]. The confluence of social identities and stigmas YBMSM face, which can manifest and interact to negatively affect health and maintain health disparities [27], may be best understood via intersectionality. Intersectionality is a theoretical framework that explores how an individual’s multiple, intersecting identities can help explain health inequalities for individuals from multiple historically oppressed groups (e.g. racial and sexual minorities). Intersectionality also recognizes the role of institutions and systems of oppression in the creation and maintenance of disparities [28]. Research has established that ethnicity, race, sexual orientation, discrimination, and stigma are key social and structural forces of HIV, and thus, an intersectional framework may be useful for informing HIV prevention interventions that address these macro-level factors [29].

There is evidence to suggest that individuals who have multiple determinants of social discrimination (e.g. sexual and racial minority status) are significantly less likely to take preventive action, utilize clinical services, and adhere to medical recommendations [30, 31] and the clustering of risk factors for youth at risk for HIV can result in a decreased likelihood of being tested [32]. YBMSM typically endure greater stigma and discrimination from the Black community than young White MSM from their communities [33, 34]. In addition, YBMSM may be subject to racism and discrimination from the White gay community, deepening their marginalization and isolation [35–37], and limiting access to important informational and protective networks [38]. Distress caused by experiences of marginalization and discrimination from their own racial group, as well as the larger gay community, may incite risky sex or drug use as coping mechanisms [26], increasing vulnerability to HIV for YBMSM.

Although often studied independently of each other, considering the interaction of multiple stigmas can provide a more comprehensive understanding of the relationship between stigma and HIV disparities. As such, this research, conducted through an intersectional lens, examines how multiple axes of YBMSM’s identities (i.e., race, sexual identity, and religiosity) intersect and result in experiences of stigma from multiple entities.

Methods

This study is based on 30 interviews with YBMSM conducted between February and June 2014 in Milwaukee, Wisconsin. Inclusion criteria for YBMSM included self-identifying as Black or African American, being biologically male, between the ages of 16 and 24, identifying as gay or bisexual or having willingly engaged in sex with another male in the previous 12 months, and having a church affiliation including belonging to a church or having a religious home, or having belonged to a church within the previous 5 years and left. Individuals no longer affiliated with a church must have been affiliated within the previous 5 years in order to limit recall bias and increase accuracy of reported experiences. The inclusion of 16–24 year-old YBMSM was due to the startlingly high incidence of HIV in this population and the fact that almost no research has previously explored religious experiences in YBMSM under the age of 18.

YBMSM were recruited through purposeful sampling techniques, using a combination of service provider and participant referrals. Six community-based organizations that work extensively with sexual minority youth, and YBMSM in particular, assisted in recruitment efforts. Program directors and case managers were given study flyers to provide information on the study. Presentations were also done during youth drop-in hours, afterschool programs, and youth activities at these organizations to provide additional information on the study and opportunities for youth to ask questions. Additional outreach was done through Craigslist, festivals, and church youth groups. Following each interview, youth were given referral cards to give to friends who might be interested in participating. Written informed consent was obtained prior to each interview. We obtained a waiver of parental consent for youth under the age of 18. Informed consent and research protocols were reviewed and approved by the Institutional Review Board at the Medical College of Wisconsin. All interviews were digitally recorded and YBMSM received $25 for participating in the study.

Interviews lasted between 45 and 120 min and were based on semi-structured interview guides that allowed for flexibility to ask follow up questions and explore certain areas in more depth [39]. In order to assess YBMSM’s experiences with faith-related stigma, homonegativity, and heteronormative messaging, participants were asked about how they thought the Black Church viewed homosexuality, what sorts of messages about sexuality and homosexuality they had received from pastors or religious leadership, and how such messages or experiences have affected their perceptions of self and sexual identity. Similarly, participants were asked about experiences of stigma and homonegativity from the community, their friends, and their families. Participants were asked if, how, and when they came out to their friends and family, how people reacted to knowing they were gay or bisexual, and whether there were any individuals they would not want to know about their sexuality. Finally, YBMSM were asked about any experiences of discrimination based on race and/or sexual orientation.

Digital recordings were transcribed verbatim into an electronic text file and transcripts were coded and analyzed using MAXQDA. Interviews were analyzed using thematic content analysis, guided by the principles of grounded theory analysis [40, 41] and constant comparative method to describe and summarize data within and between cases and examine differences across YBMSM. In line with the intersectional approach to this research, analysis occurred within a broader sociohistorical context, which required remaining cognizant of the social and political context in which individual experiences occur, giving credence to missing narratives, and understanding the often implicit nature of intersectionality [42].

Analysis occurred in two stages, corresponding to the inductive approaches of open coding and axial coding used in grounded theory [40]. The initial open coding phase was conducted by the primary author and consisted of an iterative process, wherein codes were re-organized, re-defined, divided, and grouped into larger themes and the codebook was refined through comparison, categorization, and discussion of the interpretation of codes. The codebook was supplemented with relevant a priori codes identified as relevant through a review of the extant literature. Analyses took an inductive approach which consisted of a continual development and refining of codes used to identify themes and interactions among phenomena and establish relationships within major themes. This coding process allowed for the extraction and sorting of the text by themes, which helped elucidate the range of participant experiences and perceptions and allowed for the exploration of new and unanticipated relationships, interactions, and patterns. The final codebook included 45 primary codes and 47 subcodes.

