“That Guy is Gay and Black. That’s a Red Flag.” How HIV Stigma and Racism Affect Perception of Risk Among Young Black Men Who Have Sex with Men

Abstract

Young Black men who have sex with men’s (YBMSM) attitudes and personal beliefs about themselves and their risk for HIV can be modified as a result of experiences with racism and HIV stigma. In-depth qualitative interviews were conducted with 25 HIV-negative YBMSM, aged 18–24, in North Carolina and Maryland. Data were thematically analyzed to capture participants’ experiences and thoughts related to stigmatizing experiences and their perception of risk for HIV. Participants reported experiencing HIV stigmatizing and blatant racist commentary related to their identities as YBMSM. Participants described diverse strategies to distance themselves from these negative stereotypes and decrease their sexual risk for HIV. The findings highlight that HIV stigma and racial stereotypes are one of the many types of discrimination that YBMSM experience within the Black and gay communities and in society; leading to psychological distress and an altered perception of self and sexual risk.

Introduction

Societal racism and HIV stigma can have negative and long-lasting effects on young Black men who have sex with men (YBMSM). These negative experiences influence adolescents’ development of key behavioral patterns and beliefs that impact health outcomes well into adulthood [1, 2]. Specifically, regarding HIV, experiences with racism and HIV stigma in their communities, and society can modify YBMSM’s personal beliefs, attitudes, and behaviors regarding their risk for HIV [3, 4]. Adolescence and young adulthood [5, 6]—ages 13 to 24—are critical periods where interactions with key individuals (i.e., parents, family, friends) [5-7], culture [8-10], and society [11, 12] influence a young person’s cognitive and social development. In 2016, YBMSM, aged 13–24, made up 57% (3719) of existing HIV infections among YMSM in the United States, representing a significant difference in HIV incidence as compared to Whites (1094: 17%), and Hispanics/Latinos (1687: 26%) [13]. Some researchers have attributed this disproportionate HIV representation to the increase in YBMSM’s experiences with racism [14, 15] and HIV stigma [16, 17].

Racism is defined as a dominant group’s beliefs of racial superiority based on biological differences [18]. Black adolescents and young adults perceive more racial or ethnic discrimination in their everyday lives, as compared to their White and Hispanic counterparts [19, 20], particularly if they are of a darker complexion [21]. YBMSM have also reported experiencing racial discrimination within the men who have sex with men (MSM) community [22] in the form of “sexual racism.” Sexual racism is the intentional selection and exclusion of potential sexual partners solely based on race [23] and often occurs when meeting potential sexual partners, in person [24] or online [25]. Sexual racism often results in Blacks being located at the bottom of the dating selection hierarchy and being less likely to be selected as a potential sexual or dating partner as compared to their White or Hispanic counterparts [25, 26]. However, while some may argue that racial selection in dating is simply preference [27], others may argue that this is a method of HIV prevention, secondary to the perception of high rates of HIV in the Black MSM (BMSM) community [14].

YBMSM have often reported feeling stigmatized as a group with HIV, secondary to the public perception of the high number of cases among BMSM overall [17]. Targeted HIV awareness messages, educational campaigns, and the media’s representations about the high rates of HIV in the Black community not only raised consciousness about HIV rates in YBMSM, but also negatively centered them in the HIV discourse [28]. King and Hunter’s book, “On the Down Low,” examined men on “the down-low,” also known as “men on the DL” in the Black community, positioning them as vectors of transmission within the Black community [29]. This sentiment was widely embraced, with many believing BMSM were the root HIV transmission for both men [30] and women [31], both within and outside the Black community [30]. As a consequence, many YBMSM perceive and internalize HIV stigma [32]. Furthermore, YBMSM who have received HIV-prevention messages or interventions may express a sense of hopelessness, or inevitability, regarding their future risk for becoming infected with HIV [28].

Experiences with racism and HIV stigma can cognitively modify YBMSM’s existing attitudes and personal beliefs about themselves [3, 4] and their risk for HIV [33], resulting in a diminished self-concept and an increase in their risky sexual behaviors [34]. Repeated exposure to messages about the prevalence of HIV in the gay community, and specifically in the BMSM community, can shape how YBMSM see their own risk for HIV [17, 28, 35] and the HIV risk of others in their sexual networks [14]. Subsequently, YBMSM experiences with racism and HIV stigma in the community can negatively affect their sexual [14, 36, 37] and health behaviors [38, 39], thereby increasing their risk for HIV. It is essential to understand how racism and HIV stigma influence YBMSM’s perception of risk for HIV and how this perception influences sexual practices. Therefore, the purpose of this study was to (1) identify what factors influence YBMSM’s perception of risk for HIV, and (2) describe how these factors influenced their risk-reduction strategies for HIV.

