The prevalence of HIV among young Black men who have sex with men (MSM) is three to four times higher than white MSM. Young black MSM are run-aways and homeless, forcing them to survive on the streets by becoming sex workers, engaging in unprotected anal intercourse because either they or their partner is under the influence of drugs or alcohol. Previous studies cite crack cocaine use, sex while high on crack cocaine, marijuana and alcohol, or sharing needles for injection drugs as strongly associated with HIV infection among young black MSM. The purpose of this presentation is to understand the substance use experiences of HIV-positive and HIV-negative young Black MSM.
Methods:
This narrative qualitative study, obtained from participant interviews, offers insights about the range of factors and enhance our understanding about the role that substance use plays in the lives of HIV-positive and HIV-negative young Black MSM.
Results:
The themes that emerged from the coding of this qualitative narrative study describe an across-case experiential trajectory with a summary of the significant experiences of this population. This information contributes to the limited body of knowledge currently available and will assist with the development of prevention education strategies specifically tailored to this population that address issues surrounding substance abuse in HIV transmission.
The narratives describe experiences with substance use related to the following:
(1) early substance use exposure and initiation in family - Young Black MSM are exposed to substance use in their family, with family members who are also using drugs.
(2) for coping with gay sex and being gay – Participants how substance use allowed them the freedom to explore gay sex and their sexuality, including how they bottom (be the receptive anal partner) when under the influence of drugs.
(3) peer pressure in new community to fit in with others - Participants describes meeting new people through social media and how substance use is a part of that experience
(4) exposure to lots of methamphetamine in San Francisco – Participants describe the prevalence of methamphetamine in the dominant gay community, in this case White gay men, who are often times use the drug to control young Black MSM.
(5) to numb feelings- Participants discover the benefits of methamphetamine for numbing, masking feelings and coping,
(6) sexual enhancement and survival sex – Participants discover the sexual enhancement benefit and this leads them to engage in high risk behaviors, often times as a way to obtain food, clothing and shelter.
Here is a summary of the four key findings related to the overall research aims of this study that emerged from the narrative stories of the young Black MSM:
1) “There was a lot going on in the homes of these participants.” Almost all of the young Black MSM discussed early substance use exposure in their family, including parents who were also drugs. The young men shared about broken family structures, including abuse and neglect. These social and environment factors contribute directly to their own early substance use initiation (median age 15), as well as early sex initial (median age 15), at times with parents providing the drugs. Mean age for participants is 26.
2) Over thirty years into the AIDS epidemic, stigma and homophobia continue to be an issue for these young Black MSM. Most of the participants were either kicked out of their family homes, asked to leave by their family, or wanted to get away from their family so that they could be themselves. This is blatant discrimination. Most came to San Francisco as a safe place, only to face homelessness and having to figure out how to survive on their own. This creates a sense of insecurity.
3) With the prevalence and exposure to methamphetamine in the San Francisco, young Black MSM discover the benefits of this drug for numbing, masking, and coping with everything from being gay, gay sex, dealing with peer pressure, and for sexual enhancement and survival sex. These issues act as drivers for methamphetamine use as an ineffective coping mechanism.
4) Almost all the young Black MSM had some knowledge and awareness about HIV prior to arriving in San Francisco; most were testing regularly every three months. Once under the influence of methamphetamine, the participants don’t care about condoms, nor do they have the ability to negotiate condom usage with their partners. There is a sense of anticipation, resignation and acceptance about acquiring HIV; HIV risk reduction apathy.
Conclusion:
Clinicians and researchers in all academic and practice settings will encounter HIV-positive and HIV-negative young Black men and need to understand the prevalence of substance use among this population. It is also important to take a thorough family history, social history, as well as sexual health and risk behavior assessment.
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