Beyond sexual labels: Exploring the social context of sexual health and HIV prevention among a sample of sexually and geographically diverse Black men in Georgia

Background: Black men in the Southeastern United States suffer from the highest rates of HIV in the country, regardless of sexual identification category or geographical location. Little research, however, has explored meaningful intra-racial comparisons of geographical contexts that include how mental health determinants and coping strategies factor into HIV risk protective and promoting behavior among a sexually diverse sample of Black men. Methods: We conducted qualitative interviews with 90 self-identified HIV negative/unknown status Black men of varying sexual behavioral categories, residing in three distinct metropolitan statistical areas in Georgia. We explored how unique social/demographic contexts (racism experiences, age, geographical location, socioeconomic status), mental health determinants (depression, gender role conflict, perceived stress), and culturally-specific coping strategies (Cool Pose, John Henryism) factor in their lives and may influence HIV risk protective and promoting behavior. Results: Common themes emerging from initial analysis included: 1) influence of local environment on social/sexual networking; 2) importance of religion and spirituality on an affirming coping approach to larger life stressors; 3) impact of poverty, masculine expectations and traumatic experiences on overall mental health; and 4) role of family and community formative experiences in shaping sexual scripts and condom use practices. Conclusions: Common social/structural considerations among Black men of varying sexualities and geographic locales exist. Future HIV prevention research and interventions with Black men should emphasize broader variables such as job training, education, coping and communication skills. Sexual health messages may be better received and sustained when addressed within these larger social/structural considerations.