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Research Spotlight: Black heterosexual men...

Poor and unemployed Black heterosexual men are not oblivious to their HIV risks and want and need more education and skills to protect themselves, their sexual partners, and their children from HIV/AIDS, reveals a study led by Team Represent Principal Investigator, Dr. Lisa Bowleg.

The study, published in the American Journal of Men’s Health, underscores the need for more HIV prevention messages, research, and interventions designed specifically for low-income, Black heterosexual men. While Black gay, bisexual and men who have sex with men (MSM) make up most new HIV cases among men, Black heterosexual men nonetheless rank among those most affected by HIV.  Of the 8% of men in the U.S. who reported that they contracted HIV from heterosexual sex in 2014, Black men represent 64% of those men. Additionally, the lifetime risk of Black men for becoming HIV-positive is 1 in 20, in contrast to 1 in 48 for Black women and 1 in 132 for White men (CDC, 2016). 

Researchers conducted focus groups with 28 low-income, Black heterosexual men between the ages of 19 and 51, enrolled in a Philadelphia-based workforce and fatherhood development program to learn what role, if any, HIV/AIDS played in their lives. All of the men reported having sexual intercourse in the last six months, and most were unemployed and had criminal records.

“Although Black heterosexual men are rarely the focus in HIV prevention messages, research, and interventions, compared with Black heterosexual women and Black MSM, our study empirically documents that HIV/AIDS is salient in many of their lives,” said lead author and Team Represent Principal Investigator, Dr. Lisa Bowleg.  “Poverty, unstable housing, incarceration, impoverished neighborhoods, and other structural factors put Black heterosexual men at higher risk for HIV,” said Bowleg.

Although the participants identified family, self, religion/spirituality, and money as their top priorities, the researchers found that many of the interviewees stressed the importance of HIV prevention in their lives. Most reported that they knew someone living with HIV/AIDS or observed the effects of HIV/AIDS on fellow inmates while incarcerated.   Many participants noted that this knowledge motivated them to reduce or stop their own drug and sexual risk behaviors. Several also discussed the importance of teaching their children about HIV prevention and protecting their main partners from HIV if they were not in sexually-exclusive relationships.


What Black heterosexual men want and need to prevent HIV

The participants’ answers about what they wanted and needed to prevent HIV pointed to key opportunities for HIV interventions for Black heterosexual men, say the researchers. Their responses centered on three themes:

1.How to ask a partner to be tested for HIV. Many of the men interviewed said they struggled with how to tactfully suggest to a sexual partner to get tested for HIV without offending or implying concerns about their partner’s sexual history.


2.How to use condoms when tempted not to do so. Many participants said they had difficulty consistently using condoms in times of lust or passion, or when they were drunk, lacked condoms, or had sexual partners who showed little interest in using condoms.


3.    More interactive HIV/AIDS education classes. Many participants said that they wanted more HIV/AIDS education, particularly in classes and other settings where they can openly share ideas, personal experiences, and prevention strategies.

Implications for HIV prevention interventions

The researchers said that their findings, grounded in the reported experiences of the Black men they interviewed, can inform future HIV prevention efforts for Black heterosexual men. They highlighted four significant implications for HIV prevention research, interventions, and policy:

1.     Emphasize the Black men’s role as family protectors in HIV prevention messages and interventions. HIV prevention efforts that emphasize Black men’s role as family protectors may resonate with and engage Black heterosexual men. Although none of the participants named HIV prevention in their top three life priorities, many stressed the importance of reducing HIV transmission from their partners and protecting their children from HIV risk.


2.Infuse HIV prevention education within existing programs and services for Black men. HIV interventions for Black heterosexual men can be more effective if HIV prevention messages and skills are integrated within existing programs and services that are already priorities for Black men: workforce development, community reentry post-incarceration, violence prevention, and fatherhood development, for example. Most participants said that they personally knew someone with HIV or had witnessed its effects on fellow HIV-positive inmates during incarceration, which reinforced their need to engage in more protective behaviors, such as using condoms or reducing their number of sexual partners.  


3.Incorporate information, motivation, and behavioral skills in HIV prevention interventions—not just information and education. Programs using the Information-Motivation-Behavioral (IMB) Skills model focused on educating, motivating, and training people to develop their HIV prevention behavioral skills may be more effective in reducing HIV risk, compared to HIV prevention programs that are solely informational and educational.   Many studies—including those focused on Black heterosexual men (R. A. Crosby et al., 2008; R. Crosby, DiClemente, Charnigo, Snow, & Troutman, 2009; Kalichman, Cherry, & Browne-Sperling, 1999) — have documented IMB’s efficacy for reducing sexual risk. Several participants recalled experiences of not using a condom when one was warranted. Others said that they did not know how to suggest HIV testing to their partner or did not want to disrupt the heat of passion to retrieve condoms — indicating they could benefit from behavioral skills training.  

4. Introduce format changes or other innovations more likely to successfully engage Black heterosexual men. Participants strongly favored more interactive HIV prevention education programs that encouraged and facilitated dialogue and the sharing of HIV prevention information with other men with whom they felt comfortable. Studies on community-based HIV prevention barbershop programs, for example, have documented how barbershops can be an ideal setting to engage young, Black heterosexual men (Baker, Brawner, B., Cederbaum, White, Davis, Brawner, W., & Jemmott, 2012; Wilson, Fraser-White, Williams, Pinto, Agbetor, Camilien, Henny, Browne, Gousse, Taylor, T., Brown, Taylor, R., & Joseph, 2014; Brawner, Baker, Stewart, & Davis, 2013). 

The study, “‘The Skill Is Using Your Big Head Over Your Little Head’: What Black Heterosexual Men Say They Know, Want, and Need to Prevent HIV,” was authored by Bowleg, Meaghan Mingo, and Jenné Massie of Team Represent. The full study is available online here.

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