Black Gay Research Articles

Reverie

Reverie

A Health Equity Approach for Implementation of JYNNEOS Vaccination at Large, Community-Based LGBTQIA+ Events - Georgia, August 27-September 5, 2022.

Gay, bisexual, and other men who have sex with men (MSM) have been disproportionately affected during the 2022 U.S. monkeypox outbreak, with Black or African American (Black) MSM being the most affected demographic group (1). As of September 28, 2022, Georgia had reported 1,784 monkeypox cases; 98% of which occurred in males and 77% among Black persons (2). As of September 13, 2022, 60% of reported cases were among persons with HIV infection, and 50% of persons with monkeypox had a sexually transmitted infection within the past year (3). Because of racial disparities in the incidence of monkeypox cases and a large proportion of cases among MSM in Georgia, early vaccination beginning in July focused on improving equitable access by establishing new and leveraging existing partnerships with community-based organizations that serve affected populations, including persons with HIV infection. Despite these efforts, disparities persisted because of high demand and limited vaccine supply. The Georgia Department of Public Health (DPH) requested CDC support for a vaccine pilot and received an additional allocation of 5,500 doses of JYNNEOS vaccine for administration at events leading up to and throughout a Black gay Pride festival in Atlanta, a multiday event held Labor Day weekend (September 2-5, 2022). The event celebrates lesbian, gay, bisexual, transgender, queer or questioning, intersex, asexual, and other (LGBTQIA+) communities of color and hosts more than 125,000 attendees each year. Before the festival (as of August 24), 17,546 persons had been vaccinated in Georgia, of whom 96% were male, 34% aged 25-36 years, 44% Black, and 8% Hispanic or Latino (Hispanic) (4).

As Much As I Can - Utilizing Immersive Theatre to Reduce HIV-Related Stigma and Discrimination Toward Black Sexual Minority Men.

Despite advances in biomedical HIV prevention modalities such as pre-exposure prophylaxis to prevent the transmission of HIV, racial/ethnic and sexual/gender minority populations are disproportionately impacted by HIV epidemic. Alarming rates of HIV have persisted among Black gay and bisexual men, particularly in Southern states. Utilizing data from the ViiV ACCELERATE! initiative, we explored the impact of As Much As I Can, an immersive theatre production, on HIV-related stigma behaviors. A self-administered post-performance survey was conducted with a cohort (n = 322) of randomly selected audience members. Overall, the results showed participants had a highly favorable experience, rating the performance with a mean score of 9.77/10. Respondents indicated they intended to change behaviors to promote HIV prevention education and to reduce stigma and discrimination including: (1) Say something if I hear stigmatizing language against people living with HIV (75.4%), (2) Say something if I hear anti-gay language (69.7%) and (3) Tell others about HIV prevention options (e.g., PrEP, PEP, condoms (64.1%). The findings show there is an association between HIV-related behavior intention and linkage to HIV care. Respondents who reported they were more likely to say something about HIV stigma were almost three times (O.R. 2.77; 95% C.I. 0.98-7.8) more likely to indicate they would follow up with a healthcare professional. This study suggests that immersive theatre is an effective method for communicating HIV prevention education and reducing HIV-related structural stigma and discrimination that increases HIV vulnerability for Black sexual minority men.

Perceived Barriers to and Facilitators of Long-Acting Injectable HIV PrEP Use Among Black, Hispanic/Latino, and White Gay, Bisexual, and Other Men Who Have Sex With Men.

Long-acting injectable pre-exposure prophylaxis (LAI-PrEP) was recently approved for HIV prevention as an alternative to daily oral PrEP. We explored preferences and attitudes toward LAI-PrEP among Black, Hispanic/Latino, and White gay, bisexual, and other men who have sex with men (GBM) using focus groups (n = 13) and in-depth interviews (n = 17). Participants expressed differing levels of interest in LAI-PrEP. While important benefits of LAI-PrEP included convenience, provider-facilitated PrEP discussion, and expansion of PrEP options, participants raised concerns about treatment efficacy and side effects, discomfort with needles/injections, cost, and frequency of clinic visits. Our findings highlight ongoing challenges with accessing HIV-prevention tools and provide guidance for developing strategies to enhance LAI-PrEP uptake among GBM.

Representação vs. Representatividade: Analyzing Black LGBTQ+ Identity Politics in Brazil

Abstract Since the turn of the twenty-first century, a growing number of Black LGBTQ+ political candidates have run for electoral positions in Brazil. In the last five years, a significant number of these candidates have won their campaigns from varying political leanings, despite the rise of neofascist, homophobic, and transphobic waves throughout the election and the subsequent failed reelection attempt of Brazilian ex-president Jair Bolsonaro. While many of these Black LGBTQ+ candidates ran on platforms that centered their own social location as a power analysis to help them understand and react to the inequalities and social hierarchies in the country, some candidates strategically weaponized their identities to work against a politics of social equity. The candidates in the latter category rejected the idea that identity has anything to do with politics. These conflicts arising in the political sphere point to tensions about the purpose of representational politics for the communities who share identities with the politician. In this article, I look at the various iterations of representation that have taken place for Black LGBTQ+ politicians in recent years, analyzing how different candidates weaponize their identities. I ask what Black LGBTQ+ representational politics looks like and argue that a fundamental difference exists between representação, a simple form of representation where Black LGBTQ+ people are entering the political sphere regardless of their politics, and representatividade, a radical form of representation that ensures that Black LGBTQ+ candidates work politically for the interests of their community and all those who are oppressed like them. In my article I use interviews I conducted with one leftist Black trans state representative, Erica Malunguinho, as well as news articles, campaign videos, and other materials produced by the campaigns of both Malunguinho and right-wing Black gay politician Douglas Garcia to understand how the two politicians mobilize identity politics in their policy work and produce radically different meanings of representational politics for Black LGBTQ+ communities.

Integrating HIV and Mental Health Services for Black Gay, Bisexual, and Other Men Who Have Sex with Men Living with HIV: Findings from the STYLE 2.0 Intervention.

Black gay, bisexual, and other men who have sex with men (BMSM) in the US South are disproportionately impacted by HIV. We adapted Project Strength Through Youth Livin’ Empowered (STYLE) to create STYLE 2.0 to assist young BMSM link and remain engaged in HIV care. The multi-component intervention included (1) health care navigators to facilitate linkage and engagement activities, (2) motivational interviewing by a behavioral health provider, and (3) a mobile app to reduce stigma and social isolation. We enrolled 66 BMSM from North and South Carolina in the 12-month intervention and analyzed longitudinal data to assess service utilization, dose, and delivery characteristics while also examining changes in HIV care continuum outcomes. We examined associations between intervention characteristics and HIV care continuum outcomes using logistic regression. We found that all HIV outcomes improved from baseline to 12-month follow-up, including receipt of HIV care (78.8–84.9%), retention in HIV care (75.9–87.7%), being prescribed antiretroviral therapy (ART) (96.8–98.5%), and achieving viral suppression (82.3–90.8%), although none were statistically significant. In multi-variable analyses, participants with more encounters categorized as food bank were more likely to report being prescribed ART [odds ratio (OR): 41.65; 95% confidence interval (CI): 2.72–637.74]. Clients with more referral to care encounters were less likely to have been prescribed ART (OR: 0.02; 95% CI: <0.001–0.42) and be virally suppressed (OR: 0.39; 95% CI: 0.18–0.84). Findings suggest that an integrated approach to HIV and behavioral health services may help BMSM living with HIV overcome structural and social barriers to HIV care.

A Mixed-Methods Evaluation of “The Quest,” A Health and Well-Being Intervention for British-Based Black, Asian and Minority Ethnic Gay and Bisexual Men

ABSTRACT This article provides an evaluation of a health and well-being workshop-based intervention, “The Quest” for gay and bisexual men from British Black Asian and Minority Ethnic (BAME) communities. A quantitative component assessed reported and intended sexual risk, drugs and alcohol use alongside measures of psychological well-being with pre and post-program data collected from 26 men. Fourteen men participated in focus groups that discussed experiences of the intervention. Significant improvements were found on measures of internalized homophobia, self-esteem and self-efficacy but not for health behaviors including safer sex or substance use. Qualitative feedback was generally positive especially around enhanced psychological well-being, identity integration, and enhanced self-awareness. There were some concerns over group size and whether non-BAME gay men were appropriate as facilitators. Theoretically informed, culturally competent interventions can demonstrate significant potential in enhancing the well-being of BAME gay and bisexual men but follow-up data are needed to show longer-term benefits.

Gay and Race Cognizant: Interstitial Storytelling and the Narrative Positioning of an Interracial Gay Organization in the 1980s1

In this article, I show how an interracial gay group forming in the 1980s, Black and White Men Together (BWMT), did storytelling of themselves as gay and anti‐racist. Part of a larger narrative ethnography, this article focuses on how BWMT, in a 1980s context compelling the question of interracial organizing, did storytelling to narratively construct themselves as such. This article notes how the group faced an immediate narrative environment likely to characterize an interracial gay group as either racial fetishists or colorblind interracialists and explains, through analysis of their newsletter, how they tried to create a larger story of themselves as neither. I detail the storytelling they did of themselves as gay and race cognizant—recognizing gay racial difference, confronting white gay power, and interrogating racist gay sex culture and racialized gay desire. I discuss how it operated as interstitial storytelling, drawing from and extending traditions of Black and gay liberation but with limits when deployed interracially in a colorblind context. I end by pointing out how their interstitial storytelling served to construct them as a legible intersectional movement organization and to narratively position them in relation to Black gay groups of the era.

The Ongoing Process of HIV-Stigma (Re)Production.

HIV stigma negatively affects the social experiences of people living with HIV (PLWH) and remains a challenge to HIV prevention, treatment, and care. Research has overwhelmingly focused on individual cognitive measures of HIV stigma (e.g., internalized, anticipated, and experienced). However, little research explores the interactions and societal structures through which HIV stigma is produced. Data from qualitative interviews with 30 black gay and bisexual men living with HIV in the U.S. Deep South revealed an interconnected and interdependent set of processes that produce and reproduce HIV stigma. These included social interactions (silence, euphemism, and gossip), witnessed acts of marginalization, word-of-mouth transmission of HIV misinformation, and laws and policies carried out within the education and criminal justice systems. Efforts to reduce stigma that focus on individual beliefs and attitudes are critical to improving the well-being of PLWH. However, reducing HIV stigma requires intervening on the social interactions and structures through which HIV stigma is produced and reproduced.

Multidisciplinary providers’ perspectives on engaging young black, gay, bisexual and other men who have sex with men living with HIV in mental health care services

ABSTRACT Young Black gay, bisexual, and other men who have sex with men (YB-GBMSM) living with HIV are at high risk for psychological stressors and comorbidities. We sought to gain the perspectives of multidisciplinary providers (including HIV care, mental health care, and social service providers) on their experiences with engaging YB-GBMSM in mental health care within comprehensive HIV primary care centers that included both types of services on-site. We conducted qualitative in-depth interviews with fifteen providers in two clinics, and analyzed the qualitative data using a thematic analysis approach. Our participants described high levels of need for mental health services among YB-GBMSM living with HIV, due to psychological challenges related to living with HIV as well as other frequently occurring life stressors. At the same time, barriers to accessing these services were identified, with mental health stigma, under-recognition of symptoms and confidentiality concerns being the most commonly cited. Strategies to improve mental health service uptake in light of these needs and barriers were discussed, including re-framing of mental health services, addressing logistical barriers, and utilization of a biopsychosocial perspective.

Psychological distress and adherence to anti-retroviral therapy or pre-exposure prophylaxis regimens among Urban Black gay and bisexual men (MSM).

Urban Black gay, and bisexual men (MSM) bear a disproportionate burden of HIV in the U.S. Mental health is a barrier to adherence to both antiretroviral therapy (ART) and pre-exposure prophylaxis (PrEP). The objective was to determine the association between psychological distress and ART or PrEP adherence among urban Black MSM. Using data from a four-year prospective cohort study, adherence to ART was defined as > 95% and PrEP was defined as > 80% of doses taken in the past 30days. Psychological distress measures included difficulty sleeping; feeling anxious; suicidality; feeling sad or depressed; feeling sick, ill, or not well in the past 3 months; high (vs. low) overall psychological distress was classified as above the median value. Associations were examined using Chi-square, Fisher's exact tests, and logistic regression. Among 165 Black MSM, 44.2% (73) reported high psychological distress. 65.3% (47/72) of participants living with HIV and 39.8% (37/93) of HIV negative participants were ART or PrEP adherent, respectively. Education was significantly associated with PrEP adherence (p = 0.038). Non-injection drug use in the past 3 months (p = 0.008), difficulty sleeping (p = 0.010), feeling anxious (p = 0.003), and feeling sad or depressed (p < 0.001), and overall psychological distress (p < 0.001) were significantly associated with ART adherence. High psychological distress was significantly associated with a reduced odds of ART adherence (aOR 0.23; 95% CI = 0.08-0.70) adjusting for age and non-injection drug use. Increased psychological distress was significantly associated with ART nonadherence and may represent an important barrier to viral suppression.

Preferences of Young Black Gay, Bisexual, and Other Men Who Have Sex with Men Regarding Integration of HIV and Mental Health Care Services.

Optimization of mental health service use is critical to HIV care engagement among young Black gay, bisexual, and other men who have sex with men (YB-GBMSM). Clinic-level interventions to integrate HIV and mental health services have been proposed; however, patient perspectives on such care models are often lacking. We conducted a mixed-methods study consisting of surveys (N = 100) and qualitative in-depth interviews (n = 15) with YB-GBMSM recruited from two Ryan White-funded HIV clinics in Atlanta, Georgia. Most participants (70%) agreed that integration of HIV and mental health services was beneficial to them. Thirty-six percent (36%) desired a higher level of integration than what they perceived was currently available in their clinic setting, 51% believed their clinic was already optimally integrated, and 13% preferred less integration. In the qualitative interviews, participants discussed their support for potential integration strategies such as training HIV providers to prescribe antidepressants, closer in-clinic proximity of HIV and mental health providers, and use of patient navigators to help patients access mental health care and remind them of appointments. Perceived benefits of care integration included easier access to mental health services, enhanced overall well-being, and improved HIV care engagement. In summary, YB-GBMSM were supportive of integrating HIV and mental health services, with varying individual preferences regarding the degree and operationalization of this integration. Improving integration of mental health and HIV services, and tailoring modes of service delivery to individual preferences, has the potential to improve both general well-being and HIV care engagement in this high priority population.

Relational Risk: How Relationships Shape Personal Assessments of Risk and Mitigation

Objects of risk mitigation are typically viewed as neutral items that limit exposure to an established hazard. However, people may refuse to adopt such tools, even when they feel vulnerable. This article explores how people assess their personal risk and mitigation options by examining PrEP use for HIV prevention. Drawing on semi-structured in-depth interviews with 40 Black and Latino gay, bisexual, and queer men, I argue PrEP uptake is a socially contextualized decision influenced by relational concerns. I develop the concept of relational inoculation, wherein individuals enact a sense of protection against harm through relational work. As individuals consider PrEP, they also contemplate how it may bolster or undermine intimacy they value for reducing interpersonal HIV exposure, as well as dispelling stigmatized notions of riskiness held by their intersecting ethno-racial and sexual minority communities. I develop testable propositions about how respondents’ HIV risk assessments and PrEP use are enmeshed in a societal context of surveillance, in ongoing relations with intimate partners and socially significant others, and in navigation of community belonging within this milieu of risk. This article contributes to sociological research at the nexus of race, sexuality, and health, and offers health policy insight.

Passion, commitment, and burnout: Experiences of Black gay men working in HIV/AIDS treatment and prevention in Atlanta, GA

HIV-focused organizations, care providers and research programs often hire Black gay, bisexual and other men who have sex with men (GBMSM) in their efforts to reach highly affected communities. Due to their unique social position within and outside of organizations, Black GBMSM are ideally situated to contribute to HIV care and prevention programming targeting their own communities, but may also be at risk for stress and burnout in these settings. Despite this critical role for Black GBMSM in efforts to end the epidemic, little is known about subjective experiences of Black GBMSM who work in the HIV field. We conducted qualitative interviews with 19 Black GBMSM who were identified as key informants. All were working in community-based organizations, clinical or academic settings in the area of HIV prevention and treatment in Atlanta, Georgia. We used a thematic analysis approach to identify salient themes with respect to the workplace experiences of Black GBMSM as well as the role of their identities in their work in the field. Participants discussed: (1) Shared experiences and growth; (2) Work-related stressors; (3) Worker burnout; and (4) Commitment to continue working in the HIV field. On the whole, Black GBMSM derived meaning from their work, and found their intersectional identities to be a strength in fulfilling job duties. At the same time, Black GBMSM described multiple stresses faced as they balanced their personal and professional connections to this work, while also dealing with their own challenges related to discrimination, socioeconomic status, and health. Participants repeatedly described sacrificing their own well-being for the greater good of their communities, highlighting contributors to burnout within and outside of the workplace. Our participants derived meaning from their work in the HIV field and were affirmed by professional interactions with other Black GBMSM. At the same time, they also faced work-related and other psychosocial stressors that predisposed them to frustration and burnout. To promote workplace equity and wellness for Black GBMSM, we share recommendations for HIV-focused organizations that employ and serve men in this demographic.

HIV Testing Before and During the COVID-19 Pandemic - United States, 2019-2020.

HIV testing is a core strategy for the Ending the HIV Epidemic in the U.S. (EHE) initiative, which has the aim of reducing new HIV infections by at least 90% by 2030.* During 2016-2017, jurisdictions with the highest HIV diagnosis rates were those with higher prevalences of HIV testing; past-year HIV testing was higher among persons who reported recent HIV risk behaviors compared with those who did not report these risks (1). During 2020-2021, the COVID-19 pandemic disrupted health care delivery, including HIV testing in part because many persons avoided services to comply with COVID-19 risk mitigation efforts (2). In addition, public health departments redirected some sexual health services to COVID-19-related activities.† CDC analyzed data from four national data collection systems to assess the numbers of HIV tests performed and HIV infections diagnosed in the United States in the years before (2019) and during (2020) the COVID-19 pandemic. In 2020, HIV diagnoses reported to CDC decreased by 17% compared with those reported in 2019. This decrease was preceded by decreases in HIV testing during the same period, particularly among priority populations including Black or African American (Black) gay men, Hispanic or Latino (Hispanic) gay men, bisexual men, other men who have sex with men (MSM), and transgender persons in CDC-funded jurisdictions. To compensate for testing and diagnoses missed during the COVID-19 pandemic and to accelerate the EHE initiative, CDC encourages partnerships among federal organizations, state and local health departments, community-based organizations, and health care systems to increase access to HIV testing services, including strategies such as self-testing and routine opt-out screening in health care settings.

“Wellness is wholeness”: Explorations of wellness among Black gay men

AbstractThe Indivisible Self Model of Wellness undergirded this mixed methods phenomenological exploration of the conceptualizations and experiences of wellness among nine Black gay men who had not tested positive for HIV. Data sources included in‐depth semistructured interviews and participant responses on the Five Factor Wellness Inventory. The following themes emerged from the thematic analysis of the interview transcripts: holistic self‐love, spiritual journey, kinship, social responsibility, sexual literacy, and approaches to HIV prevention. Additionally, cross‐validation of the qualitative and quantitative data revealed the central roles that social connectedness and spirituality played in these men's lives. Findings from this study provide a detailed picture of wellness within this sample and indicate considerations for expanding wellness to account for sexual health and wellness practices.

Abuse in the Continua: HIV Prevention and Care Outcomes and Syndemic Conditions Associated with Intimate Partner Violence Among Black Gay and Bisexual Men in the Southern United States.

Intimate partner violence (IPV) has been implicated in HIV acquisition and worse HIV outcomes. Limited research focuses on the experiences of Black gay and bisexual men. Using data from cross-sectional surveys in Baltimore, Maryland, and Jackson, Mississippi, we analyzed the association between IPV victimization and HIV-related outcomes among 629 adult Black gay and bisexual men, among whom 53% self-reported a negative result at last HIV test. 40% of participants reported lifetime physical, sexual, and/or psychological IPV victimization, and 24% past-year victimization. Recent and lifetime IPV were associated with recent clinical diagnosis of STI (adjPrR: 1.44; 95%CI: 1.08-1.92) and ART medication interruptions (adjPrR: 1.59; 95%CI: 1.25-2.01), respectively. Physical IPV was inversely associated with current PrEP use (adjPrR: 0.35; 95%CI: 0.13-0.90). Recent IPV was independently correlated with depression symptomatology (adjPrR: 2.36; 95%CI: 1.61-3.47) and hazardous alcohol use (adjPrR: 1.93; 95%CI: 1.42-2.61), with evidence of interactions. IPV-HIV relationships were intersected by internalized stigma, housing instability, poverty, and lack of insurance. Tailored IPV services are urgently needed for comprehensive HIV services for Black gay and bisexual men in the U.S.

Intersectional Resilience Among Black Gay, Bisexual, and Other Men Who Have Sex With Men, Wisconsin and Ohio, 2019.

Objectives. To investigate resilience strategies used by Black gay, bisexual, and other men who have sex with men (MSM) to navigate racism and heterosexism. Methods. In 2019, we conducted in-depth interviews with 46 Black MSM in Milwaukee, Wisconsin, and Cleveland, Ohio. Thematic analysis, informed by intersectionality, was used to identify intersectional resilience within the context of participants' lives. Results. Our analyses revealed ways in which Black MSM respond to stigma and oppression. We identified the following themes that capture these experiences: pride in intersectional identities, perseverance, community advocacy, and social support. Our analyses reveal how men draw on these assets and resources to positively adapt despite experiences of racism and heterosexism. Conclusions. Intersectional resilience can support Black MSM in navigating racism and heterosexism. However, public health interventions at the institutional and system levels are needed to directly target the root causes of oppression and support resources that facilitate intersectional resilience. (Am J Public Health. 2022;112(S4):S405-S412. https://doi.org/10.2105/AJPH.2021.306677).

Narrative Activism: Writing Desire For Injury-Bound Individuals

Narrative Activism: Writing Desire For Injury-Bound Individuals

The Devil Finds Use

Abstract Beginning with James Baldwin’s critique of The Exorcist in The Devil Finds Work (1976) and ending with campy allusions to the film in the works of three contemporary black gay authors, this article argues that the aesthetics of possession helps articulate queer forms of desire that blur the lines between agency and passivity. Deploying José Esteban Muñoz’s theory of disidentification, it shows how black and queer subjects disruptively locate themselves in the horror genre by drawing on their racial affinities with the genre. The first section proposes that the most prevalent claim in black horror studies today—that black life is more frightening than the supernatural—actually originates with Baldwin’s 1976 rebuke of the film. By disidentifying with horror, Baldwin shifts attention away from paranormal evils and onto a more horrifying normative world. Sketching enthusiastic alternatives to Baldwin, the latter half of this article examines idiosyncratic attachments to the film that are routed through the demonic. By disidentifying with the possessed child, the narrators of Larry Duplechan’s Eight Days a Week (1985) and Blackbird (1986), James Earl Hardy’s B-Boy Blues (1994), and G. Winston James’s Shaming the Devil (2009) all articulate fraught performances of desire.