Results

Thirty self-identified YBMSM participated in the study, ranging in age from 16 to 24, with an average age of 21. All were biologically male, and one identified as transgender. Nine of the 30 participants were bisexual, while the others identified as gay. Eight had at least some college, and six were currently in high school. Nineteen participants were affiliated with a church or attended church regularly at the time of the interview.

When asked directly about experiences of homonegativity and discrimination, several participants said they had not experienced any homonegativity. However, negative remarks made about their sexuality, the need to hide their sexuality, and difficulty with friends and family members because of their sexuality emerged in nearly all of their narratives. Homonegativity came from numerous sources, but was especially prominent within families, the broader community, and in church. Experiences of homonegativity ranged in severity from casual insults, to social exclusion and alienation from friends and family, to severe physical violence. The intersection of their race, gender, sexual identity, and religiosity presented significant challenges for many YBMSM.

24 year-old YBMSM: I feel like, I’m a Black, African American male that is bisexual… most people argue and judge because of the color of their skin, but then again, most people are getting judged because of the sexuality that they are given. And with me having two of those traits, I would, you know that that I feel like, well, most people are out to get me.

While few participant narratives explicitly acknowledged these multiple, interlocking stigmas, it becomes clear in the following sections that being a sexual minority was complicated by youths’ race and religion.

Faith-Based Homonegativity

The Church has been identified as a central feature of the Black community and often dictates or influences community norms and values. Pastors of Black churches are seen as particularly influential and are viewed as credible sources of information and guidance for the community. Although the majority of participants noted that religion and faith were important aspects of their identities, they also highlighted the homonegativity espoused by faith leaders and religious friends and family. Rooted in Christian dogma and biblical interpretations, all participants were taught homosexuality was a sin and an abomination, and many were frequently told they were going to hell. One participant, for example, recalled learning about homosexuality from his pastor and conservative Christian parents and attempted to reconcile their messages about the sin of homosexuality with the depiction of God as loving and accepting.

21 year-old YBMSM: I felt betrayed a little bit, I felt a little angry, I felt a little ashamed, I’m feeling kind of sad because if, I’m like, how are you going to preach to me that He loved all of his children? Because I’m different from the rest of His children, I’m going to hell and I’m going to burn? Like, what am I supposed to do?… I believe in Him, I know that He’s our Christ and I know that He’s our Savior, but I just don’t know if He’s going to accept me.

As he explained, he continued to struggle with how he, as a young gay man, fit into the Church. Although his faith remained central in his life and he continued regular church attendance, like many participants, he still experienced significant conflict between his sexuality and religion.

The influence and legitimacy of religiously-based messages about homosexuality was magnified when YBMSM heard messages directly from their pastors, whom they often idolized, perceived as infallible, and viewed as a direct line of communication to God.

22 year-old YBMSM: When I first started going to church I thought my pastor was a God because he was on a high pedestal and his voice echoed through the whole building. So, we got this God who is going to judge me, you know, if I was gay. So, you know, I was kind of scared.

Pastors’ messages were exceptionally influential on YBMSM’s understandings of sexuality and their place as young gay and bisexual men in the Church. Messages about the sin and abomination of homosexuality from their pastors frequently contributed to shame and confusion about their sexuality and powerful fear about the religious consequences of being gay.

Despite recognizing their importance as church leaders, many participants also criticized the judgment they received from their pastors and church congregations.

23 year-old YBMSM: I’ve had a pastor or two say that if it’s an abomination that means that it’s something that makes God sick to his stomach. So this act means God is sick to his stomach and makes Him want to puke. I’ve heard them say that. I’ve heard dude say pretty much that anybody that insists on having same-sex relations, that they’re mentally unstable… It’s awful, it’s awful, I think it’s judgmental and it’s crazy how people let beliefs dictate how they feel about somebody and they don’t even know if it’s factual and they are acting like yeah, you definitely a bad person and you are definitely going to hell.

These religiously-based homonegative messages were not confined to the Church, as participants were regularly exposed to similar messaging from their parents and extended families. The centrality of the Church in the lives of many Black families highlights the intersection of family and religious life for many YBMSM. As children, YBMSM were heavily involved in their churches, often spending at least 2 days a week in church. They had limited agency in determining their level of involvement in church and many, well into their adolescence and young adulthood, were expected by their families to maintain a significant presence in the Church. Yet, the religious foundation of many families tended to amplify the stigma around homosexuality.

20 year-old YBMSM: That’s all my mother talks about is religion. That’s all she talks about. If it’s not religion, it’s school. She talks about God and like, how He created man, woman, human… So she gives me the Bible. She just gives me a Bible to read… She always says that “God made Adam and Eve, not Adam and Steve.”

Often before they even acknowledged their own sexuality, YBMSM knew their parents did not approve of homosexuality, which was difficult for YBMSM to understand as they began to self-identify as gay or bisexual. For many participants, the religiously-induced guilt associated with their sexuality and the belief that their parents would not accept them heightened their confusion and shame and contributed to identity struggles and self-acceptance.

