Social Context and Antiretroviral Adherence in HIV-Infected Young Black MSM: A Qualitative Investigation

Despite stabilization in other demographic groups, the incidence of HIV infection is increasing among adolescent Black men who have sex with men (MSM) in the United States. Antiretroviral (ARV) adherence levels are poor in adolescents and young adults, and Black MSM often suffer from poor clinical outcomes due to multiple social stressors including poverty, racism and heterosexism. At the same time, minority youth are also known to capitalize on unique community strengths and utilize myriad coping strategies. We conducted an exploratory qualitative investigation to gain a more in-depth understanding of the lived experiences of these young men. We recruited twenty HIV-infected black MSM aged 13-24 from a comprehensive HIV care center in Atlanta, Georgia, and conducted in-depth, semi-structured individual interviews. A grounded theory approach was used to guide our textual analysis and to elicit and describe 3 major themes influencing ARV adherence: 1) formative childhood and family experiences; 2) identity issues (including HIV stigma, race/ethnicity, and sexuality); and 3) HIV-related healthcare experiences. Our findings emphasize the importance of how multiple, intersecting social identities and experiences among young Black MSM are incorporated into individual-level approaches to ARV adherence. Future interventions to improve ARV adherence and decrease HIV transmission among Black MSM would benefit from tailored approaches incorporating an intersectional and assets-based approach.