The HIV/AIDS epidemic continues to exact a severe toll on Black men in the U.S. Although they represent just 14% of the male population, Black men accounted for 47% of HIV cases among men in 2009. The association between disproportionately high rates of HIV/AIDS in Black communities and social-structural factors such as poverty, neighborhood instability, and incarceration are well documented. Despite increasing advocacy for more social-structural approaches to HIV prevention however, considerable gaps in knowledge exist about how social structural stressors at the population-level and sociodemographic stressors at the individual-level (e.g., individual socioeconomic status, perceptions of racial discrimination) are associated with Black men's sexual HIV risk behaviors. There is also a dearth of knowledge about how resilience at both the neighborhood and individual-level may protect against Black men's sexual HIV risk behaviors. We propose a 5-year cross-sectional multiphase mixed methods study in Philadelphia, PA, in which we use geospatial analysis, qualitative methods, and multilevel quantitative modeling to refine and test a conceptual model of neighborhood-level social-structural stressors, individual-level sociodemographic stressors, psychological risk factors, neighborhood-level and individual-level resilience, and Black men's sexual HIV risk and protective behaviors. The study has 3 phases. Phase I includes focus groups to explore neighborhood-level social- structural stressors and resilience and to inform spatial data analyses of social-structural stressors (e.g., neighborhood poverty, neighborhood instability, crime) that may be associated with Black men's sexual HIV risk behaviors. Phase II involves the multilevel modeling of social-structural and sociodemographic stressors (e.g., individual SES), psychological risk factors, resilience, and sexual HIV risk and protective behaviors with a probability sample of 700 Black men between the ages of 18 and 44, of all sexual orientations, recruited from 100 Census block-groups. Phase III involves the integration of the study's results with spatial data visualization and culturally grounded explanations based on interviews with 30 Black men, followed by focus groups to confirm the study's interpretations. The expected outcome of this innovative study is that it will guide the development of structural interventions to reduce HIV incidence in Black men and their sexual partners regardless of the partners'gender. The overall positive impact of the research is that it will advance empirical knowledge about the multilevel social-structural stressors and resilience of Black men's lives with implications for reducing HIV incidence and other health disparities prevalent among Black men. The proposed study is highly responsive to the National HIV/AIDS Strategy's stated goals of reducing HIV incidence in Black men and women.
The disproportionate impact of HIV/AIDS among Black men makes the development of innovative HIV prevention research that can inform structural interventions for this population, a top public health priority. The proposed research is highly relevant to public health HIV prevention initiatives in general, and in particular to the National HIV/AIDS Strategy's stated goals of reducing HIV incidence in Black men and women.