“Boys must be men, and men must have sex with women”: A qualitative CBPR study to explore sexual risk among African American, Latino, and white gay men and MSM

Background: Men who have sex with men (MSM) continue to be disproportionately impacted by HIV and sexually transmitted diseases (STDs).

Methods: This study was designed to explore sexual risk among MSM using community-based participatory research (CBPR). An academic-community partnership conducted nine focus groups throughout North Carolina with 88 MSM. The objective was to qualitatively explore sexual risk and identify potentially effective intervention approaches to reduce risk among MSM. Grounded theory was used for qualitative data analysis.

Results: Participants self-identified as African American/Black (n=28), Hispanic/Latino (n=33), white (n=21), and bi-racial/ethnic (n=6). Mean age was 27 (range 18-60) years.

We identified 12 themes, including low HIV and STD knowledge particularly among Latino MSM and MSM who use the Internet for sexual networking; manhood being affirmed through sex and sexual risk; stereotyping of African American MSM as sexually “dominant” and Latino MSM as less likely to be HIV infected; and the eroticization of “barebacking.”

We also identified 12 intervention approaches, including developing culturally congruent programming using community-identified assets; offering safe spaces for facilitated supportive men's group dialogue around issues of masculinity; family, religious and societal expectations; and intimacy among men harnessing social media used by informal networks of MSM; promoting protection within the context of intimate relationships; and focusing on developing culturally congruent programming to reach MSM who live in rural communities, speak Spanish, do not go to gay bars/clubs, and MSM who are considered to be hidden on . A statewide community forum was held to develop recommendations and move these themes to action.

Conclusions: Findings suggest that despite 3 decades since the identification of HIV, MSM in the southeastern US continue to need targeted sexual health and HIV and STD prevention education to increase knowledge and reduce misconceptions.