Provider’s Views On The Psychosocial Factors That Influence Risk Behavior Among Young Black Men Who Have Sex With Men

1. Provider’s Views On The Psychosocial Factors That Influence Risk Behavior Among Young Black Men Who Have Sex With Men Michael Leonardo Foster, EdD Susan Kegeles, PhD Gregory Rebchook, PhD Center for AIDS Prevention Studies University of California San Francisco Funded By: Universitywide AIDS Research Program National Institutes of Health

2. Aims of This Research • To explore the perceptions of Community-Based Organization (CBO) providers about three prominent psychosocial factors that influence self-concept and HIV risk behavior among young Black MSM

3. Overview • Background • Methods • Three Psychosocial Barriers To Safer Sex • Where Do We Go From Here?

4. Background Over-representation of Black AIDS cases Non-existence of evidence-based, culturally appropriate community-level HIV/AIDS prevention interventions

5. Research Questions *What factors do you think place young Black MSM at risk for contracting HIV? *How does religion influence sexual risk-taking among young Black MSM? *How do you think the influence of family affects sexual risk taking behavior among young Black MSM? *What do you think the relationship is between SES and risk-taking behavior for young Black MSM?

6. Methods • 21 front-line CBO employees (mostly program coordinators) recruited • Interviewed for 90-120 minutes • Topics: attitudes about fit between evidence-based HIV/AIDS prevention models and clients’ needs; experience implementing evidence-based programs with clients, and psychosocial factors that influence sexual risk behaviors among young Black MSM

7. Data Analysis • Extensive notes were taken during telephone interviews • Comments were recorded verbatim, whenever possible • Data were coded thematically and validated with other members of research team

8. Three Psychosocial Barriers to Safer Sex • Shame-filled Religiosity • Familial Stigmatization and Rejection • Sexual-Economic Asymmetrical Decision-Making

9. I think that religion in Black communities contributes to homophobia. And then, I think that homophobia contributes to shame and that affects how people negotiate sex. If someone is ashamed, they are more likely to seek secretive sex…Do we talk about using condoms?…or talk about how to make not using condoms safer? Those conversations don’t take place and that all contributes to how people are having sex. Shame-filled Religiosity (18)

10. Shame-filled Religiosity (continued) Religion does influence them. Religion tells them they are an abomination before God. It all ties into self-esteem. As long as church teaches HIV as punishment for gayness, these negative messages will continue to affect the self-esteem of young Black MSM and then their low self-esteem will orient them to value their own lives less and take more risks. Through homophobia, people hide their sexuality. When you do anything in the dark, everything is rushed and there is not time for safety talks and condom negotiation.

11. Shame-filled Religiosity (continued) Religion instills more shame and fear about their sexual being; that they are defying God and are going to be punished. Therefore, why would you want to be open and discuss your sexual business with someone who is already condemning you. I can see homophobia making it more difficult to have conservations with people, like pastors, who should be compassionate. What you’re getting instead is that you’re unworthy and not loved by God. They become closeted. They might not see the necessity to protect themselves and may think that their lives are not worth it, subconsciously.

12. Familial Stigmatization and Rejection (21) You see lots of times when young Black MSM come out, their families shut them away and they look for love elsewhere. Once they get ostracized, they are more likely to take risks to get that love.

13. Familial Stigmatization and Rejection (continued) If the family is not accepting, not embracing, young African American MSM are going to take their behavior underground. There is not going to be the development of a loving relationship with another man because they would have to disclose the relationship to their family.

14. Familial Stigmatization and Rejection (continued) We have learned from a young age that homosexuality is taboo. You couldn’t open up to your family and ask questions. Basically, people learn as they play. As a result, lots of stuff we do is secretive and full of risk — taking place at night or in the dark. And then, when you haven’t learned to communicate with your family, this inability also translates over into communication with sexual partners about sexual practices.

15. Sexual-Economic Asymmetrical Decision-Making (16) Sometimes men enter into relationships that are unhealthy. The person with the money is able to wield control…If I am driving his car and eating his food, sometimes people in those situations feel like they have to do whatever they are asked to do. I know people who are in situations like that who were asked to be in threesomes and foursomes. This person is what stands between you and a park bench…

16. Sexual-Economic Asymmetrical Decision-Making (continued) Lots of young guys don’t have money and they find older guys with money who give them money and they take more (sexual) risks with that person. The older person may be requiring that they have unsafe sex. The young guys feel like they have to do it because that is where the money is coming from.

17. Sexual-Economic Asymmetrical Decision-Making (continued) …[E]specially with young Black MSM, if I am bombarded with images that say this is what I am suppose to have, and everyone I see in the media has cars, bling bling, but I don’t have the resources to acquire them myself, that is going to encourage me to be involved with someone who has the resources…I am not going to demand the use of condoms with someone who has what I want. I am not going to broach the subject if it means that I am going to ruin my set-up by saying that we need to talk about HIV and safe sex. If I bring it up, he’s going to think I am HIV-positive and I am not going to risk that…I hear many young Black MSM say that I want a rich man. I don’t hear many say that I want to be a rich man myself.

18. Where Do We Go From Here?

19. Recommendations • Shame-filled Religiosity: Broaden the options for worship to include gay-positive, Open and Affirming churches • Familial Stigmatization and Rejection: Establish supportive communities of young Black MSM to work on healing from emotional scars from church and familial stigmatization and rejection. Also focus on acquiring skills to discuss sexual safety issues • Sexual-Economic Asymmetrical Decision-making: Provide holistic support for young Black MSM, including job training and skills building components to enhance their financial prospects

20. Contact Information Michael Leonardo Foster Center for AIDS Prevention Studies (CAPS) University of California San Francisco Telephone: (415) 597-8123 Email address: Michael.Foster@ucsf.edu