Methods

Design

An exploratory qualitative study was undertaken to better understand the perceptions of HIV risk among YBMSM and how these perceptions influenced their HIV prevention strategies.

Study Sample and Setting

The participants were recruited from the central and southern regions of North Carolina and the Baltimore-Washington Metropolitan area. These sites were selected for participant recruitment for two reasons. North Carolina is located in the Southeastern U.S.—a geographical region with the highest rates of HIV in the nation, particularly for YBMSM [40]. In 2016, BMSM, of all ages, comprised 69.3% of new HIV infections in North Carolina [40]. Similarly, the rates of HIV in the Baltimore-Washington metropolitan areas are among the highest in the U.S. In this metropolitan area, BMSM accounted for 63.5% of new HIV infections in MSM in Maryland [41], and 57% in Washington, D.C. [42] in 2016.

Participants were recruited utilizing purposive sampling techniques including online and smartphone applications, in-person community and clinical recruitment, and the use of respondent-driven sampling (snowball sampling). Recruitment activities began in June 2016 and ended in December 2016 when data saturation was achieved.

To be eligible for the study, participants had to (1) be between the ages of 16–24; (2) self-identify as African-American, Black, or mixed-race including African American or Black; (3) have been assigned male sex at birth; (4) self-identify as gay, bisexual, queer, or self-identify as a heterosexual male who had a past voluntary sexual experience with another man or had current sexual desires for men; (5) report being uninfected with HIV; (6) mentally capable of providing informed consent; (7) able to speak and read English; and (8) not currently using Pre-exposure Prophylaxis (PrEP). This study was focused on the prevention of HIV transmission, so men living with HIV were excluded.

Protection of Human Subjects

Human subjects’ protection was obtained from the Duke Univeristy Institutional Review Board before the initiation of any study procedures. Only IRB-approved flyers, hand cards, and online advertisements were used to promote the study. The participants signed a written informed consent prior to engaging in the individual interviews. The privacy and identity of the participants were protected using an alias chosen by each participant before the start of the interview. Each participant was given a $25 Visa gift card at the end of the interview to thank them for their time.

Data Collection

A brief demographic survey, administered at the beginning of the interview, captured individual characteristics. The individual one on one interviews captured participants’ experiences and opinions regarding their risk for HIV. Data were collected using a semi-structured interview guide that contained questions such as, “How often do you think about HIV?”, “What are some of the things that you think about?”, and “How do you think that being an African-American or Black youth influences your perception for being at risk for HIV?” The interviews lasted, on average, 60 min, but ranged from 35 min to 1 h 24 min. Interviews were conducted at a convenient location (school, library, cafe) as identified by the participant.

Data Management and Analysis

All the interviews were digitally recorded. Within 24 h of completing each interview, the digital files were downloaded to a secure electronic drive, behind a protected firewall on the Duke University server. These digital audio files were then transcribed verbatim by a transcriptionist. The lead author of this study then verified the transcripts against the digital audio files to ensure completeness and accuracy. Using NVivo 11 software [43], the verified verbatim transcripts were then analyzed using directed content analysis [44].

First cycle coding consisted of in vivo coding (using short quotes from participants) and descriptive codes to capture participants experiences and thoughts related to stigmatizing experiences and their perception of risk for HIV [45, 46]. Analytic memos were created for each interview to capture the primary researcher’s in-depth thoughts about the interview, analysis process, and emerging themes [45, 46]. The second level coding consisted of pattern coding, where descriptive codes were collapsed into smaller categories. Preliminary codes were used to form themes based on frequency, the similarity of core concepts, and marked differences between participants’ responses regarding their risk for HIV and stigmatizing experiences [46, 47]. Semantic relationships were used to organize codes based on participants’ descriptions of their experiences with racism, HIV stigma, and dating [46]. The number of participants who described a similar phenomenon in a category was calculated and reported as a percentage. Reporting the proportion of participants responses for each category allowed for a richer description of the described phenomenon.

Descriptive statistics were used to summarize the participants’ demographic data. SAS Version 9.3 was used to provide descriptive statistics for the study.

