HIV Prevention Decision Making Among HIV Negative Black Men Who Have Sex with Men
Methods: Following Seidman’s (2006) approach to in-depth interviewing, the 16 informants participated in three, ninety minute interviews. The first interview solicited life history data. The second interview solicited their experience of learning they are HIV negative and sustaining their serostatus. The third interview solicited the meaning the informants attributed to those experiences. The 48 interviews were analyzed using Runyan’s (1992) Stage-State Analysis, Narrative Analysis and Discourse Analysis.
Results: The data revealed a differentiation of sexual decision making according to age. The informants, who were 40 and older, described sero-sorting, engaging in more monogamy, and utilizing spirituality, over religion as elements of their daily routine. They also described being surprised by their serostatus results. These men conceptualized their status as “a second chance to get it right.” They also described testing less frequently than the younger informants. The informants, 39 and younger described using Truvada (PreP) as a part of their HIV prophylaxis/prevention strategies, described more sexual encounters with partners who were both non-black and HIV positive, consumed less alcohol, were college educated and had consistent work histories. They also described their prevention efforts as strategic and intentional. Remaining HIV negative was described a personal goal. The younger age group described a deliberate strategy in understanding the status of their sexual partners. Many described wanting to know the level of viral suppression in their sero-discordant partner. Both age groups rejected sero-conversion as an inevitable outcome. Both groups indicated that their male social networks are comprised mostly of HIV negative men.
Conclusions and Implications: The study data supports intentionality and a demonstrated ability to remain HIV negative among the informants. The data suggests social workers and other human service workers engaged in HIV prevention may engage in structural and social supports to promote the sero-negative status as a viable option for Black MSMs. The data also contests existing studies suggesting that Black MSMs mainly seek other Black MSMs as sexual partners. Additional research is needed to understand (1) the extent to which this phenomenon is prevalent in the larger population of HIV negative BMSMs, (2) the cultural relevance to primary and secondary HIV prevention strategies in the lives of BMSMs and (3) the HIV literacy/awareness of younger BMSMs.