When Knowledge Clashes with Judgment: Black Men's Subjective Assessments of HIV risk in Prospective Male Partners

Background: HIV infection continues to disproportionately affect 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 rich contextualization of these behaviors and contribute important information to the development of HIV prevention interventions. This study aimed to explore factors leading Black MSM to engage in either protected or unprotected sexual intercourse with another male. Methods: Thirty-four semi-structured interviews were conducted with African American MSM living in the Providence, Rhode Island area. In-depth qualitative narrative analysis sought to describe factors shaping men's subjective assessment of partners' HIV risk and their personal sexual behavior decisions. Results: Participants' assessment of HIV risk fell into three categories. First, following initial social interactions with prospective male sex partners, participants' decisions and behaviors about condom use were guided by their own intuitive judgments of partners' trustworthiness and sense of responsibility. Second, visual perceptions of a partner's hygiene guided assumptions of that partners' HIV status and consequently influenced their sexual behaviors. Finally, the location at which participants met male sex partners guided their determinations of their partner's HIV status and related health risks. Conclusions: Although men generally had high knowledge of HIV transmission and the need for condom use, their sexual decisions were guided by highly subjective and often faulty forms of logic. Men's reliance on situational, social, and visual cues to make potentially inaccurate determinations of partner's HIV status contributes to sexual risk behaviors.