Manifestation of Faith-Based Homonegativity

The pervasiveness of faith-based homonegativity led many YBMSM to internalize the negative anti-gay attitudes and messages they received from their church and family. This internalization was often characterized by acceptance of stigmatizing and anti-gay messages (e.g. homosexuality is a sin), discomfort with disclosing their sexuality, and questioning their identity.

22 year-old YBMSM: At first, growing up, I used to think like, ‘You are stupid’ and ‘How can you think that you are gay?’ or ‘You are going to be gay all of your life and you can’t get rid of it, like it’s a rash, there is no comeback.’ But as I grew up, I grew up to be more mature and understanding.

The degree of internalized homonegativity experienced by YBMSM varied. Many noted internalizing homonegative messages as children but eventually rejecting such views, while others continued to accept such beliefs, struggling with self-acceptance and disclosing their sexuality to only a handful of individuals. The most commonly accepted beliefs were rooted in Christian dogma, with several YBMSM subscribing to the belief that homosexuality was immoral, sinful, and an abomination.

19 year-old YBMSM: I think it’s abomination and it’s not supposed to happen. People who God is coming for and when He comes, we are going to be the ones left behind… [my church] don’t believe that we should be even here on earth. They feel like those who are gay should be taken off the planet earth. And to feel like that is like to say that as if I’m an alien. It’s a big smack in the face… I used to cry a lot. I’m a cry baby. I used to cry a lot and it used to hit me and it used to really hurt me, but now I just look at it here and let it go. I don’t let it affect me. It’s sad. You can’t take it back, you’ve said it, I can just move on with my life.

For some, like the participant above, the acceptance of religiously-based beliefs of homosexuality led to feelings of depression, isolation, and alienation, at least early on in their identity development.

In response to this homonegativity, some youth pulled away from the Church as soon as they were old enough and had enough independence from their parents to make decisions for themselves about religious involvement. They rejected basic Christian beliefs about the sinfulness of homosexuality and often described themselves as spiritual but no longer religious, although they all still maintained a belief in God. For others, however, organized religion remained a significant aspect of their lives and they continued regularly attending church. Either way, faith-based homonegativity had a significant effect on many YBMSM. One participant, for example, struggled with his guilt associated with his sexual identity, which affected his sexual relationships. Although he wanted to have a long-term relationship, his guilt about being in a homosexual relationship led him to avoid relationships, opting instead for casual sex partners.

24 year-old YBMSM: Religion, you know, puts a block on that, because it’s like I guess reaching for something that I really can’t have. I mean, the most that we could have casual encounters but as far as a long term thing I don’t think, I don’t think it would happen. You know, based on religion, it’s more of making a mockery of religion than, you know, with just having casual sex.

Another participant, who was HIV-positive, struggled with depression and anxiety related to his sexual orientation and talked about the guilt he felt when having sex.

22 year-old YBMSM: [The Church] has influenced my sex life, makes me feel guilty. I feel that sex is something that is sacred and I’m scared that, I don’t know. It’s just sometimes I feel like when I’m having sex with other people, I do feel as if I’m sinning. I pray for forgiveness. I would feel better if I stopped doing it, but um, if I continue to do it then I feel even worse…. but, it’s just nice to be with somebody, especially if you are feeling lonely, even if it’s for a couple of minutes.

This participant frequently used sex as a way to improve his self-esteem, reduce feelings of loneliness and isolation, and minimize his depression. Yet, such encounters often resulted in feelings of guilt, shame, and increased depression, which were influenced by religious ideologies about sex and homosexuality. Although this guilt associated with having sex with other men led to anxiety and depression, it did not result in fewer sex partners.

It was difficult for many YBMSM to reconcile their sexuality, and the way the Church viewed their sexuality, with their desire to maintain their relationship with God and the Church. YBMSM who sought to maintain their religious identity and connection to the Church often still worked to keep their sexual and religious identities separate.

22 year-old YBMSM: At first, I always thought if I have sex with a guy, it going to be considered a sin and I didn’t want to go to hell, so it took me awhile to have sex with men… And now my sex life lifestyle doesn’t know about my religion only because both sides are like at war. Homosexuality and religion is like at war, so I never tried to have the two touch. So, you know, I have always tried to keep them separate, but always made sure both sides was knowing, ok, I’m a gay male, but I practice religion.

The integration of sexuality and religiosity was difficult for many YBMSM, and like the participant above, many worked to keep these two aspects of their identity separate, although both were equally important pieces of their identity. For others, the perceived conflict between religion and sexuality led them to withdraw from the Church and organized religion completely, for at least a short period. Rather than attend church on Sundays, these participants maintained their religious identities privately, instead emphasizing their faith, the importance of prayer, and personal relationships with God. They rejected basic Christian beliefs about the sinfulness of homosexuality and often described themselves as spiritual but not religious, although they all still maintained a belief in God.

Disclosure and Self-acceptance

Recognizing their sexual identity was generally not well received in the Church, the majority of YBMSM were not open with their pastor or the broader congregation and many worried about how their pastors or other congregation members would react to knowing they were gay or bisexual. Several YBMSM noted that the anti-gay messages and stigma around homosexuality in the Church often delayed their self-acceptance and decisions to come out. For example, when asked about his decision to come out, one participant said:

20 year-old YBMSM: I think like, as far as religion, it made me wait ‘cause I was kind of scared about coming out. Because as far as homosexual is saying like you would go to hell and all of that. So it made me hold back and build up a wall against it. Just as far as not telling people or just staying to myself, not really like kickin’ it with my family and stuff. Just staying like, to myself. Just feel like, I feel like everybody was against me. Like I was doing something wrong for being like this. Just feel bad and feel teased.

