Q&A: Errol Fields on Young Black Gay Men and Perceptions of HIV Risk

TheBody.com Sits Down With the Researcher to Clarify the Findings of His New Study, Which Found That Young Black MSM Believe That "Masculine" Men Are Less Likely to Have HIV

Last week, Johns Hopkins Bloomberg School of Public Health released the results to a recent study about young black gay men and its findings are interesting.

Errol Fields, M.D., M.P.H., Ph.D.
Errol Fields, M.D., M.P.H., Ph.D.

By interviewing 35 young black gay men, ages 18-24, in Rochester, N.Y., Atlanta and New York City, researchers found that the participants almost exclusively prefer romantic and sexual partners they perceive to be masculine; are reluctant to allow a man they consider to be feminine to "top" them during sex; allow men they perceive to be more masculine to control the terms of what kind of sex happens, including condom use; and consider masculine men to be less likely to have HIV, and feminine men to be more at risk.

Given the alarming rise in rates of HIV among young black MSM, these findings could potentially shed some light on what is fueling these numbers. Because this study had such a small number of participants, it wasn't meant to be prescriptive of the entire demographic, yet some media reports have taken these findings and made sweeping generalizations about all young black MSM.

Kellee Terrell, TheBody.com's news editor, talked to the study's lead author, Harvard's Errol Fields, M.D., M.P.H., Ph.D., about the participants' misconceptions around HIV risk, how those misconceptions may impact prevalence rates and why his findings are not new or specific to black gay men.

How did this study come about?

It was part of a larger project in my dissertation looking at the statistics in young black MSM. I noticed that there aren't that many studies that focus on younger MSM, which is a high risk population. During my work doing adolescent medication, I had a 16-year-old patient who was infected with HIV by a 28-year-old partner. That experience with him made me want to better understand what's going on in that community.

These findings were a combination of three different studies that consisted of interviews with 35 black gay men from Rochester, N.Y., New York City and Atlanta. We sat down with them for between an hour and an hour and a half. Since these were three different studies, not all the questions were identical, but they were very similar. From there, we then compiled the data.

I do want to stress something very important. What we did was a qualitative study, not something that should be generalized to the entire community. We just wanted to get a better perspective in hopes to being able to end up doing quantitative research down the road. As of now, we don't have enough information to develop a strategy, or PSA, or anything, but it begs for more research along those lines.

One of the most talked about trends that you all found was the sexual preference for more masculine men. Can you talk about what masculinity meant to those you interviewed and why it was falsely linked to lower HIV risk?

This preference for masculine men, or what was perceived as masculine, was fairly dominant and oftentimes, masculinity was described as something that "was not effeminate." Other descriptions of masculinity given were images we would see in hip-hop: Thugs and "gangstas", men who bragged about sexual conquests and certain physical attire.

But we also found that many of these men preferred masculine partners because by hanging out with more masculine men, they could hide their own sexuality from other people they were not out to. Hanging with more effeminate men would give their sexuality away and they didn't want that.

In terms of HIV risk, some of them had this assumption that masculinity meant not being involved in a "gay lifestyle" and men who were "wrapped up" in the lifestyle were more likely to be infected with HIV because they were exposing themselves to something they shouldn't be. There is this underlying assumption that HIV is something that is housed in the "out" gay community, and that was evident in their bias. One man told us, "If he is a guy with a girl and two babies, then he is not messing around with a lot of other men, so he doesn't have HIV."

Do you worry that talking about masculine men who are not out and HIV risk only adds ammunition to those who want to blame HIV on the down-low?

I do worry, but what we found was that the men weren't living dual lives. From what I got was that the men were mostly having sex with men who were gay. It's not something we asked directly, but that was the sense I got.

In terms of bisexuality, some of the men we interviewed who said they were bisexual, or would talk about sleeping with women, only said that to appear more acceptable to others, when in reality, they were not that having sex with women at all. They were only having sex with men.

If men referred to themselves as on the down-low, the term was used to mean that they're still masculine and having sex with men, but that their sexuality was something that was not common knowledge to their family members or other people.

To me, the trend of the more masculine partners having more power and making the decisions about condom use seemed very similar to the gender power dynamics that heterosexual women face. Did any of the men make mention of gender roles in their relationships?

Yes. Gender norms certainly came up in the interviews. Some of the young men did identify as being the female in the relationship, or the "bitch" in those lines. But this dynamic was found mostly in young men who had older, insertive partners. They used heterosexual gender norms and described them in how they interacted with their partners.

What was particularly troubling for me was this deferring control of condom use to the insertive older partner. We see this in the heterosexual data about girls having sex with older partners and them being at greater risk for HIV because of the power dynamics.

With some of the younger men, they were having sex with men who were 5-10 years older than them. They didn't describe these relationships as problematic or said that they were coerced into sex-it seemed normal to them and that's disconcerting. Because a 14-year-old having sex with a 28-year-old is not normal.

While cultural differences are important in understanding why people do what they do, some media outlets have taken these findings and have made some problematic assumptions about all gay black men-basically pathologizing them.

Exactly, our findings are not new or solely linked to black gay men. Whether it's the Bear or the Jock, this idea of hypermasculinty is present in the white gay community. On the online sex sites, gay men of all races are writing, "no femmes or fats."

In terms of choosing sexual partners and HIV, these issues date back to the '80s and '90s, when being muscular and working out was preferable because people thought that meant men weren't sick. That's when the twink went out of flavor.

And while this preference for men who are perceived as more masculine is not unique to black gay men, I think unlike men of the majority, black men have historically had less access to the American idea of masculinity and socioeconomic empowerment. Perhaps this lack of access has created this notion that black masculinity is more about what they can access: physical strength, sexual prowess and thug mentality.

I am not sure what that means to this population, or how that changes their risk relative to each other. We don't have enough information at this point.

What do you hope this study will usher in for the future?

You know, this type of research begs for more research so that it can be generalized and used on a larger scale in the future. I hope that more work will be done on understanding what masculinity means and how can we measure that for different populations. What rings to 20-year-old white males doesn't mean the same for the young gay black population.

It's also important that we do more research on what the different expectations of masculinity are for different communities, why people desire it and how masculinity is something that's valued in certain communities. Looking at the men we interviewed, being masculine was valued and there was this huge drive in maintaining it.

Did the men in the study discuss any expectations that straight black people had for them to act masculine?

Yes. There was a lot of talk about family members trying to change their effeminate behavior and mold them into being something more masculine. There were stories about being punished for being effeminate, parents trying to play sports with them or trying to encourage them to sleep with women.

A number of men interviewed told us that their sexual orientation was a secret from their families, hence this piece about having a masculine partner to help them maintain nondisclosure. For a lot of these young men, being out with their sexuality could lead them to being isolated from their family and loved ones. One person said in order for him to be accepted, he knew that he couldn't change his sexuality, but he had created strategies of putting on a certain image in order to maintain the connection with his family.

Any final thoughts you want to share about this study?

Just that the most important thing for me is that there are these young men who have these important things to say about their lives and experiences and it's important research because it points to potential problems out there that need to be addressed. It's not clear how big or small these problems are, but they exist and we need to work to address them.

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