Relationship Context of HIV Prevention among Bisexually Active Black men

Background: The highest rates of HIV in the U.S. are found among urban Black men who have sex with men, including bisexually active men. The relationships of these men remain understudied. This analysis investigates the cultural and relationship context of HIV risk among a sample of 60 bisexually active Black men in the San Francisco Bay Area. Methods: The MASAI Study was a qualitative research project that aimed to build a theoretical framework for the structural and cultural context of sexuality and HIV among 60 HIV- and HIV+ bisexually active Black men from 2009 - 2011. A one-time qualitative interview asked about sexual identity and practices, HIV risk, disclosure, and incarceration. Qualitative analyses were conducted by trained analysts using ATLAS.ti. Results: HIV+ and HIV- men described high levels of unprotected sex with women and HIV- men. Having unprotected sex with women and having multiple, concurrent partners was described in the context of building masculinity. Disclosure of bisexual activity was more likely in long-term relationships and with male partners. Telling male partners about bisexual activity was described as enhancing sexual status, whereas telling women threatened their sense of masculinity. Conclusions: Black men negotiate relationships in the context of cultural ideologies of masculinity, race, and class. Sexual risk takes place in the context of relationship factors including processes of disclosure, as well as gender and power dynamics. There is an urgent need for culturally relevant prevention interventions that address the relationship context of HIV to reduce risk among bisexually active Black men.