Pressure to conform to masculine norms leads to psychological distress and isolation that can cause young, black men who have sex with men (MSM) to engage in behavior that raises their risk of HIV. Publishing their findings in the American Journal of Public Health, Johns Hopkins Children’s Center conducted interviews with 35 black MSM, some of whom self-identified as gay or bisexual while others did not, ages 18 to 24. The men all grew up under an anti-gay cloud and were subjected to cultural and familial dogma that reinforced the importance of traditional masculinity.

The men reported high levels of psychological anguish, as well as having experienced a pressure to conform to gender and sexuality norms and a need to shield their sexuality and to prove their masculinity. This perfect storm of repression and distress fueled sexual behaviors that put them at risk for HIV—including having intercourse without a condom—and also made them less likely to engage in monogamous relationships. Furthermore, the men said that rejections they had suffered from family or friends had influenced patterns of behavior in which they looked to replace the lost love and support through sex, which sometimes would be without a condom. In fact, some of the men dispensed of condoms during sex as a way to express love and trust with another man.

The pressure to conform to masculine ideals was high, as was the cost: raised levels of anxiety, as well as risky behaviors such as fighting, aggression, drinking and taking drugs. Also, those who did adopt a hyper-masculine persona for their communities were more likely to ignore HIV-prevention messages and services out of fear of being labeled as gay.

“HIV risk is the sum total of many factors, but social and family stress is a well-known driver of all types of risk-taking behaviors, and our findings clearly support the notion this also holds true when it comes to HIV risk,” study lead investigator Errol Fields, MD, PhD, an adolescent medicine expert at the Johns Hopkins Children’s Center, said in a release.

To read the Hopkins release, click here.

To read the study abstract, click here.