An Intersectional Approach to Gender and Preventive Healthcare Seeking: Engagement with Biomedical HIV Prevention among Black Men Who Have Sex with Men

Morgan M. Philbin, Columbia University
Jennifer S. Hirsch, Columbia University
Patrick Wilson, Columbia University
Richard Parker, Columbia University

Black men who have sex with men (BMSM) have the highest HIV rates in the U.S. Pre-exposure prophylaxis (PrEP) offers a biomedical technology to prevent HIV – but requires adherence. However, whether and how ideological and structural dimensions of gender shape MSM’s engagement with preventive healthcare remains underexplored. We conducted three interviews each with 31 BMSM, and 90-minute interviews with 17 key informants. Three institutions emerged as relevant to PrEP uptake: 1) relationships (feminine men were perceived as “having HIV/STIs,” suggesting they might feel in need of PrEP); 2) the labor market (men felt excluded, stigmatized and unable to use employment to assert masculinity); and 3) healthcare systems (men avoided medical visits to appear a “man’s man”; being “weak and worried” was associated with femininity). This context reflects the importance of an intersectional approach to increase PrEP uptake for BMSM and for conducting research on men, gender and preventive healthcare.