The Intersection of Violence and HIV Care for Young Black MSM Living with HIV

Background: Young, Black, men who have sex with men (YBMSM) face worse outcomes along the HIV care continuum relative to white MSM. Additionally, Black youth are significantly more likely to experience racism and be victims of police, neighborhood, and interpersonal violence than youth of other races/ethnicities. Violence has been identified as a critical, yet understudied, factor that may influence HIV care disparities. This phenomenological study aimed to understand the HIV and violence syndemic facing YBMSM and identify potential avenues of intervention.

Methods: In 2020-2021 we conducted in-depth interviews with YBMSM, age 16-35, living with HIV in Chicago to understand how experiences with racism, community, police, and interpersonal violence influenced their engagement in HIV care. Interviews were recorded, transcribed verbatim, coded using MAXQDA, and analyzed using thematic analysis.

Results: The sample included 31 YBMSM (M_age=28; 74%gay identifying, 45% undetectable viral load). Data were analyzed to understand how violence had affected the lives of YBMSM and influenced their HIV care. We identified several themes that shed light on the intersection between structural racism, homophobia, violence, and HIV care. Participants described how early childhood violence (e.g., sexual abuse, homophobic bullying, and community violence) contributed to poor mental health, maladaptive coping mechanisms, and normalization of violence. As one participant noted, “I was becoming a product of my environment.” Violence often continued throughout their adolescence and early adulthood and individuals described depression, anxiety, and anger. One participant described homophobic bullying at school and violence in his home and stated, “it came to a point where I had wanted to commit suicide.” The violence and mental health challenges were often amplified after receiving an HIV diagnosis: “They’re angry because they did catch HIV. They’re angry because they feel marginalized. They’re angry because they feel unloved.” This anger was frequently intertwined with depression and anxiety and contributed to a cycle of violence that negatively impacted HIV care. As another YBMSM stated “When there’s something traumatizing that occurs or I’m feeling ready to end it, that’s when I usually miss my medication.”

Conclusions: Our results provide an in-depth look into how YBMSM living with HIV in Chicago experience violence, and the effects of that violence on HIV care. Despite the normalization of violence and the cycles of violence YBMSM experienced in home, school, and community settings, they displayed extraordinary resilience and overcame significant obstacles. Multi-level resilience-based interventions that address the consequences of violence in the lives of YBMSM are needed.