Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham.
Emory University Rollins School of Public Health, Emory University.
Behav Med. 2021 Jul-Sep;47(4):324-334. doi: 10.1080/08964289.2020.1870428. Epub 2021 Mar 11.
HIV disparities among Young, Black men who have sex with men (YBMSM) persist despite concerted efforts to increase uptake of prevention tools like HIV pre-exposure prophylaxis (PrEP). We conducted in-depth interviews with 25 YBMSM (aged 18-29 years old) to understand factors contributing to PrEP access in Birmingham, Alabama. We identified that one major barrier to PrEP uptake was intersectional stigma related to their multiple identities and contributed to lack of feeling able to accept their sexual identities. Facilitators of validation and acceptance of sexual identity were strong social support networks, which participants reported consisted of, not only other gay and bisexual Black men, but also Black women, an unexplored social support group among YBMSM networks. However, participants felt that internal, perceived and experienced homophobia were exacerbated in Southern, Black communities due to perceived values surrounding masculinity, which were reinforced by religious doctrine. Looking forward, public health officials will need to add additional resources to support interventions that have meso-level impact to effectively change social norms as a critical determinant of individual-level prevention practices within this at-risk group and their social networks.
尽管为增加预防工具（如 HIV 暴露前预防[PrEP]）的采用做出了协调一致的努力，但 YBMSM（18-29 岁的黑人男同性恋和双性恋者）中 HIV 差异仍然存在。我们对 25 名 YBMSM 进行了深入访谈，以了解阿拉巴马州伯明翰影响 PrEP 可及性的因素。我们发现，阻碍 PrEP 接种的一个主要障碍是与他们的多重身份相关的交叉歧视，导致他们无法接受自己的性取向。促进对性取向的认同和接受的因素是强大的社会支持网络，参与者报告说，这些网络不仅包括其他同性恋和双性恋的黑人男性，还包括黑人女性，这是 YBMSM 网络中一个未被探索的社会支持群体。然而，参与者认为，由于围绕男子气概的观念以及宗教教义的强化，南方黑人社区中内部感知到的和经历过的恐同现象更加严重。展望未来，公共卫生官员需要增加额外资源，以支持具有中观层面影响的干预措施，从而有效改变这一高危群体及其社交网络内的个人层面预防实践的社会规范。