Results

Sample Characteristics

The sample was comprised of 25 self-identified HIV-negative YBMSM, aged 18–24 (M = 21.0, SD = 2.0). Nineteen of the participants were interviewed in North Carolina and six from Maryland/Washington, D.C. Thirteen (52%) of the participants also selected an additional racial or ethnic identity beyond their African American or Black identity (See Table 1). Seventy-six percent (n = 19) of the men identified as gay, with 96% (n = 24) reporting being part of the gay community. Thirty-two percent (n = 8) of the sample had completed college or technical school, 44% (n = 11) completed some college courses, and 24% (n = 6) had completed high school or a GED program. The majority of participants reported using dating apps to meet sexual partners, 84% (n = 21).

Table 1.

Individual characteristics—self-report

Category	n (%)
Age (M = 21.0; SD = 2.0)
18–24	25 (100.00)
Racial/ethnic identitya
Caucasian/White	2 (8.00)
Asian or Pacific Islander	1 (4.00)
Native American or Alaskan Native	2 (8.00)
Latino or Hispanic	2 (8.00)
Multi- or bi-racial	6 (24.00)
Sex at birth
Male	25 (100.00)
Gender identity
Male	24 (96.00)
Gender queer/gender non-conforming	1 (4.00)
Sexual orientationb
Heterosexual	1 (4.00)
Gay man	19 (76.00)
Same gender loving	2 (8.00)
Queer	4 (16.00)
Bisexual	5 (20.00)
Pansexual	4 (16.00)
Educational attainment
High-school or GED certificate	6 (24.00)
Some college classes	11 (44.00)
Technical school	2 (8.00)
Associates degree	2 (8.00)
Bachelor’s degree	4 (16.00)
Met sexual partnersb
Online/internet chat rooms	8 (32.00)
Bars or clubs	12 (48.00)
Through friends	18 (72.00)
Dating apps	21 (84.00)
Other: whatsapp messenger	3 (12.00)
Community membershipb
Gay/bisexual	24 (96.00)
Ballroom (house ball)	1 (4.00)
Hip hop/trap/ratchet	2 (8.00)
Discreet/DL	2 (8.00)
Poly	2 (8.00)
Leather/Kink/BDSM/RolePlay	2 (8.00)

^aSelf-reported racial or ethnic identity after selecting African American/Black

^bParticipants allowed to select more than one response

A major theme that emerged from the data was sexual racism, discrimination, and stigma. This theme had several categories that focused on sexual racism and different forms of discrimination and stigma the participants reported experiencing while dating and in their everyday lives. As part of this theme, the YBMSM discussed racism and colorism in dating, racialized stigmas attached to their sexual identities, and HIV stigma, and how these experiences affected their perception of risk for HIV and shaped their HIV risk-reduction strategies. A second theme that emerged from the data was calculating risk, which described how participants calculated the HIV risk of potential sexual partners. In this theme, participants described how they assessed, or “vetted” potential sexual partners based on several factors that included race, class, and economic status. Table 2 provides an exemplar for the two themes and categories with illustrative participant quotes.

Table 2.

Thematic display

	Category	Percentage	Code	Quotes
Theme 1
Sexual racism, discrimination, and stigma	Sexual racism	24%	Racism and colorism affecting partner selection	“Because they’ll tell me, ‘Oh you’re a good guy. If only you were white’, or like, ‘Oh man, if only you were white, you’d be perfect for my friend.’ So, it’s like I’m confused. So, I’m perfect, but because I’m black I’m not perfect?” “So, there is a degree of colorism in play. Well, many people usually perceive me as being black, if especially if I am in the gay community as a whole…[but] with people who are white, they usually don’t perceive many of the negative connotations that come with dark skin per se. There is a considerable degree of discrimination…”
			Racialized stigmas attached to their sexual identities	“I think that people are under the influence of like, ‘Oh wow, that guy is gay and black. That’s a red flag. Just his existence is a red flag. I’m going to stay away from that because I don’t want to become infected’… because of the intersection of my race and sexuality, which is perceived as also having a great increase for HIV.” “I think black males are sexualized more, and so that brings on its own thing of like attraction…Basically, it’s like penis size and pleasure I guess; you’re freakier.”
			Gay Black men are not seen as the desirable ones on campus	“…it’s very hard to find men at my school that would be willing to have a sexual experience with me because of my ethnicity or race…I go to a predominantly White institution, where gay Black men are not seen as the desirable ones on campus..”
Theme 2
Calculating risk	HIV’s impact on dating	28%	I am more inclined to vet black people	“… I’m like, you’re a white dude on a college campus. You’re like a White college kid, so like you most likely do not have HIV. But if I’m like, you’re a black dude who is in Durham, who I don’t know really anything about, you are much more likely to have HIV.”
			Financial status impacts perception of risk	“…like if I’m having sexual relations with someone who is African American and gay and from a low-income family, then I feel like that also makes my chances of catching it [HIV] go higher.”
			Being a gay, Black man, my risk is pretty high	“…I’m starting to look at the statistics and read more articles…I know that I have a high probability of catching it. And so, I think that that for me has [me] like, ‘Oh, am I safer to just have sexual relations with White guys than a Black guy?’ ”

