A qualitative study of multilevel resilience mechanisms to counter intersectional stigma among black men who have sex with men in a Southern United States city

Black men who have sex with men (BMSM) are disproportionately affected by HIV and compounded stigma from racism, homophobia, and presumed HIV serostatus. Building resilience may help mitigate these intersecting stressors; yet little is known about how BMSM define and cultivate stigma resilience using resources across various socio-ecological levels. We qualitatively explored the nuanced definitions, multilevel resources, and resilience-building mechanisms defined by BMSM. In July 2024, we conducted in-depth qualitative interviews with 20 BMSM in Nashville, Tennessee. Participants were recruited through community-based outreach and social media in partnership with an HIV service organization. Seventeen interviews were retained for analysis after excluding incomplete or invalid data. Guided by the socio-ecological model and resilience theory, we applied rapid qualitative analysis to systematically summarize transcripts, identify themes, and refine findings through iterative team discussions. Participants defined resilience as both an internal strength and an active, evolving process. Multilevel resilience resources included self-acceptance, optimism, and self-care (individual); supportive peers and chosen families (interpersonal); affirming professional services (institutional); and community education/advocacy (structural). Actionable strategies emphasized positive reframing, building supportive networks, practicing wellness, seeking professional assistance, and advocating against stigma. Participants also underlined the importance of preparing for future challenges through self-reflection, goal setting, and problem-solving. Resilience among BMSM is a dynamic, multilevel process encompassing personal, relational, institutional, and structural mechanisms. By centering on lived experiences, this study offers actionable and forward-looking insights to inform resilience-based approaches that address stigma, strengthen social support, and promote well-being among BMSM. Supplementary Information: The online version contains supplementary material available at 10.1186/s12982-026-01773-w.