title: Social risk, stigma and space: key concepts for understanding HIV vulnerability among black men who have sex with men in New York City.
abstract: Black men who have sex with men in the USA face disproportionate incidence rates of HIV. This paper presents findings from an ethnographic study conducted in New York City that explored the structural and socio-cultural factors shaping men's sexual relationships with the goal of furthering understandings of their HIV-related vulnerability. Methods included participant observation and in-depth interviews with 31 Black men who have sex with men (three times each) and 17 key informants. We found that HIV vulnerability is perceived as produced through structural inequalities including economic insecurity, housing instability, and stigma and discrimination. The theoretical concepts of social risk, intersectional stigma, and the social production of space are offered as lenses through which to analyse how structural inequalities shape HIV vulnerability. We found that social risk shaped HIV vulnerability by influencing men's decisions in four domains: 1) where to find sexual partners, 2) where to engage in sexual relationships, 3) what kinds of relationships to seek, and 4) whether to carry and to use condoms. Advancing conceptualisations of social risk, we show that intersectional stigma and the social production of space are key processes through which social risk generates HIV vulnerability among Black men who have sex with men.
authors.affiliation: a Department of Sociomedical Sciences , Mailman School of Public Health, Columbia University , New York , USA.
authors.forename: Caroline M
authors.initials: CM
authors.lastname: Parker
authors.affiliation: b College of Public Health and Human Sciences , Oregon State University , Corvallis , OR , USA.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Garcia
authors.affiliation: c HIV Center for Clinical and Behavioral Studies , New York State Psychiatric Institute and Columbia University , New York , USA.
authors.forename: Morgan M
authors.initials: MM
authors.lastname: Philbin
authors.affiliation: a Department of Sociomedical Sciences , Mailman School of Public Health, Columbia University , New York , USA.
authors.forename: Patrick A
authors.initials: PA
authors.lastname: Wilson
authors.affiliation: a Department of Sociomedical Sciences , Mailman School of Public Health, Columbia University , New York , USA.
authors.forename: Richard G
authors.initials: RG
authors.lastname: Parker
authors.affiliation: a Department of Sociomedical Sciences , Mailman School of Public Health, Columbia University , New York , USA.
authors.forename: Jennifer S
authors.initials: JS
authors.lastname: Hirsch
mesh_terms: D001741:Black or African American / Q000523:psychology*; D017280:Condoms / Q000706:statistics & numerical data; D015658:HIV Infections / Q000208:ethnology / Q000517:prevention & control*; D018451:Homosexuality, Male / Q000208:ethnology*; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D009519:New York City / Q000208:ethnology; D012309:Risk-Taking; D012725:Sexual Behavior / Q000208:ethnology; D012747:Sexual Partners; D063508:Social Discrimination; D057545:Social Stigma
keywords: Black men who have sex with men; HIV; New York City; social risk; space; stigma