**4. Evidence linking structural racism and HIV**

While there is growing recognition of structural racism and its impact on health, yet there is limited research examining the relationship between structural level factors impact on health HIV-related outcomes. A full accounting of structural racism and HIV disparities among sexual and racial minorities is beyond the scope of this chapter; rather instead we will provide an overview of the research focusing on the role of structural racism in fostering conditions that increase HIV vulnerability for Black MSM. We also acknowledge there is significant diversity within the Black MSM rubric (e.g., gay, bisexual, transgender, gender non-conforming; and same-gender-loving) with each subgroup experiencing varying levels of structural racism at the intersection of race, class, sexual, and gender identity, gender expression and HIV. Several researchers have critiqued the use of the term MSM because of who it includes and excludes, however again due to the limited scope of this chapter, we use the more traditional definition of Black MSM—an individual who identifies as Black or African American, assigned male at birth (MAB) and gay, bisexual and other men who have sex with other men [31–33]. In this section, we divide structural racism into five key domains: (1) Neighborhood Effects, (2) Social Determinants of Health, (3) Access to HIV Prevention Care and Treatment Services, (4) Incarceration, Criminal Justice System and HIV, and (5) Stigma, Cultural Competency, and Medical Mistrust. We will attempt to address each in turn.
