A qualitative exploration of the personal and situational factors implicated in the sexual risk behaviors of Black men who have sex with men

Background: HIV infection continues to disproportionately burden Black men living in the United States. Qualitative exploration of the protected and unprotected sexual behaviors of Black men who have sex with men (MSM) can provide a richer contextualization of these behaviors and contribute to effective HIV prevention interventions. Methods: Forty semi-structured interviews were conducted with Black MSM in Providence, Rhode Island. Using grounded theory methodology, narrative analysis sought to identify the factors contributing to either protected or unprotected anal sex with another man within the previous 12 months. Results: Participants described patterns of protected and unprotected behaviors within the framework of adverse developmental and social factors of their lived experiences. In particular, sexual behaviors appear to be influenced by (1) family and peer support networks, (2) multiple levels of stress, (3) need for personal gratification, and (4) fear of STI infection. Knowledge about the need for condom use was high, but was not consistently practiced in the context of other more immediate demands. Conclusions: Complex interrelated factors underlie the sexual risk behaviors of Black MSM. While men appeared knowledgeable of the importance of condom use, larger situational, personal- , and partner-related factors influence the decision to engage in protected and unprotected behaviors. Future HIV prevention efforts must extend beyond safer-sex approaches and address the larger social determinants of sexual behaviors. Additionally, further qualitative examination can deepen understanding of sexual behaviors among Black MSM and provide meaningful insight into the factors driving unprotected sexual behaviors.