“It’s an Uphill Battle Everyday”: Intersectionality, Low-Income Black Heterosexual Men, and Implications for HIV Prevention Research and Interventions

Abstract

This interview study, the initial qualitative phase of a larger mixed methods HIV prevention study focused on Black heterosexual men, used intersectionality as a theoretical framework to explore: (1) How a sample of Black heterosexual men describe and experience the multiple intersections of race, gender, and SES; and (2) How these descriptions reflected interlocking systems of social inequality for Black men at the social-structural level. Participants were 30 predominantly low-income self-identified Black heterosexual men between the ages of 18 and 44. Analyses highlighted four themes that demonstrate how participants’ individual-level experiences as Black men reflect macro social-structural inequality: (1) racial discrimination and microaggressions; (2) unemployment; (3) incarceration; and (4) police surveillance and harassment. We discuss the study’s findings within the context of social-structural factors that disproportionately and adversely impact Black men. We also highlight the implications of the intersectionality perspective for HIV prevention research and interventions for Black heterosexual men.

The HIV/AIDS epidemic has been calamitous for Black men in the United States. Although they account for just 14% of the male population, Black men represented 47% of new HIV infections among men in 2009 (CDC, 2011b). Possibly fueled by the debunked “down-low” myth (that the small number of Black men who have sex with men and women but do not identify as gay or bisexual are responsible for increased HIV/AIDS in Black communities; Bond et al., 2009; Malebranche, Arriola, Jenkins, Dauria, & Patel, 2010; Millett, Malebranche, Mason, & Spikes, 2005), Black heterosexual men, who may be at increased sexual risk, have not historically been a focus of most HIV prevention research and interventions (Bowleg & Raj, 2012; Raj & Bowleg, 2011). Their omission is puzzling in light of evidence that: Black men accounted for 69% of HIV cases due to heterosexual exposure among men in 2009 (CDC, 2011b); HIV is more efficiently transmitted from men to women; men wear the male latex condoms that public health officials recommend for HIV prevention; and men typically have more power in heterosexual relationships than women about condom use decisions (e.g., Amaro, 1995; Bowleg, Lucas, & Tschann, 2004).

Although HIV/AIDS is disproportionately high in Black communities, HIV/AIDS is not randomly distributed in Black communities. Rather, abundant evidence documents that elevated rates of HIV/AIDS in Black communities is associated with social-structural factors such as poverty (Denning, DiNenno, & Wiegand, 2011), crime and drug-trafficking ridden neighborhoods (Latkin, Curry, Hua & Davey, 2007; Lindberg & Orr, 2011), unstable housing (Aidala, Cross, Stall, Harre, & Sumartojo, 2005), and incarceration (Harawa et al., 2008; Thomas, Levandowski, Isler, Torrone, & Wilson, 2008). Social-structural factors refer to social, political, and economic factors, beyond the individual-level, that influence and constrain the health of individuals, communities, and societies (Blankenship, Bray, & Merson, 2000). Despite burgeoning advocacy for more social-structural approaches to HIV prevention (Adimora & Auerbach, 2010; Blankenship et al., 2000; Latkin, Weeks, Glasman, Galletly & Albarracin, 2010; Sumartojo, 2000), individualistic psychosocial health theories (Cochran & Mays, 1993) and the gender of Black men’s sexual partners still figure prominently in HIV prevention initiatives for Black men (Malebranche & Bowleg, in press). For example, the HIV prevention and epidemiological literature is replete with acronyms that denote men’s individual risk behavior or risk group status: men who have sex with men (MSM), men who have sex with women (MSW) and men who have sex with women and men (MSW/M). Critics argue that an exclusive focus on individual risk behaviors or risk group status in Black communities is misguided (Hallfors, Iritani, Miller, & Bauer, 2007; Wilson, Wright & Isbell, 2008) because it ignores evidence of a generalized HIV/AIDS epidemic (i.e., >1%) in impoverished Black urban communities (Denning & DiNenno, 2010; Denning et al., 2011). This dense concentration of HIV within poor Black communities increases HIV risk for Blacks even when their sexual or drug use behaviors are normative (Hallfors et al., 2007).

