Georgia College & State University

Stigma and Inadequate Care towards HIV positive African

American American/Black Gay Males

Final Research Paper

Hannah Turner

KINS 6543 - Human Sexuality

Dr. Scott Butler

26 April 2020
Human Immunodeficiency Virus (HIV) has been invading the world since it was first discovered

in 1981. Cases are still skyrocketing world wide, but within the United States, there has been a

decline. A disproportionate amount of new infections is among minority populations who are

underrepresented and not receiving proper care. In 2017, the South made up 52% of new HIV

diagnoses, with 53% of those new infections being among African Americans. (CDC, 2019a).

Gay or bisexual African American/Black males are at a higher risk of developing HIV. When

looking to current trends for the years 2010-2017, it showed that infections for African

American/Black gay and bisexual males remained stable as a whole, but infections varied among

age groups. For those aged 25-34 years old, the HIV diagnoses was up 42% among the African

American/Black gay and bisexual males (CDC, 2019b). The highest rate of transmission among

the male category is male-to-male sexual contact, making up 68.8% of the transmission category

for 2017 (AIDSVu, 2019). Prevention challenges seem to be the main reason as to why rates are

higher for the African American/Black homosexual community. According to the Centers for

Disease Control, the main prevention challenges for the African American/Black HIV positive

homosexual males are – delay in linkage to HIV medical care, a low percentage of viral

suppression, and socioeconomic factors (CDC, 2020). When looking to the overall prevention

challenges for all HIV positive males – a higher portion of gay and bisexual males have HIV,

stigma/homophobia/discrimination, 1 in 6 gay and bisexual males that have HIV are unaware of

their status, most gay and bisexual males come in contact with HIV by having sex without

condoms, gay and bisexual males are at a higher risk of other sexually transmitted infections

(STI) which makes them more susceptible to HIV, and socioeconomic factors – shows, that

African American gay and bisexual males face challenges that are different from that of the

entire HIV positive gay male community (CDC 2019c).

Stigma and Homonegativity

Homonegativity is a social construct that encompasses stigma and unfair treatment of

those who are gay, bisexual, lesbian, transgendered, etc. It seems that black gay males tend to

face more stigma and homonegativity among family and friend groups due to upbringings and

cultural norms. In a study done by Katherine Quinn and Julia Dickson-Gomez, they discuss the

relationship between homonegativity, religiosity, and intertwining identities of younger black

males who have sex with males. It is stated in their study that among gay and bisexual black

males aged 16-21, nearly 90% believed that their parents would respond unfavorably to the fact

that they were homosexual, with fewer than 2% of black gay or bisexual males being open about

their sexual identity at all times. The research done by Quinn and Dickson-Gomez discusses the

black church as playing a large role in social and spiritual light for those of the community, but

also announcing large amounts of homonegativity in their practices. The teachings of that in the

black church are generally conservative related teachings on sexuality, with masculinity playing

a crucial role in identity from the church, whereas flamboyant and feminine behaviors are taught

as undermining the masculinity power and authority (Quinn & Dickson., 2016). A study was

done to examine the different ways that black males identify themselves sexually. Results

showed that many black males who do participate in same sex relations do not consider

themselves to be bisexual, gay or homosexual. Social factors seemed to play a large role in this

identification issue or the non acceptance of a gay identity, speaking towards homophobia,

heterosexism, and a poor construct of black manhood (Brown II., 2005). Masculinity is outlined

in many of the articles on barriers for gay black males, with the concept being taught at a young

age. The idea of masculinity outlines ways that men should act with femininity outlining ways

that women should act. In the black community, it seems that being gay is therefore associated
with femininity, which is not how a man should act due to its association with weakness. This

upbringing has therefore developed a complex scheme that black gay males have to follow,

being – to be as close to masculinity and sexism as possible to escape homophobia, to then act or

be homophobic as a way of acceptance, and lastly, to participate in the way of men or that

masculinity means being hateful towards those who are homosexual (Brown II., 2005). It seems

though that this stigma stems from many aspects of life for those who are openly gay, HIV

positive, and black. One study went into detail about the different layers of stigma that black gay

males experience and outlined them during a qualitative study. Stigma did not just arise from

their race/ethnicity, sexuality, and HIV status, but also a social stigma that was experienced

among families and the black community (Arnold et al., 2014). The stigma has been seen in

many studies to lead to higher rates of risky sexual behavior, which would be defined as having

sex under the influence, having sex without condoms, or having sex with a male partner whose

