Lisa Bowleg, Ph.D., an associate professor at Philadelphia's Drexel University School of Public Health, focuses primarily on community health and prevention issues for women. Yet at this year's International AIDS Conference, she presented a study on what she calls the "missing link" of HIV-prevention work in Black communities: heterosexual men.
Here, Dr. Bowleg explains the surprising things she learned -- and their use in her future work -- about distress, sex, Black men and HIV.
What was your research about? And what made you decide to turn the focus of your work from women to men?
There are typically two people -- a man and a woman -- in a heterosexual sexual encounter. Why should she bear greater responsibility, given that his behaviors are likely to play a larger role in the transmission of the virus to her? Why do we exclude Black men from leadership to end this epidemic in our communities? Why are our expectations for Black heterosexual men so chillingly low or nonexistent when it comes to HIV prevention? You can always count on women to be out front, taking the initiative to care for their loved ones and communities. Now it's time for heterosexual brothers to step up and co-lead.
On a community level, what do you think are the best kinds of programs to protect Black heterosexual men from high-risk behavior?
Structurally based interventions are desperately needed. A host of structural factors -- such as unemployment, incarceration, racism, police harassment and surveillance, and neighborhood violence -- disproportionately impact Black men's lives. To assume that HIV prevention is or should be their primary concern seems quite shortsighted. We need interventions such as job training and workforce development and housing programs. We need to address the complex structural factors that, as Dr. Rafael Diaz has noted in his research on social discrimination and HIV risk among Latino gay and bisexual men, constrain individuals' ability to protect themselves and their partners from HIV. My research shows that we have lots to do in terms of changing traditional gender-role norms -- for example, that real men have sex with lots of women and should not be gay or bisexual. Brazil, Ethiopia and India have succeeded in changing traditional notions of masculinity to enhance HIV prevention. Similar interventions should exist for heterosexual men in the U.S.
If you had to choose one, which structural factor was most commonly discussed in your interviews as a cause of high-risk sexual behavior?
My research team and I hypothesize (and plan to test) that psychological distress links these factors. That is, men who have experienced all of these factors -- unemployment, discrimination and so on -- are likely to be more distressed. They may engage in various risk behaviors, such as having sex under the influence of drugs or alcohol or with lots of women, as a way of coping.
We also examine gender-role strain. Lots of men we interviewed have talked about the stress of not being able to financially support their families. We plan to investigate whether the man who is distressed about not being able to support his family -- our society tells us that this is what "real men" should do -- may have sex with more women to compensate.
We also are very interested in factors that protect Black men. So we're investigating how factors such as religiosity or spirituality, coping and social support might buffer against distress and in turn reduce HIV sexual risk.
Will this lead to any new studies for you?
Absolutely yes! We plan to disseminate lots of interesting findings, including on masculinity ideologies, resilience in Black men, sexual concurrency, sexual scripts, and religiosity and spirituality.
As for future studies, I am excited about a collaboration with the National Comprehensive Center for Fatherhood (NCCF), which provides employment training and life development to thousands of Black men in Philadelphia. We just conducted focus groups to examine where HIV falls as a priority for men in the NCCF program. We plan to apply for a grant to develop and test an employment-based intervention for Black men in the program. It's a wonderful opportunity to bridge academic work with that of a community-based organization.