Although he eventually came out to his family, he was still not open in church and generally subscribed to the belief that homosexuality is wrong and sinful, which was a common among YBMSM. In fact, when asked if there were any places in the community they would not want people to know they were gay, the most common response was their church. Furthermore, many employed strategies to conceal their sexual identity including modifying their dress and voice and avoiding attending services with gay friends or partners. Even YBMSM who were open with their family and community often remained closeted at church.

Interviewer: How did your religion influence your decision to come out?

24 year-old YBMSM: It definitely affected. And I want to say if anything, it delayed it… I knew it would be a hard road to walk even back then because of all the judgments people make. I mean, even to this day, I’m out, but you know when it comes to faith or religion, you know, I would say that I’m not, I guess.

Interviewer: And why is that?

24 year-old YBMSM: Growing up, you know, I’m going to say in the Black community, I was, there is a difference. I believe that we are looked on different, you know, to be more strong and you know, more masculine. So just growing up in the Church, you see people react to even that topic of conversation and you know how they act, when they know or presume that one might be homosexual.

This narrative highlights the intersection of religion, sexuality, and race. Although this participant was open with his family and generally lived as an openly gay young Black man, he, like many other YBMSM, was not open in church. He recognized the masculine expectations place upon him as a Black man, which were seen as standing in opposition to homosexuality, and was aware of the stigma, gossip, and mistreatment that accompanied even those presumed to be gay in the Church. Given the Church’s centrality in the Black community, the norms and expectations present in the community were just as prominent within the Church.

Decisions around disclosure were just as evident in YBMSM’s relationships with their families, and many YBMSM noted an especially difficult struggle in deciding whether to come out to their parents. YBMSM were close with their families, especially their mothers, and they often believed they would jeopardize that relationship by coming out. Despite the risks, the majority of YBMSM’s parents did know about their sons’ sexuality. Although there were a few YBMSM whose parents were supportive, loving, and accepting upon learning their son was gay, the majority of participants initially experienced negative interactions and homonegative messages from their parents, siblings, and extended family members, which often had underlying religious tones. One participant explained how his father invoked biblical messages after finding out he was gay.

23 year-old YBMSM: After we started talking, he was like, ‘You know, I don’t approve it, I don’t like it’ and then went to the biblical thing. You know, ‘two men aren’t supposed to lay down’ and all the rest of that shenanigans. And then he was like, ‘I can’t tell you who to love and you can’t know so if you go and do this, be careful, you know. I can’t say you got my support, you know what I’m saying.’ As we got older our relationship is more like now you couldn’t even tell at one point we weren’t even talking, you know what I’m saying? It took some work to get to that, it took a lot of work.

Although he and his father did not speak for several years because of the participant’s sexuality, as was true with many participants, they were eventually able to repair their damaged relationships with their parents. Nearly all YBMSM who were open with their families eventually found acceptance and support from some members of their family, especially mothers and grandmothers. Levels of acceptance varied. Some families knew about their son’s sexuality although it was rarely, if ever, acknowledged or discussed. Others accepted but did not condone their son’s sexuality, but no participants reported experiencing full acceptance, tolerance, and support.

To some extent, especially at first, YBMSM’s trepidations about coming out to their parents were validated, as parents’ initial reactions were less than accepting. Even when parents did not say anything intentionally hateful or homonegative, their reactions to learning their son’s sexuality were often rooted in perceptions of homosexuality as something wrong, sinful, or abnormal.

22 year-old YBMSM: My mom, she thought it was a phase. I really try and shake it out of her. ‘It’s not a phase, mama. I’m gay.’ And she’s more like into, ‘Is it my fault? Was it something that I do? Did I drink too much when I had you?’ I’m like, ‘I don’t know, but it’s not your fault.’ She’s like, ‘Is it a genetic thing?’ So, she was more worried.

Yet, while the majority of YBMSM had disclosed their sexuality to their parents, there were several who had not, and this decision was primarily in response to recognizing their parents’ homonegative attitudes and beliefs. As one 22 year-old YBMSM who was not open with his family explained, “Well, I know not to tell my family. They’re church people. I knew not to tell them and I probably won’t tell them.” YBMSM believed that their sexuality would bring shame to their entire family and understood why their parents frequently responded with anger, sadness, and disappointment. Participants accepted the notion that being gay was a negative attribute and often sympathized with their parents who struggled to accept them.

Consequences of Disclosure

YBMSM generally perceived themselves to have two options: reject or hide their sexuality in order to maintain important ties to their friends, community, and family, or disclose their sexuality and risk losing all of those connections, which were integral aspects of their identity. Despite how great the risks were, the majority of YBMSM were out, at least selectively. The hesitancy of many YBMSM to come out was often rooted in fears of losing those social ties, and such fears were not unfounded. Openly gay Black males risked losing friendships and social support from within their community, and closeted YBMSM were especially cognizant of this risk. YBMSM were hyper-aware of the homonegativity within their communities and the real and perceived dangers associated with being open in public. Some had experienced direct physical or verbal confrontations, while many more had witnessed such attacks happen to others and were fearful of such confrontations themselves. Participants reported regular harassment on city busses, walking down the street, and in grocery stores and malls.

