Background: BMSM in Philadelphia face an HIV infection rate that is five times the national average. The highest incidence is found in BMSM 13-24 years old, which accounted for 44% of all new HIV infection in Philadelphia in 2014. There is little qualitatitve data available about YBMSM in Philadelphia. The purpose of this study is to explore the social and behavioral barriers that hinder HIV prevention efforts and to identify gaps in health care that could better prevent HIV in Philadelphia. A clearer understanding of risk taking and sexual behaviors of YBMSM may help improve prevention programs.
Methods: Between January-November of 2015, participants were recruited from health department surveillance databases for an in-depth, semi-strucutred interview. Eligibility was based on 1) negative laboratory-confirmed HIV test at the time of a, 2) positive rectal chlamydia/gonorrhea test reported to the health department in 2015, 3) being between 18-24 years old and 4) identifying as a Black/African American male. A total of 114 young men were eligible for the study and saturation was reached after 10 interviews.
Results: Six main themes emerged from data analysis: 1) Partner dynamics, 2) Improving relationships with providers and their health messaging, 3) Perception of HIV, 4) Conflict regarding condomless anal intercourse (CAI), 5) STD/HIV knowledge and skepticism surrounding health care and 6) STD/HIV Testing is valued.
Conclusions: Perceived norms, attitudes and self-agency were influential in participant’s intentions of having CAI, condom negotiation and testing for HIV/STDs. Partner dynamics, especially age, may play a large role in the decision to use condoms, in defining sex roles, and in discussing sexual health, including HIV status and other protective heuristics. Participants identified friendship with health care providers and having community role models as necessary elements of effective HIV prevention in Philadelphia