Image versus Health: The Role of Perceptions of Masculinity on Sexual Risk Behaviors among HIV-Positive African American Men who have Sex with Men and Women

BACKGROUND HIV prevention has rarely explored the impact of childhood sexual abuse (CSA) across health domains among African American men who have sex with men and women (MSMW). Early sexual experiences may influence perceptions of gender roles, sexual identity, and risks for HIV/AIDS. The attribute of masculinity is commonly associated with strength and success. However, a legacy of racism and oppression may pose challenges for African American men in achieving gender-based milestones. Instead, proxies for success may include masculinity constructs with hypersexual posturing and prowess that contradict sexual health messages. METHODS Two groups, each meeting twice for 90-minutes, of HIV-positive African American MSMW participated in discussions focusing on masculinity and sexual experiences. Participants were bisexual HIV-positive African American men who engaged in unprotected sex and had histories of CSA. Discussions were recorded, transcribed, and analyzed using consensual qualitative research and a constant comparison qualitative method. RESULTS Participant mean age was 40.5 years (n=16). Majority had a high school education (69%), half were unemployed, and almost two-thirds earned less than $20,000 annually. Three themes, each with two subthemes, emerged that described the sociocultural context for engaging in high-risk sexual behaviors, and included: 1) the importance of inhabiting a "traditional" masculine gender role with: a) general and b) sexual masculine traits; 2) the influence of conceptions of masculinity on sexual identity with the associations: a) between being gay and being effeminate and b) between being gay and being HIV-positive, and; 3) CSA experiences with: a) appraisal of CSA and b) early sexual experiences as rites of passage. CONCLUSION Attempts to be masculine may contribute to high-risk sexual behaviors. Research needs to explore how early sexual experiences shape perceptions of masculinity and masculinity's influence on receiving health messages for African American MSMW who may prioritize a specific image over sexual risk reduction.