Martin Luther King MemorialAIDS 2018 PosterMenCount TeamAAMTeam Represent Staff at AIDS 2018

Represent Study

“To be a Black man is] an uphill battle every day, for the simplest fact of the racial disparities that we go through: institutionalized racism in the work area, school, all of the different partitions that’s put up and all of the things that we have to go through to just survive every day, as a Black man. It’s hard work. It’s an everyday...It’s a job every day." - Donovan, 28 years old ( Bowleg, Teti, Malebranche, & Tschann, 2013)

“How do we deal with the consequences of being a man in [the Black] community? Especially when it comes to the tough guy image—screwing [having sex with] all the women; all the different women. You know, knocking someone upside the head when they so-call disrespect you kind of stuff. And sometimes, we fall into our own trap of what does it really mean to be a man. We get that really confused and distorted. And that is a good question: What does it take to be a man? What is a real man?”  - Joe, 51 years old (from  Bowleg, Teti, Massie, Patel, Malebranche & Tschann, 2011)

Understanding Black Men’s HIV Risk in Social-Structural Context

Heterosexual men in the U.S. have the lowest lifetime risk for contracting HIV of any group—1 in 473,  compared with 1 in 6 for men who have sex with men (MSM) (CDC, 2016). This is not the case for Black heterosexual men, however. Because female-to-male HIV transmission is rarer than male-to-female transmission, just 8% of men in the U.S. reported that they contracted HIV from heterosexual sex in 2014, yet Black men represented 64% of those men. Black men’s lifetime risk for being diagnosed with HIV is 1 in 20, compared with 1 in 48 for Black women and 1 in 132 for White men (CDC, 2016). Although Black MSM account for most of this risk, Black heterosexual men nonetheless rank among those most affected by HIV. Still, HIV prevention research and interventions focused specifically on Black heterosexual men are virtually nonexistent.

What’s more, HIV prevention initiatives tend to emphasize individual risk behaviors exclusively, and ignore important factors beyond the level of the individual that increase HIV risk in Black communities. For example, HIV is more densely concentrated in low-income Black communities, and even when Black people report lower rates of sexual or drug risk behaviors compared with their White counterparts who engage in very risky behaviors, Black people are at greater risk for getting HIV and STIs. Such realities have prompted escalating advocacy for more social-structural approaches to HIV prevention.

So how might social-structural factors influence Black heterosexual men’s sexual risk behaviors? We sought to answer this question with REPRESENT , a three-year, mixed-methods study funded by the National Institute of Child Health and Human Development (NICHD). Initiated in Philadelphia, PA in 2007, REPRESENT explored how Black men’s masculinities, sexual scripts, and experiences with social-structural stressors—including racial discrimination, incarceration, and unemployment—shaped the ability of many low-income Black heterosexual men to engage in protective behaviors, such as consistent condom use or reducing the number of sexual partners.

Using intersectionality  as one of the study’s theoretical frameworks, we interviewed and surveyed hundreds of Black men throughout Philadelphia about how their intersections of race, gender, and class were related to interlocking structural inequities, such as Black men’s disproportionate incarceration and unemployment. Through qualitative analyses, we found that racial discrimination and microaggressions, unemployment, incarceration, and police surveillance and harassment were the structural stressors most often cited by participants. We concluded that Black men, faced with these stressors, often rank HIV risk and prevention low on their list of priorities.

Implications for HIV Prevention Research and Interventions

We concluded that more HIV prevention research and interventions focused on Black heterosexual men are urgently needed. What’s essential is prevention research that is informed by the perspectives and experiences of Black heterosexual men, and that addresses the social-structural issues that Black men perceive to be most relevant to their lives but may constrain their ability to reduce their HIV risk and that of their sexual partners. Improving HIV knowledge and condom use are important HIV prevention strategies, but are likely insufficient to reduce HIV in Black heterosexual communities because these interventions fail to address “fundamental causes” that increase HIV/AIDS in Black communities in the first place: social-structural factors such as poverty, housing instability, and unemployment.  

Since completing REPRESENT in 2010, we have published several articles on the social-structural context of Black heterosexual men’s HIV risk.  Our qualitative studies have explored how Black heterosexual men’s masculinities, experiences with social-structural stressors such as unemployment and incarceration, and discourses about sexual relationships with women may be associated with HIV risk.  Our quantitative studies have examined the effects of racial discrimination, neighborhood context, and posttraumatic stressors on Black heterosexual men’s sexual risk. Our mixed methods studies have evaluated quantitative measures of sexual scripts, and qualitative measures drawn from Black men’s experiences. We developed both measures based on our interviews and focus groups with Black heterosexual men.

To view our Project Represent studies, visit our Project Represent publications page.