Pressure to conform to perceived masculine norms may fuel HIV risk among gay black men

June 12, 2014 by Ekaterina Pesheva, Johns Hopkins University

(Medical Xpress)—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 and , 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 , 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 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 ' 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.


  • Young, gay black have a disproportionately high risk of acquiring HIV.
  • Masculine norms and prescribed social behaviors in the black community create isolation and distress that fuel unhealthy behaviors, including unprotected sex and multiple partners.
  • The findings of this study may offer one explanation for the high HIV infection rate in this population.
  • Researchers say and physician-level interventions need to account for these cultural dynamics and tailor messages and counseling accordingly.

Explore further: Higher HIV risk in black gay men linked to partner choice, risk perception

Related Stories

Higher HIV risk in black gay men linked to partner choice, risk perception

May 2, 2011
Young black men who have sex with men (MSM) get infected with HIV nearly five times more often than MSM from other races, even though they don't have more unprotected sex.

Services lacking for young gay black men

September 18, 2013
Physical, sexual and emotional abuse among young gay black men is a pervasive problem, yet there remains a lack of social services and resources available to help them, a Michigan State University scholar argues in a new ...

One in 10 male, same-sex Craigslist ads seek men who don't identify as gay

March 24, 2014
Online sexual hook-ups present a unique opportunity to explore many factors of decision-making that inform sexual health. A study conducted by Eric Schrimshaw, PhD, at Columbia University's Mailman School of Public Health ...

Unique study examines feelings of love tied to sex between gay and bisexual men

February 5, 2014
(Medical Xpress)—A first-of-its-kind study by researchers at George Mason University and Indiana University Bloomington draws some conclusions to an age-old question: What does love have to do with sex, in particular, among ...

Sexual agreements among gay couples show promise for HIV prevention

March 26, 2013
The majority of gay men in relationships say they establish a "sexual agreement" with their partner, primarily to prevent the spread of HIV and other sexually transmitted diseases, according to a University of Michigan study.

Rate of new HIV infections drops for first time among black women, CDC reports

December 21, 2012
(HealthDay)—For the first time, the rate of new HIV infections among black American women declined between 2008 and 2010, according to a report released Wednesday by the U.S. Centers for Disease Control and Prevention.

Recommended for you

War in Ukraine has escalated HIV spread in the country: study

January 15, 2018
Conflict in Ukraine has increased the risk of HIV outbreaks throughout the country as displaced HIV-infected people move from war-affected regions to areas with higher risk of transmission, according to analysis by scientists.

Researchers offer new model for uncovering true HIV mortality rates in Zambia

January 12, 2018
A new study that seeks to better ascertain HIV mortality rates in Zambia could provide a model for improved national and regional surveillance approaches, and ultimately, more effective HIV treatment strategies.

New drug capsule may allow weekly HIV treatment

January 9, 2018
Researchers at MIT and Brigham and Women's Hospital have developed a capsule that can deliver a week's worth of HIV drugs in a single dose. This advance could make it much easier for patients to adhere to the strict schedule ...

New long-acting, less-toxic HIV drug suppresses virus in humanized mice

January 8, 2018
A team of Yale researchers tested a new chemical compound that suppresses HIV, protects immune cells, and remains effective for weeks with a single dose. In animal experiments, the compound proved to be a promising new candidate ...

Usage remains low for pill that can prevent HIV infection

January 8, 2018
From gritty neighborhoods in New York and Los Angeles to clinics in Kenya and Brazil, health workers are trying to popularize a pill that has proven highly effective in preventing HIV but which—in their view—remains woefully ...

Researchers find clues to AIDS resistance in sooty mangabey genome

January 3, 2018
Peaceful co-existence, rather than war: that's how sooty mangabeys, a monkey species found in West Africa, handle infection by SIV, a relative of HIV, and avoid developing AIDS-like disease.


Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.