Health Educators Target Black Men ‘On the Down Low’
The "phenomenon" of men who have sex with men but do not identify themselves as gay or bisexual is frustrating HIV prevention efforts, particularly as it appears to be "more common" among African-American men than men of other races, the New York Times reports. These men live on what they term "the down low," and experts say this "secret[ive]" behavior is putting not only the men but also black women at risk. Last year, a CDC study of 8,780 men who contracted HIV through sexual activity with other men found that one-fourth of African-American respondents identified themselves as heterosexual compared to only 6% of whites. The "secret society" of men who have sex with men and women is not new, but the term "on the down low" has only recently come into use, Maurice Franklin, program director for Gay Men of African Descent, said. AIDS has become the leading killer of young black men, and more than half of those men were infected through sex with other men. A recent CDC survey found risky sexual behavior among gay and bisexual men to be increasing across ethnic groups, but the HIV infection rate was highest -- 30% -- among young blacks. "[P]revention methods targeted to African Americans have been unsuccessful -- period," psychology professor Dr. John Peterson of Georgia State University said. Peterson, who specializes in AIDS behavioral research among black men, said that the group on the down low is "much more hidden and the least receptive and accessible to prevention messages." Denial and a fear of ostracism from the black community help keep their lifestyle a secret. "The stigma is so great, that it's much easier to deny what's going on than to risk being ostracized from my community. I'm black and I'm a man; the community is the only safe haven we have," James King, an Ohio man who has lived on the down low for "many years," said. "More than among whites, African Americans may be loath to do anything, including disclosing their behavior with other men, that would alienate them from this source of comfort," Dr. Helene Gayle, director of the National Center for HIV, STD and TB Prevention, said. They need that community for "insulation and support," she added. Psychology may also play a role in the high incidence of unsafe sex among men who have sex with men. Dr. Ron Simmons, executive director of Us Helping Us, an African American focused HIV/AIDS prevention and treatment organization, said, "The D.L. guys are usually being driven by something in the moment, by feelings that they are ashamed of. They are not about to stop and put on a condom. Stopping would force them to acknowledge what they are doing."
'Fueling' the Rise of HIV Among Women
Unsafe sexual practices among men who have sex with both men and women are "fueling" the rising HIV infection rate among women. Traditionally, women contracted HIV primarily through intravenous drug use, but a recent report estimates that 54% of newly reported AIDS cases among women in 1998 were due to heterosexual contact, and 61% of those cases were reported among black women. Bisexual men are a "bridge" for HIV transmission to women, a study published last year in the Journal of the American Medical Association said. According to that study, one in six men who had sex with men had recently had sex with a woman, and "[n]early a fourth" of them had unprotected sex with both partners. Gayle said her agency's studies are pointing to a rise in infection among women through heterosexual contact because of men on the down low, and a "large portion" of those women "don't have a clue" as to what their partners are doing on the side, she said (Villarosa, New York Times, 4/3).