Sexual Harm Reduction (Seroadaptation) and the Lived Experiences of Black Men Who Have Sex With Men (BMSM) in Washington, DC

Abstract

This exploratory sequential multiple methods study encompasses three papers that address how Black men who have sex with men (BMSM) conceptualize and practice seroadaptation and overall health. The term, seroadaptation, serves as an umbrella term for a set of interrelated biomedical and behavioral approaches geared to mitigating HIV infection and transmission. The operationalization of seroadaptation has been based primarily on research with white MSM, who often report engaging HIV prevent methods involving the selection of sexual partners (serosorting) and positions (seropositioning) based on their partners’ perceived/known HIV status. Papers 1 and 2 use data collected through a qualitative study, called the PhotoUStudy, with 36 BMSM in Washington, DC, in 2019. The work was guided by a conceptual model, called the BMSM Intersectional Identity Framework Over the Life Course (BMSM Identity Framework), created for this study. Results for Paper 1 indicated that, overall, BMSM have a holistic view of health, which is grounded in their childhood and early adulthood experiences. Ten themes of holistic health were identified, all of which were centered around social network support and physical safety. Sexual harm reduction, which focused on 100% condom use and HIV testing, was an important, but singular theme. Participants’ descriptions of seroadaptation did not align with the current literature. Paper 2 also used data from the PhotoUStudy. The BMSM Identity Framework was expanded to include the holistic health themes identified in Paper 1, now called the BMSM Intersectional Health Index (BMSM Health Index). The lived environment or social geography also was captured, facilitating examination of how gentrification has disrupted, displaced, and disaggregated BMSM spaces (social geography) and social networks. Paper 3 attempted to validate the BMSM Identity Framework’s Health Index using data from the HIV Prevention Trials Network 061 (HPTN 061). Guided by the BMSM Identity Framework, variables from the HPTN 061 data set were selected to approximate the BMSM Health Index. Statistical analysis was conducted to assess whether the BMSM Health Index could predict two psychosocial health outcomes among BMSM: depression and stress.