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Poverty also plays a role in the Southern HIV epidemic eight of the ten poorest US states (as measured by lowest median income) are Southern. These conservative ideologies have been associated with increased HIV stigma, and often work to decrease the effectiveness of HIV prevention and treatment efforts. Social conservatism, including opposition to same-sex sexual behavior and marriage, is most prevalent in the South-informally referred to as the “Bible belt” due to the pervasiveness of conservative religious and political views. Several factors contribute to HIV-related disparities in the South. Fifty percent of people who are unaware they are living with HIV live in the South, and over 50% of the HIV-related deaths occur within this region. Although the Southern US is only home to 38% of the country’s population, over 50% of new cases of HIV/AIDS were diagnosed in the South in 2016. There are also significant geographic disparities in the US epidemic, with the Southern states being disproportionately impacted. Black GBMSM, particularly young Black GBMSM (YB-GBMSM) bear a disproportionate burden of HIV relative to other racial groups prevalence among YB-GBMSM is estimated at 26% (vs. Among US MSM, incidence and prevalence vary widely across age and racial/ethnic groups. Las intervenciones futuras deberían trabajar con los jóvenes, las familias y las iglesias para prevenir estas experiencias dañinas.Īn estimated 1.1 million people are currently living with HIV in the United States (US), approximately 70% of whom are gay, bisexual and other men who have sex with men (GBMSM). En conclusión, la homonegatividad experimentada, anticipada e internalizada fue generalizada en los entornos familiares y religiosos de YB-GBMSM durante el curso de la vida. La mayoría de los participantes finalmente llegaron a la autoaceptación de su sexualidad y su estado de VIH. En última instancia, muchos participantes se distanciaron de los entornos del hogar, buscando y con frecuencia encontrando apoyo extrafamiliar. Estas experiencias causaron a una homonegatividad interna e anticipada, que a su vez dio forma a los procesos de formación de la identidad sexual en la adolescencia y en la edad adulta temprana. Los ambientes sofocantes, a veces traumáticos, familiares y religiosos causaron a una homonegatividad experimentada en la vida temprana. El análisis temático identificó patrones en las formas en que se discutió la homonegatividad en diferentes puntos de la vida de los participantes. Realizamos entrevistas cualitativas con 28 YB-GBMSM que viven con el VIH para explorar las manifestaciones de homonegatividad a lo largo del curso de la vida. La teoría del estrés de las minorías postula que la homonegatividad, ya sea experimentada, anticipada o internalizada, afecta negativamente a la salud. Future interventions should work with youth, families, and churches to prevent these harmful experiences. In conclusion, experienced, anticipated and internalized homonegativity were pervasive as YB-GBMSM navigated family and religious environments over the life course. Most participants eventually reached self-acceptance of both their sexuality and HIV status. Ultimately, many participants distanced themselves from home environments, seeking and often finding extrafamilial support. These experiences led to anticipated and internalized homonegativity, which in turn shaped sexual identity formation processes in adolescence and into young adulthood. Stifling, and sometimes traumatic, familial and religious environments led to experienced homonegativity early in life. Thematic analysis identified patterns in the ways that homonegativity was discussed at different points in participants’ lives. We conducted qualitative interviews with 28 YB-GBMSM living with HIV to explore manifestations of homonegativity over the life course. Minority stress theory posits that homonegativity-whether experienced, anticipated, or internalized-adversely impacts health.