Black Heterosexual Men and Sexual HIV Risk Through the Prism of Intersectionality

Individual risk behaviors and risk group status have been the prevailing U.S. HIV prevention paradigms. Accordingly, considerable gaps in knowledge exist about how Black men’s multiple intersecting social identities (e.g., race, gender, socioeconomic status [SES], and sexual orientation) reveal interlocking systems of privilege and oppression (e.g., racism, sexism, classism, heterosexism) at the social structural level. Such questions are at the heart of intersectionality. Intersectionality is a theoretical framework that asserts that multiple social identities such as race, ethnicity, gender, SES, gender, sexual orientation (to name a few) intersect at the individual level of experience (i.e., micro level) to reflect multiple and interlocking social-structural inequality (i.e., macro level) (Collins, 1991; Crenshaw, 1989, 1991; Davis, 2008). In stark contrast to theoretical approaches that privilege the norms and behaviors of dominant groups such as middle class Whites as their starting point, intersectionality begins with the context and experiences of people from historically oppressed and/or marginalized groups (Weber & Parra-Medina, 2003). Intersectionality challenges the notion of independent, unidimensional, and additive social identities. Instead, intersectionality asserts that social identities are multiple, interdependent, and mutually constitutive (Collins, 1991; Crenshaw, 1991). Black men, from an intersectionality perspective, are not the sum of their race and gender. Rather, Black men’s race and gender constitute each other such that a single identity (e.g., race) insufficiently explains unequal or disparate outcomes unless it is intersected with other identity(ies); in the case of this study, gender and SES.

Intersectionality’s Evolutions

Intersectionality is historically rooted in Black feminist theory and scholarship (for a historical overview of intersectionality, see Bowleg, 2012a). In 1989, Black feminist legal scholar Kimberlé Crenshaw coined the term intersectionality as a description of how White feminist discourse (which interpreted women to mean White women), and antiracist discourse (which interpreted Black to mean Black men), excluded Black women. Scholarly interest in intersectionality is flourishing well beyond intersectionality’s original boundaries of women’s and feminist studies (Bowleg, 2012b), provoking new thoughts and questions about the theoretical framework (Nash, 2008) and its methodological implications (Bowleg, 2008; McCall, 2005). Two of these evolutions are central to this study: intersectionality’s applicability to men, and challenges to essentialist notions of intersectional social identities.

Black women and their intersections of race, gender, SES, and sexual orientation have been the historic focus of intersectionality scholarship (Collins, 1991; Crenshaw, 1989, 1991; Nash, 2008). Indeed, intersectionality research focused exclusively on men is rare. Black feminist scholar and intersectionality theorist Patricia Hill Collins (1991) was one of the first to advocate for an expansion of intersectionality beyond the intersections of Black women’s race, gender, and SES. Collin’s notion of an intersectional “matrix of domination” (p. 225) is expansive. It includes categories of oppression such as age, sexual orientation, religion, ethnicity, and disability. Moreover, the matrix facilitates exploration about the intersections of “penalty and privilege” (p. 225), and the contexts in which those penalties and privileges rise and fall. Men’s gender is typically associated with numerous social privileges, for example. Intersectionality highlights how men’s gender privilege ebbs and flows when it intersects with other historically devalued identities such as (Black) race, (low) SES, and/or (gay or bisexual) sexual identities. Contemporary feminist scholars have also critiqued intersectionality’s traditional premise of social identities as stable, essential and trans-historical (Brah & Phoenix, 2004; Nash, 2008; Warner, 2008). They assert instead that social processes and structural forces such as racial discrimination create and define social identities such as race, gender, and sexual orientation. Thus, the social identities that define what it means to be a Black man in 2012 differ considerably from those of 1912, and most likely those of 3012.

Intersectionality by Another Name: Theories of Black Masculinity and Sexual HIV Risk

Traditional masculinity ideologies feature prominently in the HIV prevention theory and research focused on heterosexual male adolescents and men. For example, a recent meta-analysis of HIV/STI interventions for Black heterosexual men cited machismo, with its “overemphasis on male sexual prowess, female subordination, and heterosexuality” (Henny et al., 2012) as an important determinant of sexual risk in Black and Latino communities. Research on Black men’s masculinity ideologies and sexual risk documents that the endorsement of traditional masculinity ideologies is related to having more sexual partners (Bowleg, 2004, Bowleg et al., 2011; Carey, Senn, Seward, & Vanable, 2010; Corneille, Tademy, Reid, Belgrave, & Nasim, 2008; Whitehead, 1997; Wolfe, 2003) and less consistent condom use (Santana, Raj, Decker, La Marche, & Silverman, 2006). Although some of these studies highlight the intersections of Black men’s race, gender, and SES and their relation to social-structural factors such as racial discrimination, poverty, and unemployment (see Bowleg et al., 2011; Whitehead, 1997), most do not. By contrast, even though several of the key Black masculinity theories precede formal scholarship on intersectionality, most reflect intersectionality’s core tenets. That is, they highlight Black men’s multiple intersecting identities due to race, gender, and SES. Moreover, they emphasize how Black men’s and microlevel experiences at the intersection of race, gender, and SES are linked to macrolevel social-structural factors such as racism and classism. For example, Black masculinity theorists have asserted that the economically and sociopolitically constraining environments in which low income Black men live may elicit particular types of masculinity. These types are characterized by “cool poses,” aggressiveness, violence and thrill seeking (Anderson, 1999; Aronson, Whitehead, & Baber, 2003; Majors & Billson, 1992; Staples, 1978, 1982; Whitehead, Peterson, & Kaljee, 1994), and in the context of HIV risk, hypersexuality or sex with multiple partners (Whitehead, 1997; Wright, 1993; Wright, 1997).