HIV status is unknown. One study by Ayala et al., found a connection between social

discrimination and financial hardship on the sexual risk of developing or spreading HIV. They

noted that social discrimination such as racism and homophobia, which are experienced by many

in the homosexual community, and financial hardship were directly related to a lack of social

support. The study also found that acts of discrimination, which led to a lack of social support

and financial disparities were linked to participation in high risk sexual behavior. But, what was

interesting is the study found that the risky sexual behavior was a way to mediate the

discrimination, sticky financial situations, and the lack of social support systems (Ayala et at.,

2012). Black men who have sex with men seem to be more prone to cultural stigma along with

inter community stigma which in turn leads to a delay in linkage to care. Interventions need to

aim more towards the reduction of stigma, firstly, for community and family, in order to prevent
hate and homelessness among these young men. From here, with the proper support, these

individuals may be more likely to seek care and know their HIV status before infection in order

to be prescribed PrEP to slow the spread. Family support, along with community, which plays a

large role in black individual’s life, needs to be strengthened for those with HIV, because the

stigma at home are those that cause the most detrimental damage for those males.

Inadequate Care -

Inadequate care is looked at in terms of physical, financial, political, and social barriers in

regards to healthcare and the quality of care. Black gay males with HIV face more barriers than

other races, with one study done on the progress along the continuum of HIV care showing that

black men who have sex with men (MSM) had the lowest level of care when compared to other

races or ethnicities. The study discusses lack of health insurance, stigma, and discrimination as

main blockage points for the receiving of care for not just black gay males, but all of the LBGTQ

community (Singh et al., 2014). Black gay males often face cultural barriers when it comes to

obtaining proper medical care, including discrimination and mistrust between patient and

provider, which may be developed by structural barriers as in a lack of health insurance or

improper transportation (Hussen et al., 2018). Another study done on differences in HIV care

and treatment among different subpopulations found that percentage of blacks and Hispanics

were less likely to know about their infection than other populations, and the percentages linked

to care, retained in care, and prescribed antiretroviral therapy along with a suppressed viral load

were lower among the black community than whites. From the data drawn, it compared 850,000

individuals with HIV and found that 79% of black individuals did not have a suppressed viral

load, which could be attributed to the unawareness of the virus. From the study, it discussed why

there are disparities among those with HIV in relation to care and diagnosis, especially for
younger individuals, stating that these could be contributed to lower rates of testing, a reduce

sense of urgency about the need for care among those who do have HIV, and being less routine

about the antiretroviral therapy (Hall et al., 2013). Black men who have sex with men that are

HIV positive are less likely than other men who have sex with men to achieve viral suppression.

This could widely be due to the social and economical factors stated above, such as lower

income, less likely to have health insurance, medical mistrust, along with stigma from healthcare

providers. These barriers not only harm the health of the individual who is HIV positive, but also

puts others at harms way from the individual not taking advantage of the treatment as prevention

to slow the spread of the virus (Matthews et al., 2016). Many studies have found that black men

who have sex with men are no more likely than other gay males to partake in unprotected sex or

substance abuse. So, why are the numbers so high for black gay males? Relate it back to

healthcare. If one individual has a fear of going to the doctor because of stigma or because of a

lack of health insurance, they are not going to get checked for their HIV status or received the

prescribed medication. According to CNBC, without health insurance, PrEP or pre-exposure

prophylaxis, which is the drug to help reduce the risk of infection, cost around $1,600 to $2,000

a month (Lovelace Jr., 2019). By getting adequate care to those in need, not just black males who

have sex with men, but all of the underrepresented groups, will hopefully slow the spread of

HIV. More public health interventions need to be aimed at these subpopulations to figure out

why the risk is so high for black gay males and adapt strategies towards the population to delay

HIV exposure, or to prevent it all together.

Conclusion

Black men who have sex with men (MSM) have the highest incidents rates for human

immunodeficiency virus but also seem to be the most underrepresented. A multitude of studies
have found linkages between stigma, not just by healthcare providers or other individuals in the

homosexual community, but between friend groups and family. Detrimental health affects along

with a deteriorated mental health places a large barrier for seeking and maintaining care.

Community and family play a large role in the black and African American culture and many of

these studies found the individuals hard to cope with their HIV status once they were essentially

disowned by their family and friends. This in turn led to being kicked out of the house which

could lead to homelessness or a string of risky behaviors that puts the individual and others at

risk for HIV and the non receiving of HIV related care. Stigma and homonegativity relate

directly to inadequate healthcare due to a fear of exposing one’s HIV status to their healthcare

provider. A higher amount of black males lacks health insurance when compared to other races,

meaning finding and receiving care would be incredibly expensive. Public health efforts need to

be aimed not at just reduction in price for care and testing, but on social and cultural barriers

also. By reducing the stigma of HIV for the gay black community, there would more than likely

be a more openness on the topic which would in turn lead to more testing and support for anti

retroviral medications. Education is important especially when it comes to condom usage and

safer sex practices – such as knowing one’s HIV status in order to slow the spread. But, without

the reduction in stigma between the community and family, along with healthcare providers,

there will be a lack of motivation for one to seek out proper care and to protect themselves.