19 year-old YBMSM: If strangers reacted like that, what would people close to me react like? And these people I know would hurt me if they leave or stop talking to me, that would damage me more. So, I mean, I’ve had a couple of people leave me out of my life and left me alone and that sent me into a deep depression and it went into me trying to, I don’t want to be on this earth and all of that.

In addition to mistreatment from the public, openly gay YBMSM risked losing familial and social support, which was much more impactful. Like the participant above, several participants experienced a loss of friendships and familial relationships and closeness after coming out as gay, often leading to episodes of depression, isolation, and confusion about one’s identity. For others, the mere prospect of losing friends or family over their sexuality prevented them from coming out and contributed to depression and isolation.

The risks associated with disclosure to families were even greater than those associated with disclosing to friends or being open in the community. While nearly all YBMSM experienced hurtful comments and negative initial reactions by their parents and siblings, a few faced more serious consequences from their parents. One participant, for example, ran away from home at the age of 14 because his father physically abused him after learning his son was gay.

23 year-old YBMSM: I came out at the age of 14. I started running away from home because my daddy was so upset… he was whooping me, like trying to beat me, you know, because he knew and I just didn’t take it no more. My dad, he still doesn’t accept it to this day. We don’t talk like that.

Leaving home at a young age, either by force or their own volition, is significant for any adolescent, but perhaps especially so for YBMSM for whom family and community are so closely intertwined. Furthermore, a loss of close-knit familial and community ties can result in a weakening of broader social support, as the family is often a key link to the community and YBMSM’s racial identity.

21 year-old YBMSM: They didn’t accept it at first. I was kicked out of the house when I was 17… It was like they literally cut me off. Like, they shunned me, like they turned their backs on me. And that kind of hurt my feelings because they are my parents and they are supposed to love me anyways.

In addition to the loss of social support, YBMSM who were open about their sexuality faced verbal assaults and, occasionally, significant physical assault from their friends and the broader community.

23 year-old YBMSM: I was gay bashed when I was like 12. That was, that was totally discrimination… I’m not exaggerating, but it was like at least 15 to 30 guys and they just beat me senseless. You know, I had on my little skin tight little jacket and my little tight jeans, but I hadn’t did anything wrong and it was just terrible, it was something… I don’t really look in people’s eyes anymore and I would just look away or look down. Emotionally, I was just like, I was in shock. Like, I can’t believe they just did that. What if it happens again or what can I do to prevent it, or is there some way I can avoid it?

Interviewer: What did your parents say?

23 year-old YBMSM: I didn’t tell them because I didn’t want, you know, add some damn word like, “Oh, it’s because they are trying to let you know that’s what you get.” I didn’t know what they would say or react. I wasn’t strong enough to even handle that.

As evident in the quote above, experiences of harassment and assault often led to self-blame and anxiety about future assaults, and many suggested they were deserving of their assaults because of their sexuality. At the very least, they believed their parents and heterosexual friends would blame them and rarely reported such events to anyone, much less the police. As a result of community-wide stigma surrounding homosexuality and perceived and experienced risks associated with their sexuality, participants noted the need to be cognizant and hyper-aware of their surroundings and how they portrayed themselves, whether or not they were open.

20 year-old YBMSM: Have to be aware of my surroundings, like, as far as my appearance. Even like, I guess with talking. As far as just talking and being comfortable talking and not sounding gay, as far as being somewhere in public. Even, I guess, second guessing what I’m wearing, how I’m going to do my hair, stuff like that… I just accept it. It’s the way the world is set up. Got to be a certain way or do a certain thing to fit in.

Expectations of Masculinity

Although religious messages and beliefs around homosexuality were prominent, YBMSM’s narratives also indicated parental and community expectations of masculinity were a significant contributor to homonegativity. Homosexuality was seen as nearly a direct contradiction to what it meant to be a Black man, which included stereotypical notions of masculinity and presumptions of heterosexuality. Homosexuality was associated with exaggerated stereotypes of being weak and effeminate. In general, those who were not open with their sexuality perceived themselves as more masculine, more readily subscribed to societal norms of masculinity, and worked to be perceived as heterosexual. For them, these expectations of masculinity made it difficult to be open about their sexuality.

22 year-old YBMSM: I have a friend, he’s not open to the Church or to the community. He lives a straight life, or I will say, the down low… they have to do things their way and like, in their neighborhood, there is probably a certain type of situation going on so they may have to portray a certain type of male, masculine, and being that type of male.

More so than their openly gay counterparts, YBMSM who were not open often struggled to find a balance between their identity as gay or bisexual men and the masculine expectations tied to their family, friends, and community. Being gay and masculine were seen as incompatible and anything perceived as feminine was often justification for harassment and the loss of important social ties. One participant explained why he wouldn’t want the friends and community he grew up with to he is gay.

