Racial identity, masculinity and homosexuality in the lives of young Black men who have sex with men: Implications for HIV risk

Abstract

Background. Young Black men who have sex with men (MSM) carry a disparate burden of HIV infection. A recent study reports an HIV prevalence of 16% among young Black MSM 15-22 compared to 6.9% in Latino MSM and 3.3% in white MSM in 7 urban centers (Harawa et al., 2004). Moreover, although rates of unprotected anal intercourse (UAI) are similar, young Black MSM in these settings have an odds ratio of HIV infection that is 9 times that of young white MSM (Harawa et al., 2004). The similar rates of UAI across racial and ethnic groups suggest a need to examine other, more complex factors. Accordingly, this study explores multiple disciplines and theoretical concepts that may be pertinent to HIV risk in this population including identity and identity development, social norms and normative influence, and theories of masculinity and gender role conflict.

Method. This study is based on semi-structured interview data previously collected from 35 young Black MSM (18-24) in New York City, Rochester and Buffalo, NY and Atlanta, GA. The methodology involved qualitative analysis of secondary data using a primarily inductive approach. Data were analyzed using a categorical and contextual analytic approach. In the categorical analysis, I used analytic coding based on the constant comparative method. This coding process involved an initial stage of data immersion and open coding followed by more structured coding as a theoretical scheme emerged from the data. The contextual approach employed case study analysis. Each of the 35 interviews was interpreted based on the theoretical scheme that emerged from the analytic coding process and written up as a "case study." I compared each case study to identify commonalities in the social processes and patterns of meaning that arose from the case analysis of each interview. Case comparison allowed for richer comparisons taking a more extensive account of life factors surrounding concepts of interest than can be accomplished through coding alone.

Findings. Homosexual conflict emerged as a core theme in the data. Informants described conflict between homosexuality and nearly every other aspect of their lives including expectations of masculinity, religion, reference group expectations and racial identity/group membership. Study participants described varying reactions to this conflict that ranged from disavowal to recurrent stress and strain. This sense of conflict seemed to be fueled by reference group norms and attitudes about homosexuality and expectations of masculinity. The informants' reactions to this conflict seemed to be affected by group identity and level of attachment to one's reference group and the degree of normative orientation and apparent stage of ego identity development. Conflicts between homosexuality and cultural expectations of masculinity were the most profound. The study findings suggest that negotiation of same-sex behavior and/or identity in the context of cultural expectations of masculinity that disavow homosexuality may have important implications for HIV risk. Data show that race-specific conceptions of masculinity and gender role expectations may influence partner selection, prevention heuristics, and condom decision making.