Identifying the Biopsychosocial Strengths and Resiliencies of Black MSM in New York City Who Maintain HIV-Negativity

Background and Purpose

In 2010, there was an estimated 10,600 new infections among Black MSM (BMSM) and in 2011, BMSM accounted for over 12,000 cases (39%) of all HIV diagnoses in all MSM—indicating that this population is the most affected across all major demographic subgroups and categories of risk.  BMSM who remain HIV-negative are understudied and the scientific literature does not consider their strengths resiliencies in any depth.  This study addresses the critical need increase our knowledge about the biopsychosocial strengths and resiliencies that BMSM report enable them to remain HIV-negative. 

Method

The study aimed to qualitatively explicate the biopsychosocial strengths and resiliencies that contribute to BMSM’s sustained HIV-negativity by answering the following research questions:  1) What are the biopsychosocial strengths and resiliencies that contribute to the maintenance of HIV-negativity in Black MSM? and 2) What are the strategies and tactics, besides condom use, that Black MSM employ to maintain their HIV-negative status? The study employed a constructivist grounded theory that provided a theoretical analysis of phenomena based on participants’ understandings of their sustained HIV-negativity.  Gay resilience theory provided an additional perspective for examining sustained HIV-negativity in BMSM.  For the purpose of this study, sustained HIV-negativity was conceptualized as remaining HIV-uninfected as documented by a HIV-negative test result within the last 12 months.  The study sought to recruit 20 BMSM in NYC or until “saturation” was reached in analysis or until no new properties of categories emerged.  Participants were recruited using a purposive, theoretical sampling strategy.  Each BMSM participated in three in-depth individual interviews over a period six weeks.  Narrative data were collected from all the individual interviews and at three follow up focus groups that lasted, on average, between 90-120 minutes.  Data coding consisted of a progressive coding process: open, focused, axial, and, finally, theoretical coding to make the codes integrative for generating theory.  Data analysis also employed the strategies of member checking, mentor and peer debriefing, data triangulation, and memoing. 

Results

            The study enrolled 25 HIV-uninfected BMSM aged 21-86 with no reported history of injection drug use and moderate alcohol and other drug use.  The qualitative interviews and focus groups yielded some of the following major themes/constructs that informed the preliminary development of theory:  social support, seroprotective behaviors and strategies, bucking HIV stigma, and HIV-negative specific resiliencies.

Conclusions and Implications

This study identified salient biopsychosocial strengths and resiliencies that have enables a sample of BMSM in NYC to remain HIV-uninfected.  The findings have both salient methodological and practice implications that can inform future research and practice focusing on primary HIV prevention in BMSM.  For instance, the interview/dialogic-based approach enabled BMSM to have rich and meaningful conversations that they normally would not have with neither their sexual partners nor social service providers.  Because of this type of engagement about their sustained HIV-negativity, BMSM reported feeling validated and affirmed as well as recognized for being and for remaining HIV-uninfected.  In turn, they reported this experience would help support their continued commitment to maintain their HIV-negativity.