Family and cultural pressures to conform to prescribed masculine behaviors create social isolation and distress that may drive young gay black men to seek approval and acceptance through perilous sexual behaviors, according to research led by investigators at the Johns Hopkins Children's Center. This dangerous "compensatory" mechanism, the researchers say, may contribute to the disproportionately high HIV infection rate seen in this population. In 2010, black gay and bisexual men between the ages of 13 and 24 accounted for nearly 4,800 new HIV infections -- more than twice as many as either young white or young Hispanic/Latino gay and bisexual men, according to the Centers for Disease Control and Prevention.
The study results, based on interviews with 35 young men, are described online May 15 in the American Journal of Public Health. The participants included openly gay and bisexual men, as well as men who have sex with men but do not identify themselves as gay or bisexual. The investigators say their findings offer one possible explanation for the disproportionately high HIV infection rate among young black men who have sex with men. "HIV risk is the sum total of many factors, but social and family stress is a well-known driver of all types of risk-taking behaviors, and our findings clearly support the notion this also holds true when it comes to HIV risk," says study lead investigator Errol Fields, M.D., Ph.D., an adolescent medicine expert at the Johns Hopkins Children's Center.
Participants, aged 18 to 24, all black men who have sex with men, grew up in families and communities with rigid anti-gay attitudes and traditional views of masculinity. They reported deep psychological distress, pressure to conform, a desire to camouflage their homosexuality and a need to prove their masculinity. Such pressures, the participants said, made them more prone to engage in risky sexual behaviors, less likely to form and maintain monogamous relationships, and more likely to have unprotected sex.
Participants also reported that rejection by important loved ones drove many black gay men to seek affirmation and acceptance through sex -- in some cases, unprotected. Of particular interest, according to the researchers, were some participants' views of unprotected intercourse as an expression of love and trust by their sexual partners.
Participants said their families, friends and community at large expected them to be overly masculine, aggressive and free of any effeminate behaviors. Those who failed to conform reported being ridiculed and ostracized. In an effort to compensate, many reported trying to create a hyper-masculine persona that fit the social norms. The desire to fit in, the researchers found, often drove these youth to engage in risk-taking behaviors such as fighting, aggression, drinking and taking drugs to prove one's manhood.
"The findings of our study reveal a clear clash between internal sexual identity and external expectations at a critical developmental stage age," Fields says. "This clash creates loneliness and low self-esteem and appears to drive these boys and men to risky behaviors, sexual and otherwise."
Participants reported that the ongoing efforts to keep up a straight appearance also created a sense of chronic anxiety and a fear of being found out. In addition, the study found, those who maintained a hyper-masculine public persona were more likely to avoid HIV-preventive messages and services targeting gay men for fear of being found out or perceived as gay.
A finding of particularly grave concern, the researchers say, was participants' reluctance to come out as gay or bisexual for fear of losing social and family support.
"It's a true catch-22 for these youngsters," Fields says. "On one hand, they are dealing with the chronic anxiety of hiding their homosexuality, but on the other they face the prospect of becoming social pariahs if they come out as gay or bisexual."
Race also emerged as a critical factor in the clash between homosexuality and masculinity, the study found. Participants reported an acute disdain for homosexuality in the predominantly black communities in which they grew up. The prevailing views of gay men as inferior in their manhood held by many members of these communities deepened the participants' resolve to conform and exacerbated their fear of coming out, the study found. The finding, the researchers say, suggests gay black youth may face more severe distress over their homosexuality than youth from other racial groups.
Fields says the findings underscore the need for public health interventions specifically tailored to address such cultural dynamics. Primary care physicians who care for black male teens should be keenly aware of cultural pressures and broach sexual health counseling accordingly.
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