Image Over Risk Reduction: Perceptions of Masculinity as HIV Risk Factors Among Nongay-Identifying HIV-Positive Black MSMW

HIV prevention research on nongay-identifying (NGI) Black men who have sex with men and women (MSMW) is lacking, especially in regards to the impact of childhood sexual abuse (CSA). Early sexual experiences may influence sexual identity, perceptions of masculinity, and risks for HIV. Masculinity, associated with strength and success, may be revered among Black men. However, a legacy of racism and oppression may pose challenges for Black men in achieving highly valued gender-based milestones, like head-of-household. Instead, masculinity may be displayed through hypersexual posturing and prowess with minimal concern for sexual health. Two groups of HIV-positive NGI Black MSMW participated in discussions focusing on masculinity and sexual experiences. Participants were bisexual HIV-positive Black men who engaged in unprotected sex and had histories of CSA. Discussions were recorded, transcribed, and analyzed. Participant mean age was 40.5 years (n=16). Majority had a high school education (69%), half were unemployed and a third earned less than $10,000 annually. CSA was perceived to be traumatic by 63% and was believed to influence sexual identity and perceptions of masculinity. Prescriptions to “hyper-heterosexual” behaviors, such as having multiple sex partners, exemplified masculinity and took priority over sexual health concerns. Masculinity provides benefits to NGI Black MSMW, such as community support against racism, discrimination and physical harm. However, attempts to be masculine may contribute to high-risk sexual behaviors. Research needs to explore how early sexual experiences shape perceptions of masculinity and masculinity's role in prevention messages for NGI Black MSMW, who may prioritize image over risk reduction.