“An uphill battle everyday”: Exploring the implications of structural factors for sexual HIV risk among Black heterosexual men

Background: Despite the frequent use of adjectives such as “emergency” and “crisis” to describe the severe and disproportionate spread of HIV/AIDS in Black U.S. communities, Black heterosexual men are rarely the focus of HIV prevention research. Structural approaches are important for understanding the complexities of HIV risk and protective behaviors in Black communities. Methods: To explore the implications of structural factors for sexual HIV risk, we conducted semi-structured interviews with 30 Black heterosexual men recruited from randomly selected venues in Philadelphia, PA. The sample ranged in age from 18 to 44 (M = 31.47, SD = 8.41) and was predominantly lower income. Most men (62.96%, n = 17) had incomes below the median income level of $18,704. All but one man identified as heterosexual. We analyzed the data via coding and analytical memos. Results: Analyses demonstrated 7 key themes: (1) Unemployment: “It's hard out there… I mean work-wise”; (2) Incarceration: “In and outta jail a lot”; (3) Police surveillance and harassment: “You're always a target”; (4) Racial microaggressions: “Racism, most definitely”; (5) The stress of the streets: “I'm trying to survive the streets.”; (6) Psychological distress: “It kinda depressin'; and (7) Gender role strain: “I feel like I'm letting my family down.” Conclusions: We proposed a conceptual model of how structural factors may be associated with sexual HIV risk for low income urban Black heterosexual men. Structural factors such as unemployment and incarceration may be associated with psychological distress and gender role strain, and in turn sexual risk behaviors.