Skip to main content
SpringerLink
Log in

Sexual Orientation, HIV Vulnerability-Enhancing Behaviors and HIV Status Neutral Care Among Black Cisgender Sexual Minority Men in the Deep South: The N2 Cohort Study

  • Original Paper
  • Published:
AIDS and Behavior Aims and scope Submit manuscript

Abstract

Black sexual minority men (SMM) in the Deep South are heavily impacted by HIV; yet studies fail to consider discordance across aspects of sexual orientation (i.e., identity, attraction, behavior) or how a lack of concordance enhances vulnerability to HIV. We sought to explore the overlap across aspects of sexual orientation and examine associations between each aspect and the number of sexual partners who engaged in HIV vulnerability-enhancing behaviors, and HIV prevention and care outcomes. A total of 204 Black SMM completed surveys, reporting their sexual identity, attraction, and behavior (i.e., sex with men only vs. sex with men and women), number of condomless sex or transactional sex (e.g., buyers vs. sellers) partners in the past 6 months, and adherence to pre-exposure prophylaxis (PrEP) or antiretroviral therapy (ART) among users. Less than one in four participants (22.5%) reported overlap in same-sex sexual orientations, while 17.1% of bisexual men reported overlap across aspects. In multivariable models, differences were found in how aspects of sexual orientation were associated with the number of partners who bought or sold sex; as well as how often participants tested for HIV in the past 12 months. Results suggest different aspects of sexual orientation have implications for addressing HIV among Black SMM in the Deep South.

Resumen

Los hombres negros de minorías sexuales (SMM) en el Sur Profundo de los Estados Unidos se ven gravemente afectados por el VIH; sin embargo, los estudios no suelen considerar la discrepancia entre los diferentes aspectos de la orientación sexual (es decir, identidad, atracción, comportamiento) o cómo la falta de concordancia aumenta la vulnerabilidad al VIH. Buscamos explorar el grado de concordancia entre los aspectos de la orientación sexual y examinar las asociaciones entre cada aspecto y la cantidad de parejas sexuales que se involucraron en comportamientos que incrementan la vulnerabilidad al VIH y los resultados de la prevención y atención del VIH. Un total de 204 hombres negros de SMM completaron encuestas sobre su identidad sexual, atracción y comportamiento (es decir, sexo solo con hombres frente a hombres y mujeres), número de parejas sexuales sin condón o sexo transaccional (p. ej., compradores frente a vendedores) en los últimos seis meses, y la adherencia a la profilaxis previa a la exposición (PrEP) o la terapia antirretroviral (TAR) entre los que utilizan estas tecnologías médicas. Menos de uno de cada cuatro participantes (22.5%) reportaron concordancia entre los distintos aspectos de la orientación sexual, mientras que el 17.1% de los hombres bisexuales reportaron concordancia en todos los aspectos. Utilizando modelos multivariables, se encontraron diferencias en el grado de asociación entre los diferentes aspectos de la orientación sexual y el número de parejas que compraron o vendieron sexo, así como entre los distintos aspectos de la orientación sexual y la frecuencia con la que los participantes se hicieron la prueba del VIH en los últimos 12 meses. Los resultados sugieren que diferentes aspectos de la orientación sexual tienen implicaciones para abordar el VIH entre los SMM negros en el Sur Profundo.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Data Availability

Data, material and code used in this study are available from the corresponding author upon request.

References

  1. Reif S, Cooper H, Warren M, Wilson E. HIV in the US Deep South: Trends from 2008–2019. Southern AIDS Coalition; 2021. https://southernaidscoalition.org/hiv-trends-report/

  2. Reif S, Safley D, McAllaster C, Wilson E, Whetten K. State of HIV in the US deep south. J Commun Health. 2017;42(5):844–53.

