“I wasn't really welcome in that community”: A qualitative study of place, intersectional stigma, and health among Black sexual minoritized men in Baltimore

Social and structural determinants of health are often spatially bound, limiting access to resources that influence health. Where people go and their interactions shape and are shaped by intersectional stigma, with profound potential impacts on health. Yet, further research is needed to understand how place intersects with intersectional stigma to affect people's daily lives and health. To inform place-based HIV prevention and care interventions in Baltimore, we conducted 20 in-depth interviews with Black sexual minoritized men. Interviews explored interrelationships between place, social relationships, intersectional stigma, life priorities, and health, and were audio-recorded and transcribed for analysis. Data were coded and thematically analyzed using a hybrid approach to identify emergent themes. Findings suggested an interplay between place-including material characteristics, spatially bounded social interactions, and symbolic meanings attached to different places-and their intersectional identities as Black sexual minoritized men. Place interacted with people's race/ethnicity, sexuality, and other social locations to affect whether participants felt welcome or uncomfortable, safe or under surveillance. Participants perceived the physical characteristics of places to affect health and well-being in positive and negative ways, through feelings of calmness or stress or access to food, transportation, housing, or health services. Access to healthcare and social services was clustered spatially and socially. Future research and interventions can (1) identify accessible places where people with intersectional identities feel welcome, comfortable, and safe; (2) address the spatial aspects of intersectional stigma; (3) prioritize belonging; and (4) couple structural, place-based interventions with individual-level interventions that support people in their daily lives.