UCSF

In the United States, young Black men who have sex with men (MSM), between the ages of 13 and 29 years have the highest rates of new HIV infections. The prevalence of HIV among this population is three to four times higher than their White MSM counterparts. Research indicates substance use is strongly associated with HIV infection among young Black MSM. Twelve HIV-negative and HIV-positive participants from the Bay Area were recruited for this qualitative narrative study to explore the following three aims: (a) describe the role substance use plays in the lives of young Black MSM, (b) describe their perceived risks for acquiring HIV, and (c) explore the historical and social contextual experiences that have influenced their lives. The four major findings include: (1) “there was a lot going on in the homes of these participants.” Almost all of the young Black MSM discussed early substance use exposure in their family, including parents who were also drugs. The young men shared about broken family structures, including abuse and neglect, (2) thirty years into the AIDS epidemic, stigma and homophobia continue to be an issue for young Black MSM. Most of the participants were either kicked out of their family homes, asked to leave by their family, or wanted to get away from their family so that they could be themselves, (3) with the prevalence and exposure to methamphetamine in the San Francisco, young Black MSM discover the benefits of this drug for numbing, masking, and coping with everything from being gay, gay sex, dealing with peer pressure, and for sexual enhancement and survival sex, and (4) once under the influence of methamphetamine, the participants don’t care about condoms, nor do they have the ability to negotiate condom usage with their partners. There is a sense of anticipation, resignation and acceptance about acquiring HIV; HIV risk reduction apathy. Implications of this study highlight the need for young Black MSM to have earlier substance use and HIV prevention education that include condom negotiation skills, safe spaces for empowerment and community, and increased reduction of stigma and homophobia within the Black community.