What's in a label?: Multiple meanings and associated identities of ‘MSM' among African American men in Mississippi

Background: Men who have sex with men (MSM) continue to be disproportionately affected by HIV, particularly African American (AA) MSM, and the Southern U.S. annually accounts for half of new diagnoses. Innovative strategies are needed to support the health of this community; however, to date, the majority of public health efforts approach MSM as a monolithic population erasing the diversity of identities/practices/sexualities within the category.

Methods: The qualitative study conducted four focus groups with 29 AA MSM at a local public clinic in Jackson, Mississippi to explore identities within the MSM category in relation to HIV sexual risk and testing behaviors among this population. Topic areas were types of and interactions between social groups, condom negotiation, and HIV testing. Grounded theory was used to identify patterns/ themes in focus group transcripts.

Results: Participants (ages 18-42, mean age of 25) identified/described 39 identities within the MSM category in the AA MSM Jackson community. Five themes emerged from the focus groups: 1) oppression of second class identities, 2) stereotypes, expectations, and conflicts, 3) stigmatizing down-lows, 4) navigating the stigma attached to down-low and pressures to play the hypermasculine male role, and 5) resisting stereotypes.

Conclusions: Results suggest the multiple overlapping usages of MSM as identity and behavior, reflecting internalization of behavioral categories and creation of identity labels unique to the AA community. Findings suggest that the current monolithic approach to treating MSM as one population limits public health efforts in developing effective HIV prevention programs targeting AA MSM in the Deep South.