This study represents the preliminary qualitative phase of a larger mixed methods study focused on masculinity ideologies, sexual scripts, sociodemographic stressors (e.g., poverty, racial discrimination), resilience, and HIV prevention among Black heterosexual men in Philadelphia, PA. As part of that study’s quantitative measurement development phase, we conducted individual interviews with 30 self-identified Black heterosexual men to gain a culturally grounded understanding of their experiences, and to ensure that the study’s quantitative measures would be culturally relevant to Black heterosexual men in Philadelphia. This sample size reflects the “15 ± 10” (Kvale, 1996) and “30 to 60” (Morse, 2000) metrics for qualitative interview studies. Informed by the intersectionality theoretical framework, this study explored two research questions: (1) How do Black heterosexual men in the sample describe and experience the multiple intersections of race, gender, and SES; and (2) How do these descriptions reflect interlocking systems of social inequality for Black men at the social-structural level?

Method

Participants

Participants were 30 self-identified Black/African American men who ranged in age from 18 to 44 (M = 31.47, SD = 8.41). We focused on this age range because 74% of Black men with HIV/AIDS in Philadelphia are between the ages of 18 and 44 (Philadelphia Department of Public Health & AIDS Activities Coordinating Office, 2011). The sample was predominantly low income, with half reporting annual incomes of less than $10,000; two men reported incomes in the $10,000 to $19,999 range, and 10 men (33%) reported incomes greater than $20,000 (the annual income range was less than $9,999 to $49,999). Only 11 of the 30 men (37%) reported full-time employment; 16 (53%) reported that they were unemployed. Most of the sample (n = 23; 77%) reported at least a high school degree; 7 (23%) men reported “some high school” as their highest level of education.

Procedures

We recruited participants from randomly selected venues (e.g., barbershops, parks, street corners) in Philadelphia, PA, based on U.S. Census blocks with a Black population of at least 50%. Two Black men who were trained recruiters approached Black men who appeared to be between the ages of 18 and 44 and handed them a copy of the study’s recruitment postcard. The postcard invited men to participate in a confidential study about the “health and sexual experiences of Black men.” Prospective participants were screened by phone to determine whether they met the study’s eligibility criteria of: identifying as Black/African American, heterosexual, being between the ages of 18 and 44, and having had vaginal sex in the last 2 months. We enrolled all eligible participants until we met our targeted sample size of 30. Participants received a $50 cash incentive. The Institutional Review Board at the primary author’s institution approved all study procedures.

Measures

The study used a standardized open-ended interview approach in which interviewers posed questions to participants in the same wording and sequence (Patton, 2002). The interview guide included questions relevant to the key domains and/or measures for the study’s latter quantitative phase. These included gender role norms, sexual relationships, gender role stress, religiosity and spirituality, and sexual scripts. The intersectionality analyses for this study focused on narratives in response to the interview question: “In general, how would you describe what it’s like for you as a Black man?” Two trained Black male interviewers conducted the face-to-face, digitally recorded individual interviews in private offices at the primary author’s institution in Philadelphia. Interviews ranged in length from 45 to 90 minutes. After the interview, participants completed a brief self-administered demographic questionnaire.

Data Analyses

Interviews were professionally transcribed and edited to remove identifiers. After multiple readings, the transcripts were imported into Nvivo 9.0, a qualitative data analysis software package. The first and second authors and two trained graduate research assistants coded all of the data in Nvivo independently and then discussed and compared coding to assess agreement. Using emergent rather than a priori codes, our initial codes consisted of broad labels assigned to different portions of text (e.g., an entire paragraph, a few sentences, short phrases) that reflected key themes (e.g., unemployment). The primary author’s initial list of “free nodes” (as broad codes are called in Nvivo) included 20 codes. As coding progressed, we developed more refined hierarchical codes (“tree nodes” in Nvivo) that are reflected in the themes presented in the results section. The sample “tree” hierarchical node, “descriptions of Black men” included “branches” such as “positive,” “negative,” “neutral,” and “positive and negative descriptions.” The analytical team distilled its lengthy list of free nodes into a final list of seven codes that form the basis for the study’s results (see Table 1). The team discussed this final list of codes and coded text until we reached agreement. Two additional analytical tools included analytical notes and coding matrices. We wrote analytical notes throughout all phases of coding to highlight key questions about relationships in the data and to refine codes. The coding matrices, which highlighted codes per interviewee, allowed us to assess the depth and breadth of codes across the entire sample.

