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Am J Public Health. 2015 Jan;105(1):122-131.

"I Always Felt I Had to Prove My Manhood": Homosexuality, Masculinity, Gender Role Strain, and HIV Risk Among Young Black Men Who Have Sex With Men.

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Errol L. Fields and Jonathan Ellen are with the Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, School of Medicine, and Katherine C. Smith is with the Department of Health Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. Laura M. Bogart and Mark A. Schuster are with the Division of General Pediatrics, Department of Medicine, Boston Children's Hospital, and the Department of Pediatrics, Harvard Medical School, Boston, MA. David J. Malebranche is with Student Health Services, University of Pennsylvania, Philadelphia.



We explored gender role strain (GRS) arising from conflict between homosexuality and cultural conceptions of masculinity among young Black men who have sex with men (MSM).


We conducted a categorical analysis (a qualitative, 3-stage, iterative analysis) of data from studies conducted in 2001 to 2006, which interviewed 35 men aged 18 to 24 years in 3 New York cities and Atlanta, Georgia.


Participants described rigid, often antihomosexual expectations of masculinity from their families, peers, and communities. Consistent with GRS, this conflict and pressure to conform to these expectations despite their homosexuality led to psychological distress, efforts to camouflage their homosexuality, and strategies to prove their masculinity. Participants believed this conflict and the associated experience of GRS might increase HIV risk through social isolation, poor self-esteem, reduced access to HIV prevention messages, and limited parental-family involvement in sexuality development and early sexual decision-making.


Antihomosexual expectations of masculinity isolate young Black MSM during a developmental stage when interpersonal attachments are critical. GRS may influence sexual risk behavior and HIV risk and be an important target for HIV prevention.

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