Pressure to Be Macho Puts Black Gay Men at Risk for HIV Transmission

June 17, 2014

Social and cultural pressures to adopt masculine norms -- to act, to walk, to talk and to be as masculine as possible -- cause young, black gay men extreme psychological distress and isolation, which can cause them to engage in "high-risk" behavior that can result in HIV transmission, according to research led by the Johns Hopkins Children's Center and newly published in the American Journal of Public Health. Often, these behaviors occur because young, black gay men are seeking approval and acceptance. However, these high-risk behaviors have resulted in young, black gay and bisexual men accounting for 4,800 new HIV infections in 2010 -- about 10% of all the infections in the U.S., and more than twice that of either young white or young Hispanic/Latino gay and bisexual men, according to the U.S. Centers for Disease Control and Prevention.

The study is the result of interviews conducted with 35 openly gay or bisexual young black men, as well as men who have sex with men, but who do not identify as gay or bisexual. Investigators stressed that their findings "offer one possible explanation for the disproportionately high HIV infection rate among young black men who have sex with men."

"HIV risk is the sum total of many factors, but social and family stress is a well-known driver of all types of risk-taking behaviors, and our findings clearly support the notion this also holds true when it comes to HIV risk," says study lead investigator Errol Fields, M.D., Ph.D., an adolescent medicine expert at the Johns Hopkins Children's Center.

In the interviews, which show that personal responsibility is not the end-all, be-all when discussing HIV transmission, participants -- all between the ages of 18 and 24 -- reported growing up in families and communities with rigid anti-gay attitudes and traditional views of masculinity.

Participants reported deep psychological distress, a feeling of pressure to conform and even a desire to hide their sexual orientation to prove their manliness. What's the product of all these pressures? The participants reported being more prone to engage in risky sexual behaviors, less likely to form and maintain monogamous relationships and more likely to have unprotected sex.

Most interesting to the researchers were those participants who reported that they viewed unprotected intercourse as an expression of love and trust by their sexual partners -- love and trust that they were not receiving from rigid, traditional families or a judgmental, homophobic culture. Participants reported being forced to adopt hypermasculine, aggressive behavior and that any effeminate behavior was often met with ridicule and ostracism.

"The findings of our study reveal a clear clash between internal sexual identity and external expectations at a critical developmental stage age," Fields says. "This clash creates loneliness and low self-esteem and appears to drive these boys and men to risky behaviors, sexual and otherwise."

Unfortunately, the pressure to be completely "straight-acting" and hypermasculine, combined with the need to camouflage their gay identity, often meant that participants had a chronic sense of anxiety about being "discovered," and that they would avoid gay- or bi-targeted HIV-prevention messages for fear of being perceived as gay or bisexual. Also, many were reluctant to come out for fear of losing social and family support. "It's a true catch-22 for these youngsters," Fields says. "On one hand, they are dealing with the chronic anxiety of hiding their homosexuality, but on the other they face the prospect of becoming social pariahs if they come out as gay or bisexual."

What does this mean for prevention messaging aimed at young, black gay men? Fields said that public health interventions should become more aware of cultural dynamics and that primary care physicians who care for young gay men of color should be aware of cultural and social pressures and broach sexual health accordingly.

Mathew Rodriguez is the community editor for TheBody.com and TheBodyPRO.com.