Racism and homophobia affected YBMSM's sense of belonging, sexual identity, and sexual partnership choices, and often masculinity would interact with these constructs to impact how YBMSM engaged in sexual behavior and their likelihood to seek sexual health care.
Key Findings
Background
Black gay, bisexual, and other men who have sex with men (BMSM) experience the highest rates of HIV acquisition annually out of any population in the United States, yet existing literature finds BMSM engage in fewer sexual risk behaviors than White and Hispanic/Latino MSM.
This gap between risk behaviors and HIV incidence rates is described as a central paradox motivating the review.
Young BMSM (YBMSM) are identified as heavily impacted by this inequity as they enter adulthood.
The disconnect between behavior and HIV incidence points to structural factors such as racism and homophobia as explanatory variables.
Methods
The systematic review identified 17 studies meeting inclusion criteria, with the majority being qualitative in design and conducted in urban settings.
Four databases were searched: MEDLINE, CINAHL Complete, APA PsycINFO, and Sociology Source Ultimate.
The review included qualitative, quantitative, and mixed method studies.
Studies were focused on discrimination experiences of YBMSM due to racism and homophobia in the United States.
The predominance of qualitative designs and urban settings reflects a limitation in the generalizability of findings.
Results
Racism and homophobia affected YBMSM's sense of belonging, sexual identity, and sexual partnership choices.
These structural factors were found to shape how YBMSM understood and expressed their sexual identities.
Discrimination experiences influenced who YBMSM chose as sexual partners.
Effects on sense of belonging suggest social marginalization as a mechanism linking discrimination to sexual health outcomes.
Results
Masculinity frequently interacted with racism and homophobia to influence how YBMSM engaged in sexual behaviors, including condomless sex.
Masculinity norms intersected with experiences of racism and homophobia as a compounding factor.
This interaction affected YBMSM's engagement in condomless sex specifically.
The interaction of masculinity with these constructs also shaped likelihood to seek sexual health care.
Results
Racism and homophobia were associated with reduced likelihood among YBMSM to seek sexual health care.
Discrimination experiences created barriers to health-seeking behavior in this population.
Both racism (in healthcare settings and society) and homophobia contributed to avoidance of sexual health services.
This finding has implications for HIV prevention and care engagement among YBMSM.
Conclusions
The authors concluded that future research is needed to fully understand the relationships between discrimination and sexual health in order to develop effective structurally responsive interventions.
Current evidence base is insufficient to fully characterize the mechanisms linking discrimination to HIV risk.
The authors call for interventions that are 'structurally responsive' rather than solely focused on individual behavior change.
The goal of such interventions would be to decrease the health inequities experienced by YBMSM.
What This Means
This research suggests that young Black gay, bisexual, and other men who have sex with men (YBMSM) face disproportionately high rates of HIV infection in the United States — not because they engage in more risky sexual behaviors than other groups, but because structural forces like racism and homophobia shape their lives in ways that increase vulnerability. Researchers conducted a systematic review of 17 studies and found that experiences of racial and anti-gay discrimination affected these young men's sense of belonging, how they understood their own sexual identities, and who they chose as sexual partners. Norms around masculinity also played an important role, interacting with racism and homophobia to influence behaviors like condomless sex and willingness to seek out sexual health care.
The review highlights that discrimination is not just a social issue but a health issue — when people face racism in healthcare settings or feel stigmatized because of their sexuality, they may be less likely to get tested, seek treatment, or access HIV prevention tools like PrEP. This research suggests that addressing the HIV epidemic among YBMSM requires going beyond individual behavior-focused interventions and instead tackling the structural and social conditions — racism, homophobia, and rigid masculinity norms — that create unequal health outcomes. The authors note that most studies in this area were qualitative and set in urban environments, meaning more diverse research is needed to fully understand these relationships and design effective responses.
Janek S, Matos L, Hatoum S, Mulawa M, Ledbetter L, Relf M. (2025). Racism, homophobia, and the sexual health of young Black men who have sex with men in the United States: A systematic review.. PloS one. https://doi.org/10.1371/journal.pone.0316532