19 year-old YBMSM: Ok, so I come from the hood. So I wouldn’t want my hood to know, you understand? Like, these are, first, I’m talking about here, completely your home folk. Like, I come from the hood and I don’t want none of them to know because they would probably like, like, ban me from the hood. I love the hood, you know, but it’s like, they wouldn’t want to be friends with me anymore. Like I said before, they have this tough mentality where it’s like, you know, ‘You aren’t going to be gay, you are going to be straight and you got to like women, have sex with a lot of them,’ you know?

The masculine gender-role expectations were often characterized by sexual aggression and prowess with women, making it difficult for YBMSM to come out as gay or bisexual and simultaneously maintain their masculine identities. Furthermore, participants’ communities of origin were significantly influential for many YBMSM. This participant was exceptionally secretive about his sexual identity and noted that only two people in his life, also YBMSM, knew he was gay. He still resided in the inner-city neighborhood he grew up in and was an active gang member, which brought with it additional expectations of masculinity. Failure to live up to rigid constructs and expectations of masculinity threatened these important social ties. For this young man, the ‘hood’ was an integral aspect of his identity and his connection to a strong social support network, the loss of which seemed inevitable to him if he were to be openly gay. Several participants talked about growing up in the inner-city and their neighborhoods were not only connections to important social ties, but were important aspects of their racial identities. The perceived and experienced homonegativity in the Black community inhibited their ability to come out, as doing so would potentially mean the loss of a connection to their neighborhoods and friends, and subsequently, a loss of an important part of their identities.

Several participants felt compelled to conform to stereotypical constructs of masculinity by camouflaging their sexuality and modifying their appearance and engaging in behaviors they believed demonstrated heterosexuality. In an effort to maintain a public image of masculinity and avoid social isolation, several YBMSM made a concerted effort to appear masculine and ensure their appearance, voice, and mannerisms did not reveal their sexuality. When asked about how comfortable he was with his sexual orientation, one participant noted:

22 year-old YBMSM: I tend to wise up or hide or like change my identity here and there so I can feel protected, because you, like the feminine type isn’t for men. They want masculine, so I try to portray the masculine type even though I’m not… I’m always trying to do something so I can feel comfortable or feel like I can be involved in that situation or feel protected… If I have to change a little bit, change my hairstyle to go into this area or where I say I would change my clothes to go in this area, I don’t have a problem with it.

In addition to being uncomfortable with themselves, a few YBMSM noted a discomfort being in public with their gay friends or partners, especially those who were considered to be more flamboyant or feminine. One participant, for example, was open only with his partner and one other gay friend and explained the danger in being ‘outed’ to some of his neighborhood friends.

18 year-old YBMSM: A lot of times people say other people’s opinions doesn’t matter, but when someone tells you their opinion, a lot of times it can hurt people’s feelings, especially when it’s someone you like, you know what I’m saying. This is my guy and I’m knowing him since you know, I was 12 and I’m 18 now, and now he finds out that I’m gay and he doesn’t want to kick with me anymore. You understand? And then takes something different than me and just forgets all of the stuff we have been through over the years. Of just being friends and now our whole relationship that you have cared about is gone, because of who you are.

This participant worked hard to make sure he was perceived as heterosexual and masculine, which he perceived as necessary in order to maintain friendships and social ties. As was true for the participants who were not openly gay and actively concealed their sexual identities, this participant had not experienced any direct homonegativity or discrimination. Yet, their efforts to conceal their sexual identities suggest they were certainly aware of the stigma and risks associated with being out.

Although concealing their sexuality often meant they were able to avoid direct homonegativity themselves, they were frequently privy to the homonegativity experienced by their friends and partners. Homosexuality was generally viewed unfavorably, but men with effeminate mannerisms, speech, or dress experienced an even greater pejorative response from the community, as well as from other YBMSM. Those young men who were not out often sympathized with the negative treatment their more flamboyant peers experienced, yet several also suggested others were deserving of such treatment.

One YBMSM who considered himself to be especially masculine and was not open with his sexuality noted that he hasn’t “experienced some of those things the dudes that are more flamboyant have experienced or the backlash of getting beat up upon.” He further suggested that his more flamboyant partner should change if he wanted to avoid societal homonegativity.

23 year-old YBMSM: I’m like, ‘Gee, you know, you got pink hair and that’s what they were talking about. You have pink in your hair so what did you expect them to say?’

‘Fuck that, I can wear what the fuck I want to wear’ ‘Which you did, but when you do that you present yourself in a way to receive negative comments. So, if you don’t want that, then you need to do a different change about you. You know, you want something different then do something different.’ But he doesn’t, he still does that, so, those are the consequences. That’s what comes with it. Roll with the punches and keep going.

While this participant had not experienced any negative experiences himself, he recognized the potential danger in being openly gay in his community, yet put the blame on his partner rather than the community stigma. YBMSM who did experience harassment and assault often feared their heterosexual friends and family would blame such attacks on their effeminate appearance and mannerisms. Yet, as the participant above demonstrated, at times, even other YBMSM blamed the victim and asserted that one’s physical appearance warranted harassment.

Social Support and Resiliency

Nearly all YBMSM were affected by homonegativity in some capacity, although how they dealt with it varied greatly. While the effects of the stigma around homosexuality were overwhelmingly negative, there was also evidence of resiliency. Despite periods of anxiety, depression, and uncertainty over one’s identity and experiences of homonegativity, many YBMSM had become confident, proud, young gay men.