Table 1.

Key Themes Generated by Research Questions With Sample Quotes

Category and descriptions	na (%)
Q1: How do Black heterosexual men in the sample describe and experience the multiple intersections of race, gender, and SES?
The advantages/benefits of being a Black man	7 (23)
“I don’t know if this is for every Black man but blessings be coming just out of nowhere.”
The disadvantages/cons of being a Black man	19 (63)
“Hard. The one word to sum it up is hard … just hard. Everybody looks at you in a certain way and stereotype. It doesn’t matter where you are it’s still hard.”
There are both advantages and disadvantages of being a Black man	7 (23)
“It’s kind of hard (being a Black man). I feel like a target … and in the same token I feel blessed.”
Q2: How do these descriptions reflect interlocking systems of social inequality for Black men at the social-structural level?
Racial discrimination and racial microaggressions	26 (87)
“ … Racism, most definitely.”
Unemployment	16 (53)
“I mean it is a struggle, it is always a struggle trying to find some gainful employment.”
Incarceration	10 (33)
“And we’re not even the majority of people around … but we fill up the prisons.”
Police surveillance and harassment	2 (.07)
“If you … guess you look wrong and you’re walking down the street, the cop can just hop out on you and just frisk you down you know, no questions asked.”

^an = Number of participants who articulated the theme.

Our analyses demonstrate three criteria of trustworthiness of analysis: credibility, transferability, and confirmability (Lincoln & Guba, 1985; Merrick, 1999). Credibility involves the use of techniques that increase the likelihood of believable interpretations. We met this criterion through prolonged engagement with data and peer debriefing. Our prolonged engagement with the data involved multiple reads of the transcripts, approximately 4 months of intensive coding and revisions of codes to ensure agreement, followed by approximately 2 months devoted solely to the writing and revision of analyses to ensure that our analyses reflected the experiences of all respondents. Peer debriefing involved the sharing and revision of emergent analyses in biweekly meetings with members of the research team who were not involved in coding. Transferability refers to the extent to which researchers have provided sufficient description to help readers assess whether a study’s findings can be transferred beyond the sample. Readers may assess the extent to which our findings are transferable to other populations of low-income urban Black men from the extracts of rich narratives from participants that augment our analyses in the results section. Finally, confirmability refers to the extent that the study’s methods, procedures for data collection and analyses are described thoroughly to enable others to determine whether the researchers’ interpretations are grounded in the data. We have demonstrated confirmability through the provision of detailed information about our methods, recruitment, data collection, and analytical strategies. With the exception of minor edits to improve clarity, all quotes are provided verbatim. To protect the confidentiality of interviewees, we have provided pseudonyms.

Results

The results that follow are organized in relation to the study’s two research questions. These include: (1) How do Black heterosexual men in the sample describe and experience the multiple intersections of race, gender, and SES; and (2) How do these descriptions reflect interlocking systems of social inequality for Black men at the social-structural level? Key themes by frequency in the sample are highlighted in Table 1.

Intersections of Race, Gender and SES: “Not a Flowerbed of Ease”

Pursuant to intersectionality’s posit that social identities are intersectional rather than additive, most participants discussed their experiences as Black men in intersectional rather than additive terms; that is as Black men, not as people who were Black and men. There were two notable exceptions to this trend, however. Although they acknowledged the role of race and racial discrimination in shaping social identities for Black men, men such as Tommy and Dave challenged the interview guide’s question to describe themselves in terms of the intersection of their race and gender. Tommy, a 38-year-old man noted, “I’ve never been involved in any racial or anything, so it’s just like … I’m just a man.” Similarly, Dave, a 35-year-old man explained:

I don’t strictly define myself anymore as a Black man. I understand I’m a Black man based on the political definitions of race but as I watch the world get smaller, I just consider myself a man who is attempting to both survive, strive, do well, be prosperous, and contribute to humanity in a positive way. … I do recognize the dynamics of racism, and how that impacts others in the world around me, and how I fit into that, whether or not I choose to or not.