Sexual Racism, Discrimination, and Stigma

Many of the participants reported meeting potential romantic or sexual partners using online applications, their social networks, bars, or clubs. These methods provided a convenient way to meet potential partners, but also exposed some of the participants to discrimination, stigmas, and stereotypes. Participants reported direct and indirect racist and stigmatizing commentary, which was typically linked to the Black or Black gay communities. Consequently, many participants reported feeling like either social outcasts or fetishized objects as a result of these interactions.

Some of the participants described a selection bias against them in the dating scene. They perceived that, because they were Black, YMSM of other races saw them as less desirable, eliminating them as potential sexual partners. One participant called these interactions “sexual racism,” where partner choice was not determined by compatibility and who he is as a person, but by race. It should be noted that the participants who talked in-depth about experiences with sexual racism were either currently or previously enrolled at predominantly White universities. Dove, a 19-year-old, illustrated his experience in the following statement,

…it’s called sexual racism. I think it’s something that prevails in predominantly White institutions, specifically for Black gay men.…it’s very hard to find men at my school that would be willing to have a sexual experience with me because of my ethnicity or race… I go to a predominantly White institution, where gay Black men are not seen as the desirable ones on campus, in terms of the LGBTQ community. I even had a guy once tell me that, ‘You know I understand that like I’m being prejudiced towards Black people and that I know that like it’s bad, but I don’t know how to change it. And I know that I don’t like Black men. And that like I understand that you’re a good person, but, like for some reason I’m not attracted to darker skin, or like gay men that are also Black.

Another participant, Kaiser (age 22) who described himself as multiracial, talked about racist interactions he experienced on dating apps. He described how he benefitted from colorism. Colorism is the assignment of privilege to a person based on the lightness of their skin tone, with lighter complexioned Blacks receiving more privilege than those who are of a darker complexion [48]. He stated that White YMSM perceived him differently because of his lighter-skin complexion, which allowed him to avoid some of the negative stereotypes associated with darker-complexioned YBMSM.

So, there is a degree of colorism in play. Well, many people usually perceive me as being Black, if especially if I am in the gay community as a whole…[but] with people who are White, they usually don’t perceive many of the negative connotations that come with dark skin per se. There is a considerable degree of discrimination, but I typically just have to go out there and say, are you a racist, etc., you know.

—Kaiser, age 22.

Sexual racism was not limited to potential sexual partners who were White YMSM but also occurred in the participants’ social networks containing White peers. A participant described an interaction with a person who told him that he would be a good fit for his friend, only if he were White.

Because they’ll tell me, “Oh, you’re a good guy. If only you were White, or like, “Oh man, if only you were White, you’d be perfect for my friend.” So, it’s like I’m confused. So, I’m perfect, but because I’m Black I’m not perfect? Like, now I’m not able to be introduced to your friend, or now you don’t want to have a sexual experience with me because I’m Black? Like what is that? Why are you saying that?

—Dove, age 19.

In addition to racial discrimination, several participants described societal-level stereotypes about the Black community related to sex and HIV. They stated the pervasive perception was that Blacks, as a whole, experience a higher burden of HIV compared to other racial groups. They also reported hearing stereotypes about Black men spreading HIV to their unknowing female partners and the phenomenon of Black men living on the “down low.”

Society loves to just label all young gay Black males as HIV positive, and that’s really inaccurate.

—Ricardo, age 19

I feel like, in general, people expect Black folks to be sickly in multiple capacities. Then when you get, I guess, years of information saying that like Black gay men have higher rates of STIs, and Black women are on the rise for having HIV transmission because of their positive partners, who are going to have sex with men, and not with their female partners.

—Ruby, age 23

Being labeled as a group with HIV frustrated many of the participants. They felt that the Black community, particularly the Black gay community, was unfairly targeted with HIV stigma compared to other members of the gay community. One participant highlighted the differences of how the Black gay community was portrayed in contrast to other communities.

