| Abstract: | ![]()
Objectives. We conducted a qualitative study of HIV-positive young Black men who have sex with men (YBMSM) to explore their experiences of living with HIV and adhering to antiretroviral medications (ARVs) within the developmental context of their transition to adulthood.Methods. We conducted life history interviews with 20 HIV-positive YBMSM in Atlanta, Georgia, engaged in outpatient HIV care. We addressed these questions: (1) How do YBMSM living with HIV experience the transition to adulthood? and (2) What are the important sociocontextual influences on ARV adherence for YBMSM?Results. Successful transition to adulthood and optimal ARV adherence were inextricably linked. HIV’s detrimental impact on development was moderated by the degree of physical illness at diagnosis. Many participants described resilient trajectories while coping with HIV. Adherence problems occurred primarily among participants who were not meeting their developmental goals.Conclusions. Our findings support the need for early diagnosis and linkage to care, as well as the need to develop holistic, resilience-based interventions focusing on transition to adulthood. These findings have implications for individual clinical outcomes as well as ARV-based prevention efforts among YBMSM.Young Black men who have sex with men (YBMSM) aged 13 to 24 years are acquiring HIV infection at increasing rates, more than any other demographic group in the United States.1 Between 2006 and 2009, HIV incidence among YBMSM increased by 48%.2 These disparities are particularly prominent in the southern United States, which represents an increasing proportion of HIV incidence and prevalence.3,4 Effective interventions to improve treatment and prevention of HIV among YBMSM in the South are urgently needed.5,6 Significant public health benefit has been demonstrated from the use of antiretroviral medications (ARVs) to treat both people living with HIV (treatment as prevention) and uninfected high-risk individuals (preexposure prophylaxis).7,8 Given the rising HIV rates among YBMSM and the recent shift in focus toward ARV-based prevention approaches, we can anticipate that ARVs will be prescribed to YBMSM with increasing frequency in the near future. However, the efficacy of ARV-based interventions depends on optimal medication adherence,9,10 leading to concerns about the feasibility of implementing these strategies with youths.11 Adolescence and emerging adulthood are high-risk periods for medication nonadherence because of cognitive and developmental immaturity as well as structural barriers (e.g., housing and financial instability) that often manifest during the transition to independent adulthood.12,13 In addition to these youth-related obstacles, Black men who have sex with men of all ages frequently experience significant cultural and logistical barriers to obtaining appropriate medical care,14 including discrimination and mistrust at the community, institutional, and patient–provider relationship levels.15–20Developmentally and culturally appropriate support interventions must therefore be developed for YBMSM to maximize ARV adherence and the consequent individual and public health benefits. However, there is limited research focusing on sociocontextual factors in the lives of HIV-positive YBMSM to guide development of such programming. Extrapolation of prevention and treatment strategies designed for perinatally infected youths, older adults, or nonminority individuals is likely inadequate to address the unique circumstances of infected YBMSM as they learn to cope with a newly diagnosed chronic illness, manage intersecting stigmatized minority identities, and survive the normal developmental turbulence of adolescence and emerging adulthood.21,22 Formative research is needed to fill these gaps in the literature and maximize the likelihood of successfully implementing ARV-based prevention strategies in this growing population. We conducted a qualitative study to explore developmental and health-related experiences of HIV-positive YBMSM and to answer the following questions: (1) How do YBMSM experience the transition to adulthood while living with HIV? and (2) What are the important sociocontextual influences on ARV adherence for YBMSM? |