Highlighting the link between their multiple social identities of race, gender, and SES and social-structural factors such as racial discrimination, poverty, unemployment and incarceration, respondents frequently used words such as “hard,” “challenge,” “struggle,” and “tough” to describe what it meant to be Black men. Men such as Anthony, a 29-year-old unemployed man struggled to find positive things to say about being a Black man: “All right. The good things, let’s see. … Just being alive … I don’t know the good things about being … I mean … that’s a hard one.” Asked why the question was so hard to answer, Anthony responded, “Because there’s like more negatives … like the negatives is going to balance more than the positives.” Mention of racial discrimination was omnipresent throughout the majority of the study’s narratives. Tony, a 22-year-old unemployed man, provided a typical response when he described his life as a Black man as “challenging. … tough. Tougher than it would be if, you know, I was another race.” Indeed, solely positive descriptions of being a Black man were rare. Instead, men’s positive descriptions of their lives as Black men coincided with their description of structural factors of racial discrimination, economic hardship, unemployment, and life postincarceration. Jamie a 42-year-old man stated:

Well I feel positive [about being a Black man, but] sometimes I feel like things don’t go right you know, as far as Black people, for like moneywise and financial things, situations like that. Other than that I don’t have any problems with being a Black man.

Similarly, referring to the “troubles and tribulations” of his life as a Black man, Greg, a 32-year-old man described his life this way: “It’s not a flowerbed o’ ease … So it’s not easy, and it’s not too hard.”

Although participants’ narratives were replete with accounts of unemployment and financial hardship, we found no narratives in which participants explicitly articulated their SES into their descriptions of their social identities as Black men. Paul, a 33-year-old college graduate, came closest when he summed up the challenge of being a Black man this way: “… to have less access to the system and … to work harder to get like results that maybe Caucasians, or people that come from higher economic backgrounds [readily get is] kind of depressin.’”

Intersectionality from the Micro to the Macro Social-Structural Level

Our analyses of participants’ narratives highlighted four themes that demonstrate how their individual-level experiences as Black low SES men reflect larger social-structural factors, namely the intersection of racial discrimination and discrimination based on gender and low SES status. These themes, in order of the frequency that participants discussed them, include: (1) Racial discrimination and racial microaggressions; (2) Unemployment; (3) Incarceration; and (4) Police surveillance and harassment.

Racial Discrimination and Racial Microaggressions: “Racism, Most Definitely”

Men’s narratives about their experience as Black men reflected a keen awareness of discrimination based on Black men’s intersections of race and gender. Respondents recounted their experiences with both institutional racial discrimination and everyday racial microaggressions. Racial microaggressions are “brief and commonplace daily verbal, behavioral, or environmental indignities, whether intentional or unintentional, that communicate hostile, derogatory, or negative racial slights and insults toward people of color” (Sue et al., 2007, p. 271).

For example, Marc, a 34-year-old man, cited his experiences with “racism, most definitely [and how] people react to you [and] respond to you in different situations” as a persistent stressor. Donovan, a 28-year-old, described his life as a Black man as:

An uphill battle every day, for the simple fact of the racial disparities that we go through: institutionalized racism in the work area, school, all of the different partitions that’s put up and all of the things that we have to go through to just survive every day, as a Black man. It’s hard work. It’s an everyday … It’s a job every day.

Racial discrimination in the workplace and racial microaggressions in which people, frequently Whites, suspected or perceived Black men to be criminals were recurrent throughout the study’s interviews. Sean, a 37-year-old man, said that he frequently observed differential treatment on the basis of race for Black and White employees in his workplace: “White people get to come in late, and you know, feel what they feel, but we [Black employees] get written up for certain things [that the White employees would not get written up for].” Similarly, Ricky, a 40-year-old man, described the challenges of coping with a job that he described as “very racist.” He added, “I would be here three hours telling you just the favoritism because of a person’s color of their skin on my job and it is blatant.” Others described struggles to have their coworkers or bosses perceive them as competent. Tommy observed that there appeared to be a double standard in his workplace for how he was expected to dress and how his White coworkers could dress. He noted also that colleagues often appeared to be surprised that he was knowledgeable about his job, despite the fact that he had more training and years of experience on the job than most of his colleagues.

Although descriptions of workplace challenges focused exclusively on race and racial discrimination, narratives about the participants’ experiences with racial microaggressions tended to emphasize the intersection of their race and gender. Participants described numerous encounters of being suspected, scrutinized, or perceived as engaging in criminal activity because of the intersection of their race and gender. Typical was Greg, who noted that he felt that White people often perceived him to be a “crook”: “If I’m walkin’ down the street at 11 o’clock at night, and there’s two White people walkin,’ maybe they’ll be a little frightened by me.” Corey, a 44-year-old man used the word “sad” to describe being followed around stores because storeowners suspected that he might shoplift clueless of the fact that “I got more money in my pocket that I’ve earned.”

