Public health experts have long wondered why young black men who have sex with men (MSM) get infected with HIV nearly five times more often than MSM from other races, even though they don't have more unprotected sex.
A new study by investigators at Johns Hopkins and elsewhere suggests it may be in part due to the way young black MSM select partners.
Jonathan Ellen, M.D., a pediatrician and teen health expert at Johns Hopkins Children's Center presented the findings of their study at the 2011 Pediatric Academic Societies Annual Meeting in Denver.
The study results are based on semi-structured interviews with 35 black men MSM ages 18 to 24 in NYC and upstate New York, and Atlanta, GA.
The research noted these young black MSM select partners and judge these partners' HIV status in a specific way. The most notable findings include an overwhelming preference for masculine partners, accepting masculine partners as dominant in the sex act and leaving to them decisions about condom use, perceiving masculine men as low risk for HIV and feminine men as high risk.
The researchers say this dynamic of preferring masculine men, while also equating masculinity with lower HIV risk helps explain why young black MSM contract HIV more often than their counterparts from other races.
"There may be no difference in HIV prevalence between masculine-looking and feminine-looking men, but because black MSM perceive masculine men as lower risk, their sexual encounters with such men may make HIV infection more likely," said investigator Jonathan Ellen, M.D., a pediatrician and teen health expert at Johns Hopkins Children's Center.
In other words, even though young black MSM have unprotected sex just as often as others, they may be having unprotected sex in riskier ways with partners whose HIV status they often miscalculate, the researchers explain.
In 2006, male-to-male sexual contact was associated with an estimated 63% of new HIV infections among black males. Data from CDC's National HIV Behavioral System show that, in 2008, 59% of HIV-infected black men who have sex with men (MSM) did not know they were infected, compared with 26% of white MSM.
The findings of this study offer new insight into how black MSM judge risk based on perceptions of masculinity and can help inform public health campaigns to reduce new HIV infections in this disproportionately affected group. The findings, the researchers say, can also guide safe-sex conversations between primary care physicians and patients.
Young black MSM need to be encouraged to be tested, to know their HIV status, and to be educated that masculinity/femininity doesn’t equate with HIV status.