AIDS and Behavior

, Volume 18, Issue 5, pp 972–996 | Cite as

Understanding Structural Barriers to Accessing HIV Testing and Prevention Services Among Black Men Who Have Sex with Men (BMSM) in the United States

  • Matthew E. Levy
  • Leo Wilton
  • Gregory PhillipsII
  • Sara Nelson Glick
  • Irene Kuo
  • Russell A. Brewer
  • Ayana Elliott
  • Christopher Watson
  • Manya Magnus
Substantive Review


Structural-level factors have contributed to the substantial disproportionate rates of HIV among Black men who have sex with men (BMSM) in the United States. Despite insufficient HIV testing patterns, however, there is a void in research investigating the relationship between structural factors and access to HIV testing and prevention services among BMSM. Building on previous scholarly work and incorporating a dynamic social systems conceptual framework, we conducted a comprehensive review of the literature on structural barriers to HIV testing and prevention services among BMSM across four domains: healthcare, stigma and discrimination, incarceration, and poverty. We found that BMSM experience inadequate access to culturally competent services, stigma and discrimination that impede access to services, a deficiency of services in correctional institutions, and limited services in areas where BMSM live. Structural interventions that eliminate barriers to HIV testing and prevention services and provide BMSM with core skills to navigate complex systems are needed.


Black men who have sex with men HIV HIV testing Structural barriers Healthcare services Stigma Incarceration Poverty Prevention 



The authors acknowledge colleagues Kyle Gordon, Alexander King, Vittoria Criss, Dr. James Peterson, and Dr. Sheldon Fields for their devoted work on the R21 project (MH097586). The authors appreciate Dr. Alan Greenberg for his ongoing support and thank Laura Abate for her guidance in conducting the literature search. Research reported in this publication was supported by the National Institute of Mental Health of the National Institutes of Health under Award Number R21 MH097586. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The authors are grateful for the support and guidance provided by the District of Columbia Developmental Center for AIDS Research (DC D-CFAR), an NIH-funded Program (P30AI087714).


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Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Matthew E. Levy
    • 1
  • Leo Wilton
    • 2
  • Gregory PhillipsII
    • 1
  • Sara Nelson Glick
    • 1
  • Irene Kuo
    • 1
  • Russell A. Brewer
    • 3
  • Ayana Elliott
    • 4
  • Christopher Watson
    • 1
  • Manya Magnus
    • 1
  1. 1.Department of Epidemiology and BiostatisticsThe George Washington University School of Public Health and Health ServicesWashingtonUSA
  2. 2.Department of Human Development, College of Community and Public AffairsBinghamton UniversityBinghamtonUSA
  3. 3.Louisiana Public Health InstituteNew OrleansUSA
  4. 4.Division of Student Affairs, University Health ServicesUniversity of the District of ColumbiaWashingtonUSA

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