Unemployment: “It’s Hard Out There … Workwise”

Sixteen of the study’s 30 participants were unemployed. Often, participants’ narratives about unemployment coincided with narratives about incarceration histories. The response of Karl, a 43-year-old unemployed man who had been incarcerated for 14 months exemplified this: “It is a struggle. It is always a struggle trying to find some gainful employment.” Musings about the intersections of race and gender in general, and racial discrimination in particular, on job prospects were common. For example, Tony, a high school graduate who had been looking for work for six months pondered how being Black had influenced his job search:

… I’m unemployed right now, but I’ve been goin’ on job interviews. You know, my resume is crazy [in terms of having the right qualifications], everythin.’ But every time I go to an interview, you know it seems good, but I’m not gettin’ no calls back or nothin’ like that … Like, I wouldn’t be able to go to a job interview maybe with my goatee hangin’ like this, so. I think if, if I was maybe another race, it would be cool.

We interpreted Tony’s reference to his goatee to highlight his perception of the intersection of his race and gender, because of its contrast to his perception that a White man with a goatee would get the job. Faced with their perception that it was impossible to find legal full-time employment, interviewees such as Malcolm, Lamont, and Trevor said that they regarded hustling, the selling of legal or illegal merchandise on the streets, to be a viable alternative for making money. Malcolm, who was 30 years old, described his hustling, which centered on dealing crack cocaine, as hard work: “I mean, wake up every day, hustle hard, run the streets, hustle hard and live my life.” Trevor, a 36-yearold husband and father, said that he did not like dealing drugs, but perceived few other options after so many times of being denied legal work: “When you put the [job] application in, and … get that, “Don’t call us, we’ll call you,’ … I already know they ain’t call … So I just resort back to what I do best [dealing drugs].”

Participants who struggled with chronic unemployment sounded an almost unanimous note about the distress of not being able to find or keep work. Rob, a 40-year-old married father of four, described his experience with trying to get a job while having a criminal record this way:

Right now, there’s a lotta stress and pressure on me, you know? Not working, and stuff like that. I’m still tryin’ to find a job, ‘cause I been arrested a while ago, had a conviction on me, and, it seems like every time I get after six or three months, I’m gettin’ laid off because [of] something that happened 13 or 14 years ago.

Incarceration: “In an’ Outta Jail a Lot”

Ten of the 30 interviewees disclosed that they had been incarcerated, with the most frequent reason being drug possession or distribution. Sean, who recounted a life of drugs and violence that included being shot six times, described himself as being “in an’ outta jail a lot” since the age of 33 for selling drugs. Men’s experiences with incarceration often compounded stress because it posed considerable barriers to employment. Anthony, who spent 9 months in jail for selling marijuana, summed up the issue this way: “It’s like hard for us to get jobs especially for a guy like me that got like felonies and dealing with drugs.”

Police Surveillance and Harassment: “You’re Always a Target”

To two interviewees, being a Black man meant unwarranted stops, questions, and frisks by the police. These interviewees recounted numerous instances in which the police had targeted them for questioning or searches without cause. Steve, a 23-year-old man who described his life as “hard,” recounted an incident when he went in search of a meal:

I’m … walking to the [restaurant] to get me something to eat. The cops ask, ‘What you doing and what you out here for?’ [Then they] frisk me down to see if I’ve got any guns … drugs … they just let you go if you don’t have any.”

“You’re always a target [when you are a Black man]” was how Wayne, a 26-year-old described his frequent interactions with the police: “And it happens over and over … Just getting the one over [by police], just being harassed by cops [who are] always looking [at me] like I’m suspicious … like a suspect or something, a crim[inal] or something.”

Discussion

Using intersectionality as a theoretical framework, this study’s findings demonstrate how intersections of race, gender, and SES for Black men in the sample reflect interlocking systems of oppression for Black men at the macro social-structural level. A preponderance of troubling national statistics document that the individual experiences that the Black men in this study recounted with racial discrimination and racial microaggressions, unemployment, incarceration, and police surveillance and harassment mirror those at the macro social-structural level. For example, national data document the historical and disproportionate rates of unemployment among Black men in the United States.