I think once people hear HIV, they automatically associate it with gay people. They automatically think that since you’re gay and Black, you want to have sex with every single man out there. But that’s not the case. So, once they have that assumption based on you, they think you have a higher risk of getting HIV, and that’s why they call a ‘gay man’s disease.’ So, who would they rather associate being HIV positive with? White men or gay Black men? So, by dissecting us, the gays, from the heterosexual majority, you’re putting us in a smaller circle. And then the Blacks from the Whites, that’s a smaller circle. And then they just pin it on us, when there are millions of gay White men who have HIV.

—Nick, age 20

Another participant talked about his perception of HIV-prevention messages targeted towards the Black community. This participant believed there was an overemphasis on HIV in the Black community versus other communities.

I mean I don’t feed into TV and all of that type of stuff because I think that’s where it comes from. TV will market it for gay men. TV will market it for African-American population, and you know I don’t really see it like that. Cause that’s something that anybody can really get it. I mean, yeah, it [HIV] affects me because I’m a part of the YMSM [community], but I don’t have like a specific perception.

—Garrett, age 24

Many of the participants tried to offer a counter-narrative, stating that other communities are affected by HIV as well. However, they acknowledged that the narrative that HIV is primarily an issue for the gay Black community still seemed to stick.

I always try to tell people that it’s [HIV] not just in the gay community. But it’s just more talked about. And it’s more relevant in our [gay] community, because to everybody they feel as if you’re gay you’re susceptible to it [HIV]. But when you’re straight, you’re not.

—Max, age 24

…you know I don’t think I’ve inherently thought of HIV as a homosexual disease, but it’s definitely been taught to me that way. I think I have taught myself otherwise that any human can contract a disease like HIV. But it has definitely been enforced on me to be extra, extra careful about that one, as opposed to any other STD I could contract, you know… it seems like there’s like a society consensus that HIV is like a gay Black man’s disease.

—Ryan, age 19

Several of the participants said that Black men, especially BMSM, were hypersexualized by other MSM and society in general, which exacerbated assumptions of why they were at higher risk for HIV. This hypersexualizing was often linked to historical stereotypes of Black men of being well-endowed, hypersexual, and more likely to push sexual boundaries.

I think Black males are sexualized more, and so that brings on its own thing of like attraction…Basically, it’s like penis size and pleasure, I guess; you’re freakier.

– Cheese, age 21

…people have like a view of once you are Black, they have a view of what you should be like, stereotypes, like “thuggish” and the whole size thing…We’re all seen as being really sexually active, like, they see us like, having sex all the time, like sexually risky, no condoms, like just plain gay. But yeah, but the fact that the risk thing is like being really sexually active, more so than anybody else.

—Shaggy, age 22

But many Black men who are very buff are fetishized to a large degree and are viewed as being viewed as hypermasculine studs per se. As a result, a stud doesn’t care about himself. He just goes and has sex and just rah, rah, rah and stupid trivial, superficial bullshit like that…

—Kaiser, age 22

With additional probing, the participants offered their own hypotheses for why these perceptions existed and persisted. Several discussed stereotypical media portrayals as one reason. The participants felt that the media portrayal of BMSM was biased and based upon social stigmas (hypersexual, “down-low,”). Participants stated that these media portrayals exacerbated society’s perception of them as a group.

…they’re portrayed, as a whole people with HIV in the gay community…But when you like, for example seeing a Tyler Perry movie and they have a gay actor, it’s always sort of the over-masculine, down low, or hidden guy that tends to get in these situations where he ends up contracting HIV or a different virus. Then he has to be exposed and sort of pariah for it.

—James, age 23

The participants talked a great deal about racist, discriminatory, and stereotyping messages and interactions they experienced while dating and in everyday life. Although many of them expressed displeasure over these interactions and comments, quite a few of the participants internalized these messages, which shaped how they viewed themselves, other YBMSM, and their own risk for HIV.

Well, they say that we are the highest race that gets HIV, and then by me being a homosexual Black male, I think my risk is pretty high, higher than the normal Black person.

—Dog, age 22

I think it’s [my risk] a little more than average, but then again, you can’t put nothing past nobody just because you gay, you gonna catch it. I do feel like a lot of gays are open to catch[ing] it a lot easier than the average straight person. So, I do feel like me being gay; I am more risky to catching it.