Human immunodeficiency virus is not something that just affects one person, but affects

everyone around them without the proper care and support. The spread can be slowed with more

awareness and more support for those who are infected. It takes a village to stop the storm. But

more importantly, it takes the reduction of stigma and healthcare disparities in order to help those

who are at highest risk.

 References

1. Arnold, E. A., Rebchook, G.M., & Kegeles, S.M. (2014). ‘Triply cursed’: racism,
homophobia and HIV-related stigma are barriers to regular HIV testing, treatment
adherence and disclosure among young Black gay men. Culture, Health & Sexuality,
16(6), 710. https://doi.org/10.1080/13691058.2014.905706
2. Ayala, G., Bingham, T., Kim, J., Wheeler, D. P., & Millett, G. A. (2012). Modeling
the Impact of Social Discrimination and Financal Hardship on the Sexual Risk of
HIV Among Latino and Black Men Who Have Sex With Men. American Journal of
Public Health, 102(S2), S242-S249. https://doi.org/10.2105/AJPH.2011.300641
3. Edward Brown II. (2005). We Wear the Masks: African American Contemporary Gay
Male Identities. Journal of African American Studies, 9(2), 29
4. Hall HI, Frazier EL, Rhodes P, et al. Differences in Human Immunodeficiency
Virus Care and Treatment Among Subpopulations in the United States. JAMA Intern
Med. 2013;173(14):1337–1344. doi:10.1001/jamainternmed.2013.6841
5. “HIV and African American Gay and Bisexual Men.” Centers for Disease Control
and Prevention, 4 February 2020,
6. “HIV and Gay and Bisexual Men.” Centers for Disease Control and Prevention, 12
November 2019, https://www.cdc.gov/hiv/group/msm/index.html
7. “HIV in the United States by Region.” Centers for Disease Control and Prevention, 30
October 2019, https://www.cdc.gov/hiv/statistics/overview/geographicdistribution.html
8. "HIV in the United States by Region." Centers for Disease Control and Prevention,
30 October 2019,
https://www.cdc.gov/hiv/statistics/overview/geographicdistribution.html
9. Hussen, S. A., Jones, M., Moore S., Hood, J., del Rio, C., Smith, J. C., Camacho-Gonzalex,
A., & Harper, G. W. (2018). Brothers Building Brothers by Breaking Barriers:
development of a resilence-building social capital intervention for young black gay
and bisexual men living with HIV. AIDS Care, 30, 51-58.
https://doi.org/10.1080/09540121.2018.1527007
10. “Local Data: Atlanta.” AIDSVu, 2020,
https://aidsvu.org/local-data/united- states/south/georgia/atlanta/. Accessed 21 Apr. 2020
11. Lovelace, Berkeley Jr. (2019, June 11) Free daily HIV prevention pills will soon be
available to private insurance holders. CNBC.
https://www.cnbc.com/2019/06/11/private-insurers-must-cover-prep-at-no-cost-to-
high-risk-patients.html
12. Matthews, D. D., Smith, J. C., Brown, A. L., & Malebranche, D. J. (2016). Reconciling
Epidemiology and Social Justice in the Public Health Disclosure Around the
Sexual Networks of Black Men Who Have Sex With Men. American Journal of
Public Health, 106(5), 808-814. https://doi.org/10.2105/AJPH.2015.303031
13. Quinn, K., & Dickson-Gomez, J. (2016). Homonegativity, Religiosity, and the Intersecting
Identities of Young Black Men Who Have Sex with Men. AIDS and behavior, 20(1),
51–64. https://doi.org/10.1007/s10461-015-1200-1
14. Singh, S., Bradley, H., Hu, X., Skarbinski, J., Hall, H. I., Lansky, A., & Centers for Disease
Control and Prevention (CDC) (2014). Men living with diagnosed HIV who have sex
with men: progress along the continuum of HIV care--United States, 2010. MMWR.
Morbidity and mortality weekly report, 63(38), 829–833.
15. Sophia A. Hussen, Marxavian Jones, Shamia Moore, Jasper Hood, Justin C.
Smith, Andres Camacho-Gonzalez, Carlos del Rio & Gary W.
Harper (2018) Brothers Building Brothers by Breaking Barriers: development of
a resilience-building social capital intervention for young black gay and bisexual men
living with HIV, AIDS Care, 30:sup4, 51-58, DOI: 10.1080/09540121.2018.1527007