title: Understanding structural barriers to accessing HIV testing and prevention services among black men who have sex with men (BMSM) in the United States.
abstract: Structural-level factors have contributed to the substantial disproportionate rates of HIV among Black men who have sex with men (BMSM) in the United States. Despite insufficient HIV testing patterns, however, there is a void in research investigating the relationship between structural factors and access to HIV testing and prevention services among BMSM. Building on previous scholarly work and incorporating a dynamic social systems conceptual framework, we conducted a comprehensive review of the literature on structural barriers to HIV testing and prevention services among BMSM across four domains: healthcare, stigma and discrimination, incarceration, and poverty. We found that BMSM experience inadequate access to culturally competent services, stigma and discrimination that impede access to services, a deficiency of services in correctional institutions, and limited services in areas where BMSM live. Structural interventions that eliminate barriers to HIV testing and prevention services and provide BMSM with core skills to navigate complex systems are needed.
authors: Department of Epidemiology and Biostatistics, The George Washington University School of Public Health and Health Services, 950 New Hampshire Ave, NW, Washington, DC, 20052, USA, mattelevy@gwu.edu.
authors: Matthew E
authors: ME
authors: Levy
authors: Leo
authors: L
authors: Wilton
authors: Gregory
authors: G
authors: Phillips
authors: Sara Nelson
authors: SN
authors: Glick
authors: Irene
authors: I
authors: Kuo
authors: Russell A
authors: RA
authors: Brewer
authors: Ayana
authors: A
authors: Elliott
authors: Christopher
authors: C
authors: Watson
authors: Manya
authors: M
authors: Magnus
mesh_terms: D001741:Black or African American / Q000523:psychology* / Q000706:statistics & numerical data; D015658:HIV Infections / Q000175:diagnosis* / Q000208:ethnology / Q000517:prevention & control; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility; D054625:Healthcare Disparities / Q000706:statistics & numerical data; D018451:Homosexuality, Male / Q000208:ethnology / Q000523:psychology*; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data; D010342:Patient Acceptance of Health Care / Q000208:ethnology / Q000523:psychology* / Q000706:statistics & numerical data; D011203:Poverty; D011330:Prisons; D012944:Social Support; D014481:United States / Q000453:epidemiology