—Joe, age 23

There appeared to be an acceptance by some that contracting HIV would be inevitable. One participant was asked about his risk for HIV and why he thought he had a high probability of a future HIV infection. He not only stated that having sex with other Black men put him at high risk, but that some YBMSM almost accepted this as an inevitable future.

I mean, I’m a gay Black guy. I have sex with predominantly other gay Black guys. It’s definitely not inevitable, but it’s not impossible either. It’s just kind of statistically more likely, I guess. I think I read somewhere where it’s like one in every two [persons], which scary…it’s just really more likely for us, so I feel like me, and a lot of other Black guys can sometimes feel like it’s almost inevitable. I know some people actually with the mentality like, ‘Oh, I might as well go ahead and get it because it’s going to happen regardless.’ Which is sad, but that’s what some people think.

—Sebastian, age 20

Another participant, expressing frustration about the constant HIV stigma, almost seemed resigned to the fact that people will always judge him because of the intersection of his race and sexual identity.

Oh, well, if they think I’m going to get HIV, I might as well just say I have it. You know, I think that people are under the influence of like, ‘Oh wow, that guy is gay and Black. That’s a red flag. Just his existence is a red flag. I’m going to stay away from that because I don’t want to become infected’… because of the intersection of my race and sexuality, which is perceived as also having a great increase for HIV. So, I think that that’s why it’s so frustrating. No matter what I do, people can still look at me and see the intersection of my identity, and not want to be with me, romantically or sexually.

—Dove, age 19

Another participant echoed this sentiment, saying that this type of discrimination not only occurs with White YMSM but also comes from within the Black community.

There’s considerable amounts of discrimination against Blacks, even by some Blacks as well. Many only prefer Latin or light guys, you know.

– Kaiser, age 22

A few other participants stated, based on their own experiences and perceptions, that they believed the stereotypes of YBMSM being lazy and hypersexual were true. This perception appeared to be internalized and shaped the way participants viewed the YBMSM community.

I would say Blacks are more…[have] a lack of concern about what is important as far as working and getting themselves together…mainly Blacks fail to realize that they need to go get their education and go to work and do stuff…They would rather go out and be having sex with multiple people. It changed me, like the way I looked at gays or like HIV…Like that’s crazy. It made me look at like people differently.”

—Curly, age 18

It was also apparent that rumors centered on people’s sexuality and presumed HIV status also shaped how participants viewed members of the YBMSM community, especially if they were bisexual.

[It’s just] Kind of what people say. Just the fact that what you see in clubs, and even on the apps, like it’s, I don’t know… like, Black guys, because you also have the ones who are down-low.

—Shaggy, age 22

However, one participant not only internalized these stigmatizing and racist messages but also seemed to use it to his advantage to navigate the dating world. He had a perception that his physical characteristics of lighter-skin and a larger penis fit a stereotype, which not only gave him some privileges in dating but also lowered his risk for HIV.

I also think that I have a degree of privilege as well. Many people who are White are fairly racist too, want to have sex [with me] due to penis, [my] big penis privilege, but also because I am of a lighter skin tone as well too. So, I am not subjected too much of that racism, even though it is still very present. So, I have a larger availability of partners as well; as a result, my likelihood of the contraction of HIV is lower.

—Kaiser, age 22

“Kaiser” expressed a sentiment that several of the other participants discussed: having White sexual partners lowered his risk for HIV. Each participant interviewed acknowledged and talked about the high rates of HIV in both the Black and gay communities. However, for some of the participants, internalizing racist stereotypes and HIV stigma affected the way they perceived and evaluated potential partners who were Black males.

Calculating Risk

Partner vetting was described as the practice of deciding how “safe” (i.e., HIV negative) a potential sexual partner was prior to initiating sex—protected or unprotected. The vetting process included a complex social calculation that was based on perceptions of race and class. Many of the participants described how the intersection of race and class influenced how they chose sexual partners when the potential partner was a Black male. Many expressed a preference to date outside their race. Some participants also discussed how they analyzed a person’s racial and educational background, along with where they met men as a method to identify and screen out potentially high-risk sexual partners; thereby lowering their risk for HIV.

I definitely do like a weird race class analysis when I see them, I’m like, you’re a White dude on a college campus. You’re like a White college kid, so like you most likely do not have HIV. But if I’m like, you’re a Black dude who is in Durham, who I don’t know really anything about, you are much more likely to have HIV. But then I’m like, if you’re a Black dude on a college campus, I probably don’t think you have HIV. So, I don’t really vet you the same way. So, like more, not necessarily just a race—it’s like a race/class [analysis], everything happens in like that split second.

