title: The limitations of 'Black MSM' as a category: Why gender, sexuality, and desire still matter for social and biomedical HIV prevention methods.
abstract: The USA faces disproportionate and increasing HIV incidence rates among Black men who have sex with men (BMSM). New biomedical technologies such as pre-exposure prophylaxis (PrEP) have been developed to address their HIV risk. Very little consideration, however, has been given to the diversity obscured by 'BMSM' as a category, to how this diversity relates to men's sexual partnering strategies, or to the relevance of these issues for new HIV prevention methods. We conducted a community-based ethnography from June 2013 to May 2014 documenting factors that affect the acceptance of and adherence to PrEP among BMSM. We conducted in-depth interviews with 31 BMSM and 17 community stakeholders, and participant observation. To demonstrate the diversity of social identities, we present a taxonomy of indigenous categories organised along the axes of sexual identity, sexual positioning, and gender performance. We analyse how HIV prevention strategies, such as PrEP, may be more effective if programmes consider how gender, sexuality, and sexual desire shape sexual partnering strategies. This article underlines the importance of attending to the diversity of sexual and social subjectivities among BMSM, of bringing the study of sexuality back into HIV prevention, and of integrating biomedical prevention approaches into community-based programmes.
authors.affiliation: a College of Public Health and Human Sciences , Oregon State University , Corvallis , OR , USA.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Garcia
authors.affiliation: b Mailman School of Public Health , Columbia University , New York , NY , USA.
authors.forename: Richard G
authors.initials: RG
authors.lastname: Parker
authors.affiliation: b Mailman School of Public Health , Columbia University , New York , NY , USA.
authors.forename: Caroline
authors.initials: C
authors.lastname: Parker
authors.affiliation: b Mailman School of Public Health , Columbia University , New York , NY , USA.
authors.forename: Patrick A
authors.initials: PA
authors.lastname: Wilson
authors.affiliation: c HIV Center for Clinical and Behavioral Studies, Columbia University , New York , NY , USA.
authors.forename: Morgan
authors.initials: M
authors.lastname: Philbin
authors.affiliation: b Mailman School of Public Health , Columbia University , New York , NY , USA.
authors.forename: Jennifer S
authors.initials: JS
authors.lastname: Hirsch
mesh_terms: D000293:Adolescent; D000328:Adult; D001741:Black or African American / Q000523:psychology*; D000884:Anthropology, Cultural; D054521:Cultural Competency; D005783:Gender Identity; D015658:HIV Infections / Q000208:ethnology / Q000517:prevention & control*; D018451:Homosexuality, Male / Q000208:ethnology* / Q000523:psychology / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D033262:Narration; D010342:Patient Acceptance of Health Care / Q000208:ethnology* / Q000523:psychology / Q000706:statistics & numerical data; D065129:Pre-Exposure Prophylaxis / Q000379:methods / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology; D055815:Young Adult
keywords: Black men who sex with men; HIV and AIDS; epidemiological categories; masculinity; partnering strategies; pre-exposure prophylaxis; sexuality
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