Sustained Seronegativity Among Black MSM in NYC: The Neg4Life Pilot Study

Purpose.  HIV seroprevalence data continue to indicate that the Black men who have sex with other men (BMSM) population is the most affected across all major categories of risk: gender, age, race, and behavior.  BMSM are disproportionately affected, unlike any other population in the US.  Researchers have investigated causes of this phenomenon among BMSM and their intertwined, complex, social and sexual networks.  The purpose of these studies has been HIV prevention development.  Considerable research has focused on the risk factors for HIV infection among BMSM.  However, the majority of BMSM who maintain HIV-negativity have not received much attention.  Since the aim of primary HIV prevention is to keep HIV-negatives negative, this group of BMSM warrants attention.  Unfortunately, the scientific literature does not address this aim.  Moreover, there is a crucial gap in the literature about behaviors, circumstances, or other factors HIV-negative BMSM report that enable them to remain HIV-negative.  

Method.  The Neg4Life pilot study had two main research questions: (1) How are non-injection drug using (non-IDU) BMSM maintaining seronegativity? and (2) Why are non-IDU BMSM maintaining seronegativity?  This qualitative study had a phenomenological methodological approach: collecting their narratives about their direct, lived experience of the phenomenon of sustained seronegativity amid high rates of seroprevalence among BMSM in NYC.  I recruited and interviewed 33 self-identified BMSM, aged 22-86, in New York City metro area using a purposeful, respondent-driven, snowball sampling strategy.  I collected qualitative data from focus groups of and individual interviews with BMSM via 90-minute semi-structured interviews.  I conducted a total of three focus groups and five individual interviews with BMSM who self-reported as seronegative.  The interview data were digitally recorded, transcribed verbatim, and coded using thematic coding analysis.  

Results.  Questions in the semi-structured interview guide addressed and explored five main domains.  Some questions asked about typical HIV prevention related items: sexual practices and knowledge, attitudes, beliefs, and skills.  Others queried about expectations (of self and from others), communication with sex partner(s), and the experience of sustaining HIV-seronegativity while living in the country’s HIV epicenter.  As a byproduct of the coding process and analysis, several major themes emerged from the data.  They consisted of “fear and anxiety,” “luck,” “self-care,” “spirituality,” “overall health and wellbeing,” “valuing self/self-value,” “”self-regulation,” “social support,” and “conviction and commitment to remaining uninfected.”  

Implications.  The purpose of the Neg4Life pilot study was to explore how and why many BMSM maintain seronegativity.  Preliminary findings from the study found among this cohort of HIV-negative BMSM living in New York City important protective factors, behaviors, and circumstances in their lives that support their sustained seronegativity.  This preliminary analysis suggests that further research on and prevention efforts for HIV-negative BMSM should examine the use of sex- and drug-related risk and harm reduction strategies, degrees and levels of social support, as well as degrees and levels of emotional concern about HIV and spirituality.  Additionally, special consideration needs to be given to motivators and motivations for HIV testing, safer sex practices, monogamy and primary relationships, and sexual practices with casual partners.