—Ruby, age 23

A second participant echoed this sentiment, stating that meeting men in the community, versus on campus, increased his risk for HIV, especially if the men were Black. This perception of increased HIV risk prompted him to recalculate his dating options to lower his risk for HIV.

…frequently I’ve thought about like, ‘Wow I could really catch this.’ And I think also just like when I’m starting to look at the statistics and read more articles about it, me, specifically as a gay Black male in the Baltimore City area there’s a very high rate of HIV/AIDS… I know that I have a high probability of catching it. And so, I think that that for me has [me] like, ‘Oh, am I safer to just have sexual relations with White guys than a Black guy?’

—Dove, age 19

Some of the methods they used were reminiscent of the HIV stigma and racism they described experiencing themselves while dating and in everyday life. This assessment factored in not only race and class, but also social location. Social location is the assessment of a person’s place in society based on specific characteristics (i.e., race, income) [49]. In this case, participants judged other YBMSM’s HIV risk based on their race, gender, sexual orientation, and socioeconomic status, seemingly internalizing negative and stereotypical commentary about the YBMSM community. Ironically, participants seemed aware they were employing racial bias and HIV stigma to screen other YBMSM, potentially discriminating against their own community.

You know, I feel myself having to like waiver the guys that I date, or like even like prejudging guys if I think that they look dirtier. Which is kind of a bad thing. I know it’s terrible! But like if a guy looks like he may hang around other people who could possibly have it, then I’m more negligent of having sexual relations with someone like that. I think if someone is wearing, like, clothes that are kind of hanging down, or they may even be dressed almost like a drag queenish type thing. But maybe not completely put together, sometimes those are like red flags for me. Like, “Is that person safe?

—Dove, age 19

This participant also discussed his perception of the role a person’s economic status played in their risk for HIV.

I know this is kind of bad too, but, like, people with lower incomes might also possibly have a higher rate of HIV. And so like, figuring out like your financial status as well. Cause just like access to health care, and access to condoms or other things that could help you prevent HIV exist there too. So, like if I’m having sexual relations with someone who is African American and gay and from a low-income family, then I feel like that also makes my chances of catching it [HIV] go higher.

—Dove, age 19

One participant openly discussed that he might be participating in “anti-Black racism” by invoking these stereotypes in partner selection.

…it’s really, really strange way of thinking, the way that I do, but it makes me feel more inclined to vet Black people when I engage in sexual practices. And I am just like, is this anti-Black? Is this, like, racist that I am doing this? Or is this warranted because in the way in which anti-blackness has created a scenario in which it’s more likely for like Black people to have HIV? So, like, am I am doing good health practicing, or am I participating in anti-Black racism right now. I can’t tell right now. And it’s really frustrating. And so, [I’m] always thinking about that.

—Ruby, age 23

Discussion

The majority of the sample (52%) in our study reported a stigmatizing interaction that heightened their awareness of persistent narratives that all YBMSM have HIV. The participants also reported encountering racial stereotypes of them as Black men, some of which the participants internalized themselves. HIV stigma and racial stereotypes are different types of discrimination that YBMSM experience within the Black and gay communities and in society; leading to psychological distress and an altered perception of self and sexual risk. These encounters proved to be a source of stress and internal conflict for some of the participants, which prompted some YBMSM to develop alternative strategies to distance themselves from (1) negative racial stereotypes, (2) other members of the YBMSM community, and (3) to decrease their sexual risk for HIV.

Similar to other studies, YBMSM in our study experienced psychological distress and internal conflict in response to experiencing HIV stigma [50] or racism [14, 50, 51]. Our study found that many of the YBMSM had thoughts regarding HIV and other YBMSM that were often informed by internalized racist and homophobic ideologies. These scripts characterized their internal conflict when presented with a potential sexual partner that was another YBMSM. Such internal scripts are not unexpected given the prevalence of stigmatizing messages YBMSM encounter in the Black and gay communities, the media, and society at large regarding HIV and race [14, 24, 52]. Exposure to persistent negative messages about being Black and rejection from other racial groups can cause low self-esteem, psychological distress, and anxiety [50, 53]. Persistent exposure to negative messages about YBMSM risk for HIV prompted study participants to develop complex algorithms to assess their potential sexual partners HIV risk, with some preferring to date only White MSM.