Writing about chronic unemployment among Black men in Philadelphia in his classic sociological study, W.E. Du Bois reflected in 1899, “Everyone knows that in a city like Philadelphia a Negro does not have the same chance to exercise his ability or secure work according to his talents as a White man” (Du Bois & Eaton, 1899, p. 98). Thus, far from being an artifact of the contemporary economic recession, Black men’s history of chronic unemployment is linked to broader structural forces such as institutionalized racism (Du Bois & Eaton, 1899; Royster, 2003) deindustrialization, trade liberalization policies, and subsequent declines in mass production in the United States that have eroded work for low-skilled workers (Wilson, 1996; Schwartzman, 1996). Low-skilled Black men who “were at the end of the employment queue” (Wilson, 1996, p. 29) even before the large economic restructuring of jobs in the 1970s and the contemporary recession, have borne the disproportionate brunt of unemployment for decades in ways that differ markedly from that of the recently unemployed general population. For example, although the overall unemployment rate in the United States in January 2012 was 8.3%, the seasonally adjusted unemployment rate for Black men age 20 and older was 12.7% compared with 6.9% for White men in the same age group (U.S. Bureau of Labor Statistics, 2012).

Black men also face disparate rates of incarceration compared with men from other racial and ethnic groups. In 2008, incarceration rates for Black men were 6.5 times that of White men (Sabol, West, & Cooper, 2009). Black men’s incarceration is also linked to broader structural forces such as institutional racism codified in a variety of state and federal government policies including, but not limited to: the politics of mass incarceration (Alexander, 2010), racial profiling (e.g., Driving While Black, stop-and-frisk practices; Gelman, Fagan, & Kiss, 2007; Harris, 1997; Lundman & Kaufman, 2003), differential sentencing rates for crack cocaine versus powder cocaine possession, the War on Drugs and mandatory sentences for drug crimes, and the political economy of the prison industrial complex (Brewer & Heitzeg, 2008; Pettit & Western, 2004; Takagi & Platt, 1982).

Echoing the findings of other research with Blacks that document the ubiquity of racial discrimination (Mays, Cochran, & Barnes, 2007; Williams, Neighbors, & Jackson, 2008), respondents’ narratives were replete with descriptions of racial discrimination and racial micro-aggressions. The tendency for participants to mention racial discrimination in the context of their descriptions and experiences as Black men, bolsters contemporary intersectionality theorists’ assertions that social identities are not essential and stable. Rather, they are shaped by social processes and social-structural forces such as racial discrimination (Brah & Phoenix, 2004; Nash, 2008; Warner, 2008).

Limitations of the Study

There are at least four limitations to our research. First, we applied the intersectionality framework to the data a posteriori. An a priori application of intersectionality to the study’s interview guide would have allowed participants to elaborate on their intersectional experiences, and reflect on other social identities (e.g., low SES, heterosexual). Second, our interview guide’s question asking participants to describe their experience as Black men may have prompted participants to respond in terms of intersections of race and gender only, thereby obscuring other key intersectional social identities such as SES or disability status. Tommy and Dave’s narratives suggest that not all Black men perceive the intersection of race and gender to be salient to their self-definitions. Third, the sampling and qualitative methods that we used do not allow generalization beyond the study’s sample. Finally, the study’s sample was predominantly low income and unemployed. Having a more socioeconomically diverse sample of men would have allowed us to explore the intersections of “penalty and privilege” (Collins, 1991, p. 225) for higher SES Black men and to be able to compare and contrast the impact of low and high SES on Black men’s experiences with the social-structural factors that men in this study discussed.

Study Implications

Theoretical implications

The aforementioned limitations notwithstanding, the study has important implications for applying the intersectionality framework to theory, research, and interventions for Black men. The most obvious theoretical implication of our work is the need for more intersectionality theory and research focused on Black men. As we have noted, an abundant scholarship on the intersections of Black men’s race, gender, and SES exists, but much of this work was published before the emergence of intersectionality scholarship. Because Black women’s race, gender, and SES have been the historical subjects of intersectionality (Nash, 2008), there is a dearth of knowledge about the intersectional experiences of Black men, and other men of color.

Needed in particular, is intersectionality-informed language to describe Black men’s experiences at the intersection of racial and gender discrimination (Bowleg, 2012b). The micro level experiences that men in this study recounted of incarceration and police surveillance and harassment disproportionately affect Black boys and men. They do not affect all Black people equally (though Black girls and women are hardly exempt), and they certainly do not affect all men. That is, these systems of oppression coalesce around Black men’s intersections of race, gender, and often low SES status. Thus, to frame them only in terms of a single social-structural factor such as racial discrimination fails to account for how discrimination based on race also intersects with gender for Black men. Much of the problem here lies in the fact that gender is often a euphemism for women’s gender, and sexism conjures images of discrimination on the basis of female sex, not male sex. Nonetheless, this absence of appropriate language to describe Black men’s micro and macro level experiences at the intersection of race, gender, and SES facilitates the invisibility of Black men’s lives in social and behavioral theory, research, and interventions.

