“It's hard bein' a Black man”: The ecological context of Black men's heterosexual HIV risk behaviors

Background: The HIV/AIDS epidemic continues to have a severe and disproportionate impact in Black communities, with Black heterosexually active men playing a major role in HIV transmission. Yet, this population is largely invisible in HIV prevention research. This NIH/NICHD-funded study used qualitative methods to gain a culturally grounded understanding of how structural context (racial discrimination, unemployment, incarceration) masculinity, sexual scripts, and religiosity/spirituality may influence condom use among 56 Black heterosexual men in Philadelphia, PA.

Methods: We conducted 4 focus groups (n = 26) and 30 individual interviews to explore themes relevant to Black heterosexual men's perspectives about structural contextual factors, masculinity, sexual scripts, and religiosity/spirituality and condom use.

Results: Participants ranged in age from 18 to 44 (M = 31.30, SD = 8.23) with 51.7% reporting annual incomes of less than $19,999 and 41.1% reporting incomes greater than $20,000. Analyses identified new dimensions relevant to structural context (e.g., unemployment, financial hardships, problems finding work post-incarceration), masculinity (e.g., redefining aggressive to mean taking care of one's children), and religiosity and spirituality (e.g., religion as a coping strategy). Analyses also identified new themes: life as a struggle psychological distress, and experiences of violence.

Conclusions: Participants frequently described structural factors such as unemployment and racial discrimination as influencing stress and psychological distress in ways that have implications for lack of interest in condom use. These findings suggest that a social discrimination framework is vital to understanding the links between structural factors, psychological distress and individual HIV risk behavioral choices among Black heterosexual men.