Similar to other studies, YBMSM may have experienced “sexual racism” when trying to date White MSM [24, 25]. There has been discourse that sexual preference by race is not truly racism, equating it to a preference for other physical characteristics such as height and weight. However, for some participants in our study, the strategy to primarily date White MSM was not just a desire to decrease their sexual risk for HIV [54], but may also be a form of internalized racism. Internalized racism occurs when minority racial groups accept the White dominant society’s negative and discriminatory messages about themselves as accurate [55]. This internalization was evidenced when one participant in our study stated his lighter skin tone made him more desirable to White YMSM (colorism). Colorism, when adopted by the Black community is a form of internalized racism, with members of the Black community believing having lighter complected skin will buffer them against classism and racism [56], and with some of our participants, HIV. Internalizing sexual stereotypes about Black men and believing in colorism may be signs that YBMSM are trying to distance themselves from “stereotypical” YBMSM and trying to be viewed as a “different kind of Black” [57] and therefore more desirable to White MSM.

This dating preference can also be the result of internalized oppression from potential White partners, where YBMSM are fetishized and sought out by White MSM because of seemingly positive stereotypes of Black men (large penis size, sexual aggressive) versus compatibility [23, 58]. Several participants in our study discussed being aware of and embracing these racial, sexual stereotypes for Black men, with some leveraging these stereotypes to increase their chances to partner White MSM.

Limitations

There were several limitations for this study. Participants were recruited from several metropolitan areas throughout North Carolina and Maryland, two states with different political, social, and economic environments. The sample recruited from these locations were not equal, with 19 participants interviewed in North Carolina and six participants from Maryland and Washington, D.C. The participants were recruited from a combination of online applications (Facebook, GPS dating apps) and a community organization that primarily served BMSM and transgender women. Participants who were recruited from these locations may have been inherently different from participants who were recruited by friends or recruited from community events. The participants in this study were also highly educated, with 44% (n = 11) reported taking some college classes and 32% (n = 8) having completed college or technical school. Having such a high rate of college-educated participants would influence the type of interactions they had and how they viewed and articulated their viewpoints on race, stigma, and dating.

Future Directions

Future studies should examine the role of HIV prevention messaging and internalization of HIV stigma play in YBMSM’s development of HIV-reduction strategies that may put them at increased risk for HIV [59]. Another area of potential research should explore how experiences of racism and oppression alter self-concept and HIV prevention strategies in BYMSM. Future studies should also explore the role colorism plays in perception of risk for HIV for YBMSM. Specifically, if darker-complexioned YMSM have differing attitudes regarding sexual and HIV risk, versus their lighter-complexioned counterparts. Another area of exploration is the role classism, and racial stereotypes play in YBMSM’s perception of HIV risk. Understanding the role these, sometimes unconscious, biases play in YBMSM’s calculation of risk, can help design interventions that can help rewrite these internal scripts. Currently, there is little data on the effects of sexual stereotyping on YBMSM sexual risk [60]. Additional research should be conducted to develop a new measurement instrument that would measure and quantify the types of sexual and racial stereotyping of BYMSM experience, and how these experiences subsequently influence perception of HIV risk and sexual behaviors in YBMSM.

Conclusions

This study provided evidence that societal, interpersonal, and individual-level factors, both external and internal, affect YBMSM’s perception of risk for HIV and influence their subsequent sexual behaviors (e.g., partner selection) to reduce that risk. Specifically, the findings of this study provided evidence that experiences with racism and HIV stigma can shape YBMSM’s perception of themselves, and how they calculate their own and their sexual network’s HIV risk, which could, in turn, influence their sexual and health behaviors. Prevention programs and risk assessments should consider more in-depth evaluations of HIV risk, outside of sexual behavior (e.g., factors that put partners at risk for HIV). YBMSM’s experiences with racism and HIV stigma can also affect their engagement in the health care system, especially for HIV prevention and sexual health services. YBMSM who report experiencing racist or stigmatizing interactions, particularly in the health care setting [61-64], may be less likely to seek preventative health services, namely for PrEP [38]. Community and campus HIV prevention programs should take into consideration how historical factors, such as racial stereotypes, along with HIV stigma can influence their patterns of sexual behavior and may serve as a barrier to YBMSM’s uptake of HIV-prevention messages. Health professional programs also need to incorporate historical context and a social justice lens in their educational curricula to gain a fuller understanding of the role an oppressive environment plays in the health outcomes of YBMSM [2, 65, 66].