Links Between Sexual Orientation and Disclosure Among Black MSM: Sexual Orientation and Disclosure Matter for PrEP Awareness

  • Ryan J. WatsonEmail author
  • Lisa A. Eaton
  • Jessica L. Maksut
  • Katherine B. Rucinski
  • Valerie A. Earnshaw
Original Paper


The HIV epidemic in the United States has disproportionately burdened Black men who have sex with men (MSM), particularly in the South. While pre-exposure prophylaxis (PrEP) has high demonstrated efficacy, uptake is low among Black MSM. We utilized a sample of 345 HIV-negative or unknown HIV status Black MSM from Atlanta, Georgia. Bivariate and multivariable logistic regression models examined the effects of sexual orientation and disclosure on PrEP awareness and use. Despite the majority of the sample reporting PrEP awareness (91%), few Black MSM in our sample had ever used PrEP (10%). Bisexual Black MSM were less likely to have been aware of PrEP compared to their same-gender loving/gay counterparts. Black MSM who had disclosed their sexual orientation to some or all of the members of their networks were more aware of PrEP compared to their counterparts who reported lower levels of disclosure, but were not more likely to actually use PrEP. Alarmingly, the gap in PrEP awareness and use has not decreased over the past 5 years. These findings suggest that disclosure may be a relevant characteristic to consider for PrEP awareness, but there may be more to consider in closing the awareness-uptake gap among Black MSM.


PrEP MSM Sexual minority HIV prevention 



Research was funded by NIH Grants R01MH109409, R34MH115798, K01DA047918, T32AI102623, and K01DA042881.

Compliance with Ethical Standards

Conflict of interest

The authors have no conflicts of interest to report.

Ethical Approval

This research involved Human Subjects and was conducted with the approval of the University of Connecticut Institutional Review Board and research was conducted in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.


  1. 1.
  2. 2.
    Bureau U. State & County Quick Facts. 2008.
  3. 3.
    Murnane PM, Celum C, Nelly M, et al. Efficacy of pre-exposure prophylaxis for HIV-1 prevention among high risk heterosexuals: subgroup analyses from the Partners PrEP Study. AIDS (London, England). 2013;27(13):2155–60.CrossRefGoogle Scholar
  4. 4.
    Millett GA, Peterson JL, Flores SA, et al. Comparisons of disparities and risks of HIV infection in black and other men who have sex with men in Canada, UK, and USA: a meta-analysis. The Lancet. 2012;380(9839):341–8.CrossRefGoogle Scholar
  5. 5.
    Maulsby C, Millett G, Lindsey K, et al. HIV among black men who have sex with men (MSM) in the United States: a review of the literature. AIDS Behav. 2014;18(1):10–25.CrossRefGoogle Scholar
  6. 6.
    Matthews DD, Herrick AL, Coulter RW, et al. Running backwards: consequences of current HIV incidence rates for the next generation of black MSM in the United States. AIDS Behav. 2016;20(1):7–16.CrossRefGoogle Scholar
  7. 7.
    Eaton LA, Matthews DD, Driffin DD, et al. A multi-US city assessment of awareness and uptake of pre-exposure prophylaxis (PrEP) for HIV prevention among Black men and transgender women who have sex with men. Prev Sci. 2017;18(5):505–16.CrossRefGoogle Scholar
  8. 8.
    Meyer I. Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: Conceptual issues and research evidence. Psychol Bull. 2003;129(5):674–97. Scholar
  9. 9.
    Watson R, Fish J, Allen A, Eaton L. Sexual identity disclosure and awareness of HIV prevention methods among Black men who have sex with men. Journal of Sex Research. 2017. Scholar
  10. 10.
    Eaton LA, Kalichman SC, Price D, Finneran S, Allen A, Maksut J. Stigma and conspiracy beliefs related to pre-exposure prophylaxis (PrEP) and interest in using PrEP among Black and White men and transgender women who have sex with men. AIDS Behav. 2017;21(5):1236–46.CrossRefGoogle Scholar
  11. 11.
    Golub SA. PrEP stigma: implicit and explicit drivers of disparity. Curr HIV/AIDS Rep. 2018;15(2):190–7.CrossRefGoogle Scholar
  12. 12.
    Cahill S, Taylor SW, Elsesser SA, Mena L, Hickson D, Mayer KH. Stigma, medical mistrust, and perceived racism may affect PrEP awareness and uptake in black compared to white gay and bisexual men in Jackson, Mississippi and Boston, Massachusetts. AIDS Care. 2017;29(11):1351–8.CrossRefGoogle Scholar
  13. 13.
    Ayala G, Makofane K, Santos G-M, et al. Access to basic HIV-related services and PrEP acceptability among men who have sex with men worldwide: barriers, facilitators, and implications for combination prevention. J Sex Transm Dis. 2013;2013:11.Google Scholar
  14. 14.
    Pachankis JE, Goldfried MR. Social anxiety in young gay men. J Anxiety Disord. 2006;20(8):996–1015.CrossRefGoogle Scholar
  15. 15.
    Juster R-P, Smith NG, Ouellet É, Sindi S, Lupien SJ. Sexual orientation and disclosure in relation to psychiatric symptoms, diurnal cortisol, and allostatic load. Psychosom Med. 2013;75(2):103–16.CrossRefGoogle Scholar
  16. 16.
    Morris JF, Waldo CR, Rothblum ED. A model of predictors and outcomes of outness among lesbian and bisexual women. Am J Orthopsychiatry. 2001;71(1):61–71.CrossRefGoogle Scholar
  17. 17.
    D’Augelli AR, Hershberger SL, Pilkington NW. Lesbian, gay, and bisexual youth and their families: disclosure of sexual orientation and its consequences. Am J Orthopsychiatry. 1998;68(3):361–71.CrossRefGoogle Scholar
  18. 18.
    Friedman MS, Marshal MP, Stall R, Cheong J, Wright ER. Gay-related development, early abuse and adult health outcomes among gay males. AIDS Behav. 2008;12(6):891–902. Scholar
  19. 19.
    Marcus JL, Hurley LB, Hare CB, et al. Preexposure prophylaxis for HIV prevention in a large integrated health care system adherence, renal safety and discontinuation. J Acquir Immune Defic Syndr. 2016;73(5):540.CrossRefGoogle Scholar
  20. 20.
    Watson RJ, Wheldon CW, Russell ST. How does sexual identity disclosure impact school experiences? J LGBT Youth. 2015;12(4):385–96.CrossRefGoogle Scholar
  21. 21.
    Parsons J, Rendina H, Lassiter J, Whitfield T, Starks T, Grov C. Uptake of HIV Pre-exposure prophylaxis (PrEP) in a national cohort of gay and bisexual men in the United States. J Acquir Immune Defic Syndr. 2017;74(3):285–92.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Human Development and Family SciencesUniversity of ConnecticutStorrsUSA
  2. 2.Institute for Collaboration on Health, Intervention, and Policy, University of ConnecticutStorrsUSA
  3. 3.Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreUSA
  4. 4.Department of Human Development & Family SciencesUniversity of DelawareNewarkUSA

Personalised recommendations