Implications for HIV prevention research and interventions

Preventing HIV in Black heterosexual men in general, and Black communities in particular is a core element of our work as HIV prevention researchers. Thus, although this study’s design did not allow us to investigate how participants’ perspectives about intersectionality at the micro and macro level might be associated with their sexual HIV risk behaviors, the research nonetheless illustrates how intersectionality can address some of the gaps in HIV prevention research and interventions for Black heterosexual men. For example, one of intersectionality’s core tenets is that people from multiple historically oppressed groups, not dominant groups, are the starting point (Weber & Parra-Medina, 2003). Findings from this study suggest that HIV prevention research and interventions informed from Black heterosexual men’s perspectives would necessarily have to address the social-structural issues that they perceive to be most relevant to their lives; not just the priorities of researchers (e.g., increasing HIV risk perception, condom use, or condom self-efficacy).

As such, our findings align with those of a recent meta-analysis of HIV/STI interventions for Black heterosexual men. The meta-analysis found that although HIV/STI interventions for Black heterosexual were effective in reducing HIV sexual risk behaviors and STIs, the most efficacious interventions focused specifically on Black men, and men with incarceration histories (Henny et al., 2012). The study also found the provision or referral of medical services other than HIV/STI-only services to be the most robust intervention component. The reasons for this reflect the social-structural factors that form the crux of the intersectionality framework, that the micro level experiences reflect multiple interlocking social-structural inequality. As such, Black men are disproportionately less likely than other populations to have health insurance (DeNavas-Walt, Proctor, & Lee, 2011), and thus less access to health care.

Moreover, there is ample evidence of an association between increased HIV/AIDS in Black communities, and many of the same social-structural factors, such as poverty and incarceration, that characterize the lives of low income Black men (CDC, 2011a). For example, Black men’s disparate representation among the incarcerated has clear implications for HIV risk in Black communities. In 2008 the confirmed AIDS rate among the incarcerated was 2.4 times greater than the general population (Maruschak & Beavers, 2009/2010). Yet, structurally informed HIV prevention research and interventions have lagged behind interventions informed by primarily individualistic theories of behavior change. An intersectionality perspective highlights the need for micro and macro level interventions, such as multilevel HIV prevention interventions, that address behavior change at the individual level, as well as social-structural issues such as poverty, unemployment, and racial discrimination. Moreover, considerable gaps in knowledge exist about how social-structural factors, such as racial discrimination and poverty, become “embodied” (Krieger, 1999, p. 296) in individuals in ways that increase sexual HIV risk.

Racial discrimination loomed large in the narratives of men in this study in ways that have important implications for HIV prevention research and interventions for Black men. Racial discrimination is the historical antecedent of Black men’s disproportionate rates of poverty, unemployment, incarceration, and police surveillance and harassment at the individual and social-structural level. Yet, in the HIV prevention literature racial discrimination rarely appears on the list of structural factors that may increase HIV risk (Bowleg et al., 2012b). Moreover, although countless studies document the link between Black people’s experiences with racial discrimination and numerous adverse health outcomes (Mays et al., 2007; Williams et al., 2008), there is a surprising dearth of HIV prevention research focused on the effects of racial discrimination and sexual risk for Blacks. Just four studies, three conducted with Black heterosexual men (Bowleg et al., 2012a, 2012b; Reed et al., in press) and another with African American youth (Roberts et al., 2012) exist. Together, these studies document that Blacks who report more racial discrimination also report more sexual HIV risk behaviors. These studies lay the ground for more research on racial discrimination and risk and the need for social-structural-level interventions to limit the negative effects of racial discrimination on Black men. A recent Philadelphia City Council (2011) resolution encouraging employers not to ask about incarceration histories in an attempt to break the link between unemployment and incarceration for Black men, exemplifies a structural intervention that may have important implications for reducing Black men’s HIV incidence. Similarly, Black men bear the disproportionate burden of “stop-and-frisk” practices that allow police to stop and frisk people suspected of illegal activities (Gelman et al., 2007). The repeal of stop-and-frisk practices exemplifies another structural intervention with implications for reducing Black men’s disproportionate rates of incarceration, unemployment, and presumably HIV risk as well.

For most of the men in our study, prejudice and discrimination based on the intersections of their (Black) race, (male) gender, and (low) SES define what it means to be a Black man. As such, our study highlights the utility of an intersectionality perspective for advancing knowledge about Black men’s lives at the micro level to inform research and interventions to alleviate the intersectional burdens of “the uphill battle” of being a Black man at the macro social-structural level.