20th International AIDS Conference - Melbourne, Australia


MOPE292 - Poster Exhibition

Masculinity and biomedical HIV prevention technologies: factors influencing want, need, and adherence to pre-exposure prophylaxis (PrEP) among Black men who have sex with men in New York City, NY

M.M. Philbin1, J. Hirsch2, K. Grisham2, C. Parker2, J. Garcia2, P. Wilson2, R. Parker2

1Columbia University, New York State Psychiatric Institute, HIV Center for Clinical and Behavioral Studies, New York, United States, 2Columbia University, Sociomedical Sciences, New York, United States

Background: Black men who have sex with men (BMSM) have the highest rates of HIV incidence in the USA; HIV prevention technologies, such as pre-exposure prophylaxis (PrEP), present a strategy to address their vulnerabilities. Given that men are less likely to adopt health protective behaviors for chronic diseases, there are many unanswered questions regarding how masculinity might complicate whether BMSM want, need, and are ultimately adherent to, PrEP.
Methods: Twenty-six BMSM in New York City participated in three 90-minute in-depth interviews, with the sample varying by age, income, sexual identity, and insurance coverage. We also interviewed thirteen key informants (e.g. community leaders and service providers). Following consent, interviews were taped, transcribed, and analyzed within and across cases to explore themes related to masculinity, HIV prevention and PrEP.
Results: Participants both implicitly and explicitly described how beliefs about masculinity shape HIV risk and prevention practices, specifically the want for and adherence to PrEP. Three pertinent findings were that masculinity influences how BMSM:
(1) access HIV-related care;
(2) determine sexual roles and
(3) perform gender in given physical (versus virtual) spaces.
Men reported not attending medical visits to appear as a “man''s man”; being “weak and worried” and taking medication were associated with femininity (which influenced BMSM''s want for PrEP). Participants described stigma towards those who present as feminine, including perceptions that they were “promiscuous,” “sluts” and “have HIV/STIs;” BMSM suggested that taking PrEP could subject individuals to the stigma of “failed” masculinity. Masculinity was asserted by being a “top” during sex, which participants viewed as less risky, thus affecting BMSM''s perceived need for PrEP. Lastly, BMSM reported feeling stigmatized for transgressing masculine/feminine binaries in public and private spaces, even when their sexuality was accepted.
Conclusions: BMSM asserted their masculinity in ways that have implications for their engagement with PrEP, particularly around self-care and sex and gender performance. Gender norms and hierarchies influence perceptions of HIV risk, which subsequently affect BMSM'' openness to PrEP-related messaging and services. Increased attention to gender, including norms and the negotiation of gendered performances, is vital for the development of meaningful and effective PrEP-related interventions among BMSM.

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