Negotiating Masculinity: Sex and Incarceration among HIV- and HIV+ Bisexually Active Black men

Background: The parallel epidemics of HIV and incarceration disproportionately affect Black men. One in 21 Black men, and one in nine Black men between the ages of 25 and 34, are currently incarcerated in the United States. The highest rates of HIV in the U.S. are found among urban Black men who have sex with men, including bisexually active men. Methods: The MASAI Study was a qualitative research project with 60 HIV- and HIV+ bisexually active Black men from 2009 - 2011. A one-time qualitative interview asked about sexual identity and practices, incarceration, and HIV risk. Two trained analysts used ATLAS.ti to conduct qualitative analyses of the socio-spatial context of incarceration and HIV risk. Results: Forty-nine men (82%) in this sample had been incarcerated in their lives. These men described a tenuous maintenance of masculinity inside that they negotiated through sexual practices amidst complex sexual and social hierarchies. Sexual activity ranged from consensual to coercive. Some men described experiences of coercive sex if they did not cohere to the gendered systems inside. “Being a man” was intimately linked to their wellbeing and often survival in the system. Some men described not wanting to or not having sex inside because they were not willing to risk their reputation as heterosexual on the street. Conclusions: Bisexually active Black men describe negotiating gendered sexual and social systems while incarcerated. Understanding the context of incarceration for men's sexual practices and identities is critical for advancing HIV prevention efforts among Black men in particular.