Down-low (sexual Slang) - HIV/AIDS

HIV/AIDS

Men who have sex with men and women are a "significant bridge for HIV to women," a CDC study suggested. The CDC's Young Men's Survey shows that about one in 10 men reporting sex with men also has sex with women. And more than one in four of these bisexual men has unsafe sex with both kinds of partners. "Men who also had sex with women had similar levels of HIV and STDs and higher levels of many risk behaviors,".

The CDC report that analyzes the above mentioned survey states that "many men who have sex with men (MSM), especially young and minority MSM, do not disclose their sexual orientation" in order to avoid "social isolation, discrimination, or verbal or physical abuse". The report connects non-disclosure to an increased risk of HIV by stating: "Young MSM who do not disclose their sexual orientation (nondisclosers) are thought to be at particularly high risk for human immunodeficiency virus (HIV) infection because of low self-esteem, depression, or lack of peer support and prevention services that are available to MSM who are more open about their sexuality (disclosers)."

The CDC added a note to their report stating, in part:

"The findings in this report are consistent with previous research suggesting that among MSM, nondisclosure of sexual orientation is associated with being a member of a racial/ethnic minority group, identifying as bisexual or heterosexual, having greater perceived community and internalized homophobia, and being less integrated socially within homosexual communities (1—3,6). Although this study did not find that nondisclosing MSM were at higher risk for HIV infection than MSM who are more open about their sexuality (1—3), the data suggest that a substantial proportion of nondisclosers are infected with HIV and other STDs and are at high risk for transmitting these infections to their male and female sex partners.

The finding that more than one in three nondisclosers reported having recent female sex partners suggests that nondisclosing MSM might have an important role in HIV/STD transmission to women. This might be particularly true for black nondisclosing MSM, of whom approximately one in five was infected with HBV and one in seven was infected with HIV."

The CDC cited three findings that relate to African-American men who operate on the down-low (engage in MSM activity but don't disclose to others):

• African American men who have sex with men (MSM), but who do not disclose their sexual orientation (nondisclosers), have a high prevalence of HIV infection (14%); nearly three times higher than nondisclosing MSMs of all other races/ethnicities combined (5%).

• Confirming previous research, the study of 5,589 MSM, aged 15–29 years, in six U.S. cities found that African American MSM were more likely not to disclose their sexual orientation compared with white MSM (18% vs. 8%).

• HIV-infected nondisclosers were less likely to know their HIV status (98% were unaware of their infection compared with 75% of HIV-positive disclosers), and more likely to have had recent female sex partners.

In Beyond the Down Low, Keith Boykin denies this connection, attributing the media claim to sexism, racism, homophobia and classism. Boykin stated that despite the numerous media accounts linking the down-low to the occurrence of AIDS in the African-American community, the U.S. Centers for Disease Control and Prevention has never cited men on the down-low as a factor. and that no extensive research has ever been published about men on the down-low, in part because of the difficulty of identifying the targeted population. In his book, Beyond The Down Low: Sex, Lies and Denial in Black America, he writes that men on the 'down-low' are not the cause of the HIV/AIDS epidemic in black America. Boykin argues that the down-low debate demonizes black men, stigmatizes black women, and encourages an unhealthy "battle of the sexes" that distracts the community's attention from the issues of HIV prevention, personal responsibility and condom use.

A cross study analysis that reviewed 24 articles (and published in the Journal of the National Medical Association) found that "black MSM are more likely than MSM of other racial or ethnic groups to be bisexually active or identified; and, compared with white MSM, are less likely to disclose their bisexual or homosexual activities to others." The authors concluded that:

"The high prevalence of HIV in the black community and the greater likelihood of bisexuality among black men place heterosexual black women at risk for HIV infection. However, the contribution of high-risk heterosexual black men to the rising HIV caseload among black women has been largely ignored. Future research must evaluate the relative contributions of bisexual men and exclusively heterosexual black men to HIV cases among black women."

Additionally, a qualitative study, published in the Medical Anthropological Quarterly, concluded that:

"... covert and unprotected sex among bisexually active black men was commonplace for reasons that included prostitution, habituation to same-sex relations during incarceration, and the desire to maintain a facade of heterosexuