Black Pride Events Research Articles

Which types of social support matter for Black sexual minority men coping with internalized homophobia? Findings from a mediation analysis.

Minority stress theory views social support as a protective factor against the effects of minority-specific stressors like internalized homophobia (IH) on mental health in sexual minority populations. However, much of the empirical validation of this theory has been conducted within predominantly White samples, resulting in a limited understanding of how the theory applies to Black sexual minority individuals. Current examinations of social support fail to capture the nuances of how Black sexual minority men may access support systems differently, resulting in a need to investigate how social support, IH, and mental health operate for Black sexual minority men. This study examined relationships between IH, depression, and different types of social support (i.e., family, friends, Black community, gay community) using a mediation model. We used data from the POWER (Promoting Our Worth Equity and Resilience) Study, which recruited Black sexual minority men at Black Pride events across six cities in the United States from 2014 to 2017, to test four mediation pathways concurrently in Stata 17. Participants (N = 4,430) completed a questionnaire assessing a variety of health and life domains, including depression symptoms, internalized homophobia, and social support. IH was positively associated with depression. Lower levels of family, friend, and Black community support were all positively associated with depression symptoms. Additionally, IH was positively associated with all types of support. Finally, family, friend, and Black community support partially mediated the relationship between IH and depression. Results suggest that the relationship between social support and depression is complex for Black sexual minority men. Findings suggest family support is an important factor for clinical intervention efforts targeting depression, and that gay community support systems should assess how their environments can better support Black sexual minority men. Overall, findings demonstrate the necessity of future examination of how social support functions differently within Black sexual minority communities.

Syndemic Health Disparities and Sexually Transmitted Infection Burden Among Black Men Who Have Sex with Men Engaged in Sex Work in the U.S.

Black men who have sex with men (MSM) engaged in sex work (BMSM-SW) experience elevated HIV and sexually transmitted infection (STI) prevalence. Further, BMSM-SW have been shown to have higher rates of syndemic psychosocial health conditions which contribute to HIV risk behavior and incidence, and poorer care outcomes than other groups of men who have sex with men. However, syndemic perspectives have not been applied to understanding past-year STI burden among BMSM-SW in the U.S. Sexually active Black MSM ≥ 18years old were recruited from Black Pride events in six U.S. cities (n = 4421) between 2014 and 2017. Multivariable logistic regressions assessed correlates of past-year sex work engagement; whether BMSM-SW had higher odds of syndemic conditions; and whether BMSM-SW had higher odds of self-reported, past-year STI diagnoses. Structural equation models assessed relationships between sex work engagement, syndemic conditions, and STI controlled for sociodemographics and number of sexual partners. A total of 254 (5.7%) Black MSM reported past-year sex work, of whom 45.3% were HIV positive. BMSM-SW were significantly more likely to be Hispanic, to report past-year bisexual behavior, and to report annual income < $10,000. In multivariable models, BMSM-SW were significantly more likely to report intimate partner violence, assault victimization, polydrug use, and depression symptoms; they were also more likely to report past-year gonorrhea, chlamydia, and syphilis. Syndemic conditions mediated the relationship between past-year sex work and past-year STI burden, constituting a significant indirect effect. BMSM-SW in the U.S. face severe biopsychosocial health disparities. Interventions developed for BMSM engaged in sex work are lacking. Our results suggest that interventions containing safer sex work education and sex-positive biobehavioral HIV/STI prevention alongside substance use, mental health, employment, and education components will be most effective.

Injection drug use, unknown HIV positive status, and self-reported current PrEP use among Black men who have sex with men attending U.S. Black pride events, 2014–2017

Injection drug use, unknown HIV positive status, and self-reported current PrEP use among Black men who have sex with men attending U.S. Black pride events, 2014–2017

Injection drug use, unknown HIV positive status, and self-reported current PrEP use among Black men who have sex with men attending U.S. Black pride events, 2014–2017

ObjectiveBlack gay, bisexual, and other men who have sex with men (BMSM) are at elevated risk for HIV infection in the United States. BMSM who inject drugs may be face even higher HIV risk. MethodsRandom time-location sampling was used to survey BMSM attending Black Pride events in 6 U.S. cities about HIV risk and protective behaviors, including injection drug use, prior HIV testing, and pre-exposure prophylaxis (PrEP). 3429 individuals who reported a HIV negative/unknown serostatus at enrollment were included in the analysis. HIV status was determined by in-field rapid HIV testing. Results3.6% of BMSM had injected drugs in their lifetime and 58.5% of BMSM who had injected drugs reported sharing syringes in the past six months. BMSM who had injected drugs more commonly reported current PrEP use than BMSM who had never injected (32.5% vs. 8.2%, p < 0.001). BMSM who had injected drugs were 3.6-fold (95% CI: 2.4, 5.4) more likely to report currently using PrEP than BMSM who had never injected after adjustment for sociodemographic, substance use, and sexual risk characteristics. Among BMSM who reported ever injecting drugs (n = 123), 31.7% tested HIV positive. HIV prevalence did not differ by self-reported PrEP use among BMSM who had injected drugs (p = 0.59). ConclusionsBMSM who inject drugs who reported currently using PrEP were no less likely to test positive for HIV than those who did not use PrEP. Wrap-around services to support consistent PrEP use and long-acting PrEP formulations may improve the effectiveness of PrEP among BMSM who inject drugs.

HIV Testing and ART Adherence Among Unstably Housed Black Men Who Have Sex with Men in the United States.

Black men who have sex with men (BMSM) have the highest HIV incidence rate among all MSM in the United States (US), and are also disproportionately affected by homelessness and housing instability. However, little is known about the effects of homelessness on the HIV testing and care continuum for BMSM. Between 2014 and 2017, the Promoting Our Worth, Equality, and Resilience (POWER) study collected data and offered HIV testing to 4184 BMSM at Black Pride events in six US cities. Bivariate analyses were used to assess differences in sociodemographics and healthcare access between BMSM who self-reported homelessness and those who did not. Multivariable logistic regression models were used to assess differences in HIV testing by homelessness status. Finally, bivariate and multivariable models were used to assess differences in HIV care continuum and treatment adherence outcomes by homelessness status. 615 (12.1%) BMSM in our sample experienced homelessness in the last 12months. BMSM who self-reported homelessness had higher odds of receiving an HIV test in the past 6months compared to their stably housed counterparts. BMSM who self-reported homelessness had higher odds of reporting difficulty taking ART and of missing a dose in the past week compared to stably housed BMSM. Findings suggest that HIV testing outreach and treatment-related services targeting unstably housed BMSM may be effective. Future community-based research is needed to investigate how homelessness and housing instability affect ART adherence, and how this population may experience success in HIV testing and adherence despite economic and social marginalization.

Black Men Who Have Sex with Men and Lifetime HIV Testing: Characterizing the Reasons and Consequences of Having Never Tested for HIV.

HIV testing remains a critical point of entry to HIV treatment services and now biomedical prevention as well. Yet despite the high HIV prevalence among Black men who have sex with men (MSM), insufficient attention has been given to factors associated with those Black MSM in the United States who have never received an HIV test in their lifetime. Promoting Our Worth, Equality, & Resilience (POWER) is a cross-sectional observational study that recruited Black MSM at Black Pride events across six cities in the United States from 2014 to 2017. Participants completed an anonymous questionnaire and were offered free, confidential HIV testing. Of the 4174 Black MSM without a prior HIV diagnosis, 404 (9.68%) had never tested for HIV (mean age = 31.03years). Lower education and greater internalized homophobia were associated with never having tested for HIV. Higher age (AOR = 1.05, 95%, 1.02-1.07) and assumption of HIV-positivity (AOR = 3.24, 95% CI 1.53-6.84) were both associated with increased odds of an HIV-positive test result (n = 119; 36%). To compare, HIV prevalence among Black MSM who had received at least one HIV test before study participation was 23%. While a minority of Black MSM had never received an HIV test, this group had a significantly higher likelihood of HIV infection. Alternative HIV testing strategies are needed to facilitate HIV testing initiation among Black MSM for whom conventional HIV testing modalities are insufficient.

Characterizing the HIV Care Continuum and Identifying Barriers and Facilitators to HIV Diagnosis and Viral Suppression Among Black Transgender Women in the United States.

Although black transgender women (BTW) experience high prevalence of HIV in the United States, no characterization of the HIV care continuum exists for this population. This study addresses this gap by (1) characterizing the HIV care continuum, and (2) exploring correlates of HIV diagnosis and viral suppression among a community-based sample of BTW. Data came from Promoting Our Worth, Equality, and Resilience (POWER). From 2014 to 2017, POWER recruited BTW who attended Black Pride events in 6 U.S. cities. Participants completed a behavioral health survey and were offered onsite HIV testing. Simple frequencies were used to characterize the HIV care continuum, and multivariable logistic regression analysis was used to identify correlates of HIV diagnosis and viral suppression. A total of 422 BTW provided completed data for our analysis, 45.0% of whom were living with HIV. Over half of the HIV-positive BTW (51.4%) reported being undiagnosed at the time of survey, and 24.5% reported viral suppression. Incarceration and a lack of access to medical care were significantly and positively associated with an undiagnosed HIV-positive status in multivariable models. Incarceration, homelessness, polydrug use, physical assault, intimate partner violence, and current hormone use were significantly and negatively associated with viral suppression in multivariable models. Developing and implementing interventions that address timely HIV diagnosis may assist in informing the HIV disparity among BTW in the United States. Interventions should address the fundamental causes of poor health in this population.

Assessing HIV Stigma on Prevention Strategies for Black Men Who Have Sex with Men in the United States.

The deleterious effects of HIV stigma on HIV+ Black MSM care continuum outcomes have been well-documented. How HIV stigma shapes HIV prevention for HIV- persons in this community is poorly understood. We sought to test the relationship of HIV stigma with HIV- Black MSM on HIV testing, pre-exposure prophylaxis (PrEP) awareness, and PrEP use. We recruited 772 participants at Black Pride events across five US cities in 2016. Multivariable logistic regression models assessed the association of external HIV stigma on prevention outcomes adjusting for sociodemographic variables. Stigma waspositively associated with PrEP awareness (AOR = 1.34; 95% CI = 1.09, 1.66; p value = 0.005), and not associated with PrEP use or HIV testing in our sample. These findings highlight the complex nature of HIV stigma among BMSM and include results for PrEP, which can affect uptake other prevention methods. We support anti-HIV stigma efforts and advise further exploration on HIV stigma among BMSM and prevention outcomes.

Psychosocial Health Disparities Among Black Bisexual Men in the U.S.: Effects of Sexuality Nondisclosure and Gay Community Support.

Compared with Black gay men, Black bisexual men experience psychosocial health disparities, including depression, polydrug use, physical assault, and intimate partner violence (IPV). Black bisexual men are also less likely to disclose their sexuality, which may result in them receiving less sexual minority community support, exacerbating psychosocial health disparities. We assessed relationships between bisexual behavior, bisexual identity, sexuality nondisclosure, gay community support, and psychosocial morbidities among Black men who have sex with men (MSM). Between 2014 and 2017, survey data were collected from Black MSM≥18years old (n=4430) at Black Pride events in six U.S. cities. We differentiated between bisexual-identified men reporting past-year sex with men and women (bisexual MSMW, 8.4%); gay-identified men reporting sex with men only (gay MSMO, 73.1%); gay MSMW (8.0%); and bisexual MSMO (8.4%). Multivariable regressions contrasted these groups by psychosocial morbidities, sexuality nondisclosure, and gay community support. Structural equation models assessed total, direct, and indirect effects. Compared with gay MSMO, bisexual MSMW and gay MSMW were significantly more likely to report polydrug use, depression symptoms, IPV, physical assault, sexuality nondisclosure, and lack of gay community support. Lack of gay community support had significant indirect effects on the relationships between bisexual behavior and psychosocial morbidity (p<.001) and between bisexual identity and psychosocial morbidity (p<.001). Sexuality nondisclosure had significant indirect effects on relationships between bisexual behavior (p<.001), bisexual identity (p<.001), and lack of gay community support. Psychosocial health disparities experienced by Black bisexual men are associated with both bisexual behavior and bisexual identity. Interventions decreasing biphobia will facilitate opportunities for protective sexuality disclosure and access to sexual minority community support.

Between the Two: Bisexual Identity Among African Americans

This paper compares “essentialist” to “social constructionist” perspectives on sexual identities among African Americans. Essentialists argue that sexual orientation and identity exist within a binary system in which people classify themselves as either straight or gay. They suggest that sexual identity is an essence that is universal and can be seen throughout history and across cultures. Social constructionists argue that sexual orientation and identity are not fixed, but rather are historically contingent, culturally specific, and shaped by social, political, economic, and cultural forces. These contrasting perspectives are examined through the lens of the case of African Americans who identify as bisexual. Using data from the Black Pride Survey 2000, this paper examines factors that are related to bisexual identity among African Americans who participated in Black Pride events. It presents the results from logistic regression models that predict bisexual identity with social, demographic, personal, religious, and behavioral characteristics. The results suggest that African American men who participated in Black Pride events are less likely to identify as bisexual when they are older, Muslim, married, attend churches that more fully accept homosexuality, and have higher percentages of male sexual partners. Men who are dating (rather than in committed relationships or same sex marriages) and those with their own biological children are more likely to identify as bisexual. African American women who participated in Black Pride events are more likely to identify as bisexual when they are younger, Protestant, attend churches that are less fully accepting of homosexuality, have higher percentages of male sexual partners, and are biological parents. These results support the social constructionist view that sexual identities are not binary nor fixed, but rather are historically contingent, culturally specific, and shaped by social, economic, and cultural forces. The implications of these findings for sexuality in the African American community are examined.