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Black populations in the United States are disproportionately affected by HIV. This disparity may be affected by social and structural barriers to HIV testing, leading to undiagnosed infection and prolonged HIV transmissibility. Using data from a nationally representative sample of 1,727 Black men in the 2015 Behavioral Risk Factor Surveillance System we tested for differences in poverty, depression, and health care barriers between Black men who had been HIV tested in the past year and those who had not. We also tested a syndemic index of these factors. Number of syndemic factors was linearly associated with less HIV testing (aPR=0.79, 95% CI 0.66-0.95). Assumptions of unidimensionality were met. The use of a syndemic index was a superior approach to analyzing these factors individually, both in terms of model fit and associations detected. The accumulation of poverty, depression, and health care barriers has an adverse impact on HIV testing among Black men.

Black populations in the United States are disproportionately affected by HIV. This disparity may be affected by social and structural barriers to HIV testing, leading to undiagnosed infection and prolonged HIV transmissibility. Using data from a nationally representative sample of 1,727 Black men in the 2015 Behavioral Risk Factor Surveillance System we tested for differences in poverty, depression, and health care barriers between Black men who had been HIV tested in the past year and those who had not. We also tested a syndemic index of these factors. Number of syndemic factors was linearly associated with less HIV testing (aPR=0.79, 95% CI 0.66-0.95). Assumptions of unidimensionality were met. The use of a syndemic index was a superior approach to analyzing these factors individually, both in terms of model fit and associations detected. The accumulation of poverty, depression, and health care barriers has an adverse impact on HIV testing among Black men.

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Black sexual and gender minorities (SGM) are at greater risk for HIV compared to their White, cisgender, heterosexual counterparts. Linkage to culturally sensitive health care is, therefore, pivotal for HIV prevention and treatment of Black SGM. Unfortunately, social and structural challenges undermine Black SGM individuals' abilities to obtain adequate health care services, indicating a need to understand Black SGM perceptions of health care. To address this gap, we interviewed Black men who have sex with men and transwomen about their experiences with health care providers. Participants discussed needs and concerns, including provider SGM identity diversity and education; assumptions, judgment, stigma, and discrimination; and ability to establish a personal bond, trust, and familiarity. Black SGM indicated that providers often did not meet their needs in different ways regarding their SGM identities. Findings suggest a need for provider cultural sensitivity education programs that address the needs of Black SGM in health care.