    Article  Google Scholar 

  3. Centers for Disease Control and Prevention. Ending the HIV Epidemic in the U.S. (EHE) [Internet]. 2022. https://www.cdc.gov/endhiv/index.html

  4. Lieb S, Fallon SJ, Friedman SR, Thompson DR, Gates GJ, Liberti TM, et al. Statewide estimation of racial/ethnic populations of men who have sex with men in the US. Public Health Rep. 2011;126(1):60–72.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Centers for Disease Control and Prevention. New CDC Vital Signs report reveals a decade of continuing HIV inequities [Internet]. 2021. https://www.cdc.gov/nchhstp/newsroom/

  6. Crosby RA, Mena L, Geter A, Hickson D. Similarities and differences in sexual risk behaviors between young black MSM who do and do not have sex with females. AIDS Behav. 2016;20(4):717–21.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Feinstein BA, Moran KO, Newcomb ME, Mustanski B. Differences in HIV risk behaviors between self-identified gay and bisexual young men who are HIV-negative. Arch Sex Behav. 2019;48(1):261–75.

    Article  PubMed  Google Scholar 

  8. Garcia J, Parker RG, Parker C, Wilson PA, Philbin M, Hirsch JS. The limitations of ‘Black MSM’ as a category: why gender, sexuality, and desire still matter for social and biomedical HIV prevention methods. Glob Public Health. 2016;11(7–8):1026–48.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Truong N, Perez-Brumer A, Burton M, Gipson J, Hickson D. What is in a label? Multiple meanings of ‘MSM’ among same-gender-loving Black men in Mississippi. Glob Public Health. 2016;11(7–8):937–52.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Institute of Medicine. The health of lesbian, gay, bisexual, and transgender people: building a foundation for better understanding. Washington: National Academies Press; 2011.

    Google Scholar 

  11. Watson RJ, Allen A, Pollitt AM, Eaton LA. Risk and protective factors for sexual health outcomes among black bisexual men in the US: internalized heterosexism, sexual orientation disclosure, and religiosity. Arch Sex Behav. 2019;48(1):243–53.

    Article  PubMed  Google Scholar 

  12. Watson RJ, Morgan E, Sherman J, Caba AE, Wheldon CW, Chan PA, et al. Pre-exposure prophylaxis (PrEP) use, anticipated PrEP stigma, and bisexual identity among a Black and Hispanic/Latino sexual and gender diverse sample. Behav Med. 2022;25:1–9.

    Article  Google Scholar 

  13. Timmins L, Duncan DT. It’s raining MSM: the continued ubiquity of contentious terminology in research on sexual minority men’s health. Am J Public Health. 2020;110(11):1666–8.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Parker R. Sexuality, culture and society: shifting paradigms in sexuality research. Cult Health Sex. 2009;11(3):251–66.

    Article  PubMed  Google Scholar 

  15. Baunach DM, Burgess EO. Sexual identity in the American deep south: the concordance and discordance of sexual activity, relationships, and identities. J Homosex. 2013;60(9):1315–35.

    Article  PubMed  Google Scholar 

  16. Halkitis PN, Kapadia F, Bub KL, Barton S, Moreira AD, Stults CB. A Longitudinal investigation of syndemic conditions among young gay, bisexual, and other MSM: The P18 Cohort Study. AIDS Behav. 2015;19(6):970–80.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Quinn K, Bowleg L, Dickson-Gomez J. “The fear of being Black plus the fear of being gay”: the effects of intersectional stigma on PrEP use among young Black gay, bisexual, and other men who have sex with men. Soc Sci Med. 2019;232:86–93.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Meyer IH. Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: conceptual issues and research evidence. Psychol Bull. 2003;129(5):674–97.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Bowleg L. The problem with the phrase women and minorities: intersectionality—an important theoretical framework for public health. Am J Public Health. 2012;102(7):1267–73.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Bowleg L. “Once you’ve blended the cake, you can’t take the parts back to the main ingredients”: black gay and bisexual men’s descriptions and experiences of intersectionality. Sex Roles. 2013;68(11–12):754–67.