19 year-old YBMSM: [Homophobia] actually just make me grow… So, I feel like it’s just made me push even harder as a person, it made me want to shoot harder from my success. Because it’s like you downgrade me so much and you feel that I’m not worth anything, well that only makes me push harder to show you that I’m worth way more than you think. I’m worth way more than I even know. So it’s affected my life a lot. I mean, I’ve had my hurt time and my depression.

Although YBMSM who were open often faced more explicit homonegativity than those who were not, they were also often able to establish a peer support system that celebrated their sexuality and was often protective against some of the bullying and gay bashing they experienced in school, at home, and in the broader community.

22 year-old YBMSM: In high school there was a lot of conflicts and aggression towards me. I mean literally every day, every day in my first year… which had made me and other people develop a small group and comfort zone, which made me kind of happy that they were not liking us because they brought me to other LGBTQA people with each other and understanding each other and develop a small family. They weren’t really violent or physical with us, but they did have harsh verbal words, so you know, that kind of hurt us. But you know, after a year when I was in high school we got comfortable with ourselves and they moved on… It made me feel very confident in myself and I could speak up for myself

Similarly, YBMSM who were more open with their sexuality were able to construct “gay families” or socially configured kinship structures, and close support networks of other Black gay youth and young adults. Gay families provided a source of support that was frequently lacking in YBMSM’s biological families and communities and offered younger Black MSM mentorship and guidance in dealing with homonegativity.

19 year-old YBMSM: My pastor and a couple of church mothers, they gave me the whole runaround on, um, ‘If you don’t change your ways you are going to hell’ and all of that. And then I was like, ‘Ok. You are trying to help but that’s not the way you can help me saying stuff like that. It just harms the person or hurts the person harder.’

Interviewer: Was anyone in your life ever supportive of you or telling you you didn’t have to change?

19 year-old YBMSM: Actually that would be my gay mother and that’s when I found my gay parents and that’s who guided me through the community. And I really thank her a lot for being there for me because if it wasn’t for her I could have been in places that could have led me so that I wouldn’t be here today. I couldn’t be here today, I wouldn’t be able to speak the way that I’m speaking. I wouldn’t be able to carry myself the way I’m carrying. The opportunity that’s been available, it’s because of her that I pushed the way that I pushed. So, because of my gay mother it’s like you can’t change who you are, be who you are and love the way that you are.

Several YBMSM also found solace in supportive school groups and community organizations including LGBT community organizations and Gay Straight Alliances at school, or had established gay families. These youth tended to be more comfortable and confident with their sexual identities and generally had more positive self-concepts than YBMSM who did not associate with the gay community.

22 year-old YBMSM: [LGBT Community Organization] have been a very, very important aspect of my life. They helped me feel comfortable even more with my environment and you know, they taught me things that I wouldn’t have even think. They’re like my second family, and I can go to them and they can come to me when things are in need.

Not surprisingly, YBMSM who were not as open with their sexuality generally did not associate with the broader LGBT community and were not involved with any LGBT organizations. Although closeted YBMSM were able to maintain strong social ties within their biological families and communities of origin, they lacked association with the broader LGBT community, which was clearly beneficial for many YBMSM in coping with homonegativity.

Discussion

The influence of the Black Church in experiences of homonegativity was evident among the YBMSM in this study. The Church is deeply intertwined within many YBMSM’s families, making it especially difficult for YBMSM to distance themselves from the Church in an effort to protect themselves against faith-based stigma. Further, religious ideologies around homosexuality extended beyond the physical structure of the Church and were frequently reinforced by family and community members.

Many YBMSM believed that, as Black men, they faced an expectation of stereotypical masculinity, which was seen as the antithesis of homosexuality. This perception is supported by Brown, whose research suggests that in the Black community “if one expresses masculinity, he is not hated as vociferously for his homosexuality as his effeminate counterpart.” [12, p 34] Although more masculine YBMSM are able to avoid more explicit homonegativity, expressions of hypermasculinity (exaggeration of traditional masculine roles through behaviors such as physical dominance and anti-femininity) are associated with psychological distress, sexual risk, and other health risk behaviors among MSM [43, 44]. Furthermore, an individual need not be the direct recipient of prejudice and discrimination to be affected by its adverse consequences. In fact, a growing body of evidence indicates that simply growing up in discriminatory environments is associated with increased psychological distress and fewer attempts to negotiate safe sex [26, 45]. This may be especially relevant for YBMSM who were not open to their friends, family, or community, as well as those who worked to be perceived as more stereotypically masculine and generally avoided discrimination based on sexual behaviors or identity. For example, one participant noted that although he had not experienced direct homonegativity, he felt sadness and frustration watching his openly gay friends get harassed on the street. Others, anxiously anticipating harassment, felt pressured to hide their sexuality. Thus, although closeted YBMSM tended to believe they had not been affected by homonegativity, its indirect consequences were evident throughout their narratives.

