Participants were almost equally divided between New York City and upstate New York discussion groups (49% versus 44%), with the remaining participants comprising the Atlanta group. They were also equally divided in terms of identifying their sexual orientation as “gay” (53%) versus other identification categories (homosexual, bisexual, same-gender-loving, two-spirited: 47%), and regarding HIV status: HIV positive (48%), HIV negative (47%), with 5% reporting their status as “unknown.” The demographic profiles of the participants can be found in Table 2.

Adaptation to Racial and Sexual Prejudice

The theme of racial identification as black men was an irrefutable reality and viewed as the primary identity targeted for discrimination by the outside world (location and age of participants in parentheses):

“Being a black man is a hard struggle. Not just being gay, being straight—being a general black man is an everyday struggle. I don’t care how you put it, white America either wants me in a cell or in a grave.” (Rochester, 21)
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“We [black men] have to wake up in the morning and put on armor every day.” (Rochester, 20)

“Because we’re black, we all have the same face, so to speak. So when you approach somebody, they think that you’re going to automatically cross them in a very aggressive, intimidating way. You’re black first. (Atlanta, 33) “For me, whether it’s sexuality or just gender, it’s always gonna be an issue of race. I’m gonna be seen as a black man.” (Albany, 42)

The words used to describe their racial awareness reflected perceptions of the world viewing them as aggressive black-male stereotypes, and day-to-day existence as a battle or struggle. Additionally, displacement from family, church, and the black and gay white communities for how they

Table 1. Focus Group Moderator Guide QUESTIONS

• Experiences with healthcare providers (10 minutes)
• Tell me the first words or images that come to your mind when you hear the word “doctor.”
• Normative Influences (10 minutes) What were/are your family’s attitudes and beliefs about medical providers and healthcare?
• Barriers to healthcare (10 minutes) What makes it difficult for you to see a medical provider?
• Perception of reception (20 minutes)
• Tell me about your last experience seeing a
• medical provider.
• Race/sexuality issues and medical providers (20 minutes)
• As black men who have sex with men, what role does race and sexuality play in your interactions with medical providers?
• Adherence issues and medical providers (10 minutes)
• Tell me what factors contribute to you following or not following a medical provider’s recommendations (such as getting blood tests, taking medications, etc.).
• Communication and medical providers (20 minutes)
• Tell me about the communication between you and medical providers.
• Future relations between AAMSM and medical providers (10 minutes)

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When I go back to the medical profession to report on this focus group, what do you want me to tell them?

existed as homosexuals played an important role in everyday life:

“I think the biggest betrayal that I faced is the one that comes from my own family. The fact that most of the people in my immediate family have religious beliefs that are contrary to the [homosexual] lifestyle I live.” (Albany, 36)

“The experience that took me away from doctors was with the church. I thought I had a doctor that was cool. He invited me to a special church service. We get there, the topic, ‘Homosexuals: Should we pin ‘em up in an alley, or should God destroy them?’ And I fell apart because I was so hurt.” (Brooklyn, 30)

“Some people in the gay community, they can be real vicious, especially if you ain’t comfortable with your ‘gayness.’ And you go into a bar or hang out with somebody, and they cut you up. You so far in the closet, it’s gonna take a search team to find you.” (Buffalo, 28)

“I mean, you get this big old turn off, they [the black community] lights go out once your sexuality comes out. So when the lights go out, you go out. You don’t say nothing about your sexuality because you don’t want that. You look to these people for support, for love, for guidance, and once your sexuality comes out, it changes.” (Rochester, 20)
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The sense of disconnect from mainstream white culture combined with social isolation from the black community for being homosexual displaced some BMSM from any real sense of community belonging. In order to achieve a sense of “belonging”, adapting to the climate of different social communities was a coping mechanism utilized to fit in, although not without its price:

“Bottom line, I was a chameleon. I knew how to get with the drug people, I knew how to hang with the white people, I knew how to hang with the gay people, I knew how to hang with the Baptist folks. Wherever I needed to fit in, I fit in.” (Rochester, 40)

“To certain people, at certain points in their life, they don’t even know who they are because they keep putting on all these armors, all these different characters. You put on all these armors to the point where you ask yourself, you stop. You ask yourself, ‘Who am I?’ I mean, you get lost.” (Rochester, 21)

Efforts to fit in with different communities, wearing different masks during varying social situations, could leave one with a disjointed sense of self and still without a sense of truly belonging to any one of these communities.
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Displacement and Medical Expectations

Expectations of medical providers were often influenced by the social context of racial and sexual displacement that BMSM experienced in their daily lives:

“When I go into a physician’s office, and when I identify myself as a gay person, part of that is looking for acceptance from them, because I haven’t gotten it from my family, you know?” (Albany, 42)

“As you take a car to a mechanic to fix it and you want a good mechanic working on your car. That’s all I want from going to a doctor. Fix whatever ails me. And be capable of doing that.” (Manhattan, 31)

“A doctor deals with people from all walks of life. So you expect them to be understanding and professional.” (Harlem, 28)

“I need a doctor that’s not gonna judge my sexual preference, because you’re dealing with it all the time. And the last thing you need is somebody to judge you when you’re sick and at your worst… to preach to you about your sexual preference.” (Albany, 25)
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Experiences of prejudice and discrimination appeared to foster feelings of attachment or detachment from medical experiences: Utilize medical services and set high expectations of objective, nonjudgmental, and personal care, or expect discriminatory treatment and relegate the medical interaction to merely “fix whatever ails me.” Either way, it was apparent that the social context from which these men emerged had an impact on their approach to their medical experiences.