    Article  Google Scholar 

  21. Philbin MM, Parker CM, Parker RG, Wilson PA, Garcia J, Hirsch JS. Gendered social institutions and preventive healthcare seeking for black men who have sex with men: the promise of biomedical HIV prevention. Arch Sex Behav. 2018;47(7):2091–100.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Elopre L, McDavid C, Brown A, Shurbaji S, Mugavero MJ, Turan JM. Perceptions of HIV pre-exposure prophylaxis among young, black men who have sex with men. AIDS Patient Care STDS. 2018;32(12):511–8.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Power J, Amir S, Lea T, Brown G, Lyons A, Carman M, et al. Bisexual men living with HIV: wellbeing, connectedness and the impact of stigma. AIDS Behav. 2021;25(12):4085–93.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Quinn K, Dickson-Gomez J, Zarwell M, Pearson B, Lewis M. “A gay man and a doctor are just like, a recipe for destruction”: how racism and homonegativity in healthcare settings influence PrEP uptake among young black MSM. AIDS Behav. 2019;23(7):1951–63.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Quinn K, Dickson-Gomez J. Homonegativity, religiosity, and the intersecting identities of young black men who have sex with men. AIDS Behav. 2016;20(1):51–64.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Driver R, Kalichman SC. Precarious manhood and intentions to initiate preexposure prophylaxis among Black sexual minority men. Health Psychol. 2022;41(7):474–83.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Feinstein BA, Dyar C. Bisexuality, minority stress, and health. Curr Sex Health Rep. 2017;9(1):42–9.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Timmins L, Schneider JA, Chen YT, Goedel WC, Brewer R, Callander D, et al. Sexual identity, sexual behavior and pre-exposure prophylaxis in black cisgender sexual minority men: The N2 Cohort Study in Chicago. AIDS Behav. 2021;25(10):3327–36.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Malebranche D. Bisexually active black men in the United States. Arch Sex Behav. 2008;37:810–6.

    Article  PubMed  Google Scholar 

  30. Millett G, Malebranche D, Mason B, Spikes P. Focusing down low bisexual black men, HIV risk and heterosexual transmission. J Natl Med Assoc. 2005;97(7):52–9.

    Google Scholar 

  31. Jeffries WL. Beyond the bisexual bridge. Am J Prev Med. 2014;47(3):320–9.

    Article  PubMed  Google Scholar 

  32. Fish JN, Krueger EA. Reconsidering approaches to estimating health disparities across multiple measures of sexual orientation. LGBT Health. 2020;7(4):198–207.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Duncan DT, Hickson DA, Goedel WC, Callander D, Brooks B, Chen YT, et al. The social context of HIV prevention and care among black men who have sex with men in three US Cities: The Neighborhoods and Networks (N2) Cohort Study. IJERPH. 2019;16(11):1922.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Chen YT, Duncan DT, Issema R, Goedel WC, Callander D, Bernard-Herman B, et al. Social-environmental resilience, PrEP uptake, and viral suppression among young black men who have sex with men and young black transgender women: the neighborhoods and networks (N2) study in Chicago. J Urban Health. 2020;97(5):728–38.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Nelson KM, Eaton LA, Gamarel KE. Preferences for condomless sex in sexually explicit media among Black/African American men who have sex with men: implications for HIV prevention. Arch Sex Behav. 2017;46(4):977–85.

    Article  PubMed  Google Scholar 

  36. Bond KT, Yoon IS, Houang ST, Downing MJ, Grov C, Hirshfield S. Transactional sex, substance use, and sexual risk: comparing pay direction for an internet-based US sample of men who have sex with men. Sex Res Soc Policy. 2019;16(3):255–67.

