“The fear of being Black plus the fear of being gay”: The effects of intersectional stigma on PrEP use among young Black gay, bisexual, and other men who have sex with men

Elsevier, Social Science & Medicine, Volume 232, July 2019, Pages 86-93.
Katherine Quinn, Lisa Bowleg and Julia Dickson-Gomezad.

In the United States, reducing new HIV infections will require a prioritization of HIV prevention among young Black gay, bisexual, or other men who have sex with men (GBM), a population that continues to carry a disproportionate burden of HIV (Centers for Disease Control and Prevention, 2016). Between 2011 and 2015, HIV diagnoses among GBM remained stable overall, yet diagnoses among GBM aged 25 to 34 increased 30% (Centers for Disease Control and prevention, 2018). Furthermore, despite having fewer sex partners and HIV-related risk behaviors than their White counterparts (Friedman et al., 2009), half of Black GBM are projected to acquire HIV in their lifetime, compared to 25% of Latino GBM and just 9% of White GBM (Hess et al., 2017).

In addition to racial and sexual identity stigma, Black GBM may also face PrEP stigma. Researchers have demonstrated that PrEP stigma, the perception that PrEP is only for promiscuous, irresponsible individuals, may be higher among Black individuals compared to those in other racial or ethnic groups. Neighborhoods with greater PrEP stigma tend to have a higher concentration of racial minority residents (Mustanski et al., 2018). Collectively, these stigmas reflect community and social norms and are rooted in power inequities and systems of oppression that undermine the health and well-being of marginalized groups. Importantly, an intersectional approach to understanding stigma considers how systems of oppression work together to produce or uphold inequality and privilege (Cole, 2009). Stigmatizing environments and internalized stigma can reduce motivations to use condoms (Smith et al., 2012) and may similarly reduce motivations and opportunities to seek out PrEP.

Minimal research has explored the relationship between intersectional stigma and PrEP awareness and uptake among young Black GBM. In this qualitative study, we aim to develop a richer understanding of the experiences of young Black GBM and the ways in which intersectional stigma affects perceptions of and decisions about PrEP use. We seek to understand how the intersection of racism, homonegativity, HIV stigma, and PrEP stigma collectively affect HIV risk and prevention opportunities for young Black GBM.