In the United States, no population is at greater risk of HIV infection than African-American men who have sex with men (MSM): the Centers for Disease Control and Prevention estimate that if current rates continue, 1 in 2 men in this group will be diagnosed with HIV in their lifetime. At Temple’s School of Social Work, researchers are working to reduce that staggering statistic by rethinking the very terms that scientists use to describe this population.
In a paper recently published in Archives of Sexual Behavior, Associate Professor of Social Work Scott Rutledge, Professor of Social Work Larry Icard and others analyzed data from African-American MSM in a larger randomized clinical trial of an HIV prevention intervention. The researchers looked at how these men defined their sexual identity, and how that identity was associated with sexual behavior and other characteristics. By uncovering these links, the research team hopes to set the stage for more effective HIV prevention interventions for African-American MSM.
Why is self-identity important? ‘MSM’ is a term used by researchers, but it’s rarely used by individual men to describe themselves. And although epidemiological research includes all men who have sex with men in the same category, there are big differences among them. “It’s certainly not a monolithic group,” says Rutledge.
So the researchers took a different approach, instead asking men how they identified themselves—as gay, bisexual, straight, or down low. The research team also asked participants about sexual behaviors, demographics and factors in their lives that would increase or decrease HIV infection risk. Then the team compared responses based on sexual identity subgroups.
Big differences started to emerge. For example, men who identified as straight or down low were much less likely to be open with others about their sexual behavior with other men. They also reported more drug and alcohol abuse—which can lead to risky behavior like sex without a condom—than gay and bisexual men. On the other hand, the data showed that gay men engaged more in the kinds of sexual behavior that is riskiest for HIV infection. In other words, the findings suggest that all four subgroups of men were at risk of becoming infected or infecting others—but for different reasons.
Understanding this might inform how researchers build new HIV prevention interventions. “If there are significant differences in people’s sexual behavior or risk behavior, maybe interventions can be tailored to them,” says Rutledge. “Rather than building an intervention that assumes everyone is all the same, we can build it for a particular subgroup, or tailor the intervention to the individual.” For example, an intervention designed for straight-identified men might put extra emphasis on how substance abuse increases their risk of HIV infection, or might target ways that they engage in sexual behavior with women.
Another way the data could be used: encouraging care providers to be sensitive and attentive when talking with their clients. “Many providers still use ‘gay’ as an all-encompassing label that many people are still resistant to,” says Rutledge. “I think the more that we try to use language that’s inclusive for people, it can be a signal to them that we actually might be able to provide services in a way that makes them feel like they belong.’”