    Article  Google Scholar 

  37. Jeffries WL. HIV testing among bisexual men in the United States. AIDS Educ Prev. 2010;22(4):356–70.

    Article  PubMed  Google Scholar 

  38. Malebranche DJ, Arriola KJ, Jenkins TR, Dauria E, Patel SN. Exploring the “bisexual bridge”: a qualitative study of risk behavior and disclosure of same-sex behavior among black bisexual men. Am J Public Health. 2010;100(1):159–64.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Bird JDP, Voisin DR. “You’re an open target to be abused”: a qualitative study of stigma and HIV self-disclosure among black men who have sex with men. Am J Public Health. 2013;103(12):2193–9.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Friedman MR, Bukowski L, Eaton EA, et al. Psychosocial health disparities among black bisexual men: effects of sexual nondisclosure and gay community support. Arch Sex Behav. 2019;48(1):213–24.

    Article  PubMed  Google Scholar 

  41. Ott MQ, Corliss HL, Wypij D, Rosario M, Austin SB. Stability and change in self-reported sexual orientation identity in young people: application of mobility metrics. Arch Sex Behav. 2011;40(3):519–32.

    Article  PubMed  Google Scholar 

Download references

Funding

The authors disclose receipt of the following financial support for the research, authorship, and/or publication of this article. The project described was supported by Award Number U01PS00512 from the National Center for HIV, Viral Hepatitis, STDs and TB Prevention and T32MH019139 from the National Institute of Mental Health.

Author information

Authors and Affiliations

  1. HIV Center for Clinical and Behavioral Studies at New York State Psychiatric Institute and Columbia University, New York, NY, USA

    Redd Driver & Dustin T. Duncan

  2. Department of Psychiatry, Columbia University, New York, NY, USA

    Redd Driver

  3. Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA

    Redd Driver & Dustin T. Duncan

  4. Department of Medicine, University of Chicago, Chicago, IL, USA

    John A. Schneider & Russell A. Brewer

  5. Department of Public Health Sciences, University of Chicago, Chicago, IL, USA

    John A. Schneider

  6. Chicago Center for HIV Elimination, University of Chicago, Chicago, IL, USA

    John A. Schneider

  7. Crown School of Social Work, University of Chicago, Chicago, IL, USA

    John A. Schneider

  8. Us Helping US, People Into Living, Inc, Washington, D.C., USA

    DeMarc A. Hickson

  9. School of Psychology, Swansea University, Swansea, Wales, UK

    Liadh Timmins

  10. Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA

    William C. Goedel

Authors
  1. Redd Driver
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. John A. Schneider
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. DeMarc A. Hickson
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Liadh Timmins
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Russell A. Brewer
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. William C. Goedel
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Dustin T. Duncan
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

RD: Conceptualization, methodology, formal analysis, writing—Original draft. JASchneider: Investigation, writing—review and editing, supervision. DAH: Funding acquisition, writing—review and editing. LT: Data collection, methodology, writing—review and editing. RB: Writing—review and editing. WCG: Writing—review and editing. DTD: Funding acquisition, conceptualization, methodology, validation, writing—review and editing, supervision.

Corresponding author

Correspondence to Redd Driver.

Ethics declarations

Conflict of interest

The content is solely the responsibility of the authors and does not necessarily represent the official views of the Centers for Disease Control and Prevention, National Institute of Mental Health, or the National Institutes of Health.

Ethical Approval

Ethics approval for the present study was provided by the New York University Grossman School of Medicine’s institutional review board. Columbia University Mailman School of Public Health’s institutional review board provided ethical approval for secondary analysis.

Informed Consent

All participants provided written informed consent to participate in all study activities.

Consent for Publication of Images or Data

N/A.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Driver, R., Schneider, J.A., Hickson, D.A. et al. Sexual Orientation, HIV Vulnerability-Enhancing Behaviors and HIV Status Neutral Care Among Black Cisgender Sexual Minority Men in the Deep South: The N2 Cohort Study. AIDS Behav 27, 2592–2605 (2023). https://doi.org/10.1007/s10461-023-03984-7

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10461-023-03984-7

Keywords

Search

Navigation