Given the pervasiveness of homonegativity, YBMSM set careful boundaries about revealing their sexual identities in attempts to mitigate experiences of discrimination and homonegativity from their friends, families, and communities, and only a few participants were openly gay in all aspects of their lives. In his work on stigma, Goffman emphasized choices around disclosure, developing concepts such as ‘passing’ or hiding a stigmatized characteristic [3]. Such efforts were evident among YBMSM, many of whom sought to downplay their gay appearance and aimed to pass as heterosexual. For some YBMSM, the ability to conceal their sexual identity allowed them to potentially avoid the negative consequences that may accompany being an openly gay YBMSM. Yet, camouflaging sexual identity may increase HIV risk by limiting access to protective factors including HIV prevention [46] and parental and social support during sexuality development and early sexual decision-making [47]. YBMSM who were not out reported more infrequent HIV testing and little, if any, involvement in LGBT organizations.

Yet, disclosure of sexual identity is not so straightforward for YBMSM, who risk rejection and isolation from family, friends, and the community for coming out. Given the emphasis on stereotypical notions of masculinity, the pervasiveness of faith-based homonegativity, and the conflation of being gay as being weak and feminine, Black men may risk losing their connection to the Black community by openly identifying as gay. A loss of these important social and familial ties, which several YBMSM did experience, may exacerbate HIV risk as YBMSM seek to find social support through sexual relationships [36]. Although to some extent this may be true for all MSM, it may be particularly relevant for Black MSM because of the centrality of family life and the interlocking nature of family and community. Furthermore, disclosing sexual orientation may result in a loss of a presumed-heterosexual privilege and a simultaneous ostracism from the Black community that provides refuge against racism [48]. For example, the participant in this study who described himself as ‘hood,’ feared that coming out as gay would threaten important childhood friendships and his primary connection to his neighborhood, which was a central aspect of his identity. Thus, disclosure for many YBMSM may be a double-edged sword, wherein youth risk the loss of important social ties and exacerbate HIV risk by disclosing to friends and family, yet also risk significant mental health consequences by remaining closeted.

As evidenced both explicitly and implicitly in their narratives, YBMSM carefully navigate their multiple, intersecting identities, seeking to minimize experiences and consequences of homonegativity and negotiate their identity and place in their communities and families. The nature of homonegativity, especially that experienced by Black MSM, might explain the absence of some of the most commonly cited protective factors against stigma, especially social integration. Black MSM typically encounter homonegativity from individuals embedded within their social environments and communities, including families and churches [34]. Homonegativity and stigma experienced by Black MSM has been hypothesized to be particularly damaging because it comes from the entities that they might expect to treat them with increased respect, support, and love. It was clear that preserving a connection to their families and communities of origin was important, despite any conflict their sexuality may engender.

The stigma associated with homosexuality made it difficult for some YBMSM to be open about their sexuality with important people in their lives and also undermined their ability to seek out organizations and social groups that could help them cope with that stigma. YBMSM frequently turned to the Black gay community, namely friendship networks and constructed families, to cope with homonegativity and receive support and acceptance when they experienced rejection and isolation from their families and communities of origin. Among YBMSM, increased peer support, namely, the support of other Black gay and bisexual male friends, is associated with more recent HIV testing and a strong social support network can buffer some of the structural barriers that can impede positive health behavior and may help YBMSM cope with anxiety [49].

Despite the importance of these findings, there are limitations to note. This study was limited to YBMSM who had current or recent religious involvement and thus, the prevalence of faith-based stigma and the influence of religion on family and community homonegativity may be greater among this population. YBMSM whose families are not religious may have different experiences with stigma and disclosure with their families and communities and homonegativity may not be as prevalent. Future work should similarly explore homonegativity among a more expansive population of YBMSM to determine the extent to which religion affects the broader YBMSM population

Our results lend support for the need to develop community-, family-, and church-based stigma reduction interventions that address homonegativity, particularly among YBMSM. Although religious affiliation and strong family and community ties offer numerous health benefits [50, 51], they can also be sources of intolerance and condemnation. Given their moral authority and influential presence in the Black community [52], pastors and other faith leaders may be especially effective at reducing stigma and improving tolerance and acceptance of YBMSM. Initial efforts should focus on increasing awareness about the detrimental health effects associated with stigma and increase recognition that stigma need not always come by way of direct verbal assaults or discrimination, but rather can be experienced indirectly via daily microaggressions.

Similarly, family-based interventions that address stigma and expectations of masculinity may increase acceptance of YBMSM by their families, increasing social support and mitigating one source of homonegativity. That most YBMSM had disclosed their sexuality to at least one family member and eventually found some familial acceptance highlights the importance of involving families in stigma-reduction interventions for YBMSM. Interventions to increase peer and social support, with a focus on the support of other Black gay and bisexual peers, may be an important avenue to pursue to help buffer against stigma and other social and structural barriers to positive health behaviors.

Finally, results from this study suggest that stigma among YBMSM must be understood through the lens of intersectionality. YBMSM’s multiple, interlocking identities are important to explore not only as important individual characteristics, but as a reflection of larger social and historical processes, politics, and experiences. These historically devalued identities reflect current and historical stigmas and inequalities that culminate to establish and uphold racial disparities in HIV [53]. Intersectionality provides context for the ways in which YBMSM are simultaneously socialized into various racial, gendered, and sexual identities and how they experience the overlapping stigmas consequential to these identities. Future research seeking to understand health disparities among YBMSM should bear in mind these intersecting identities and continue to place findings within the context of sociopolitical and historical structures to identify systemic and structural causes for disparities.