New research sheds light on why young black males have high HIV infection rates

New research is shedding light on why young black males who have sex with males have among the highest rates of HIV infection in the United States, even though their reported use of condoms is similar to males of other racial and ethnic backgrounds.

A key factor may be black men's cultural beliefs about masculinity, which may influence how they choose their sex partners, make judgments about HIV risk and make decisions about condom use, according to a study to be presented Monday, May 2, at the Pediatric Academic Societies (PAS) annual meeting in Denver.

Young black males who have sex with males have twice the number of new HIV infections as young Hispanic and white men who have male partners, according to Errol L. Fields, MD, PhD, MPH, lead author of the study and a pediatric resident at Children's Hospital Boston and Boston Medical Center. They also are five times more likely to be HIV-infected than white males of similar ages.

"We interviewed young black men to hear the stories behind these statistics," Dr. Fields said.

Thirty-five black males ages 18-24 years in New York City, upstate New York and Atlanta took part in semi-structured interviews that explored cultural and psychosocial factors that may influence how they choose sexual partners, assess HIV risk and decide whether to use condoms.

Most of those interviewed said they preferred to partner with men whom they perceived as masculine. Some of the young men said they allowed partners who were more masculine to control what sexual activity they engaged in and whether they used condoms.

"We found that their beliefs about masculinity may affect their ability to protect themselves against HIV," Dr. Fields said. "For example, many believed that men who acted more feminine were at greater risk for HIV than men who acted more masculine. These beliefs may have led to greater risk behavior with men who were perceived to be masculine because they believed these men were less likely to have HIV."

The study findings suggest that cultural beliefs about masculinity may affect HIV risk in black adolescents and young adult males who have male sexual partners and should be considered in prevention strategies directed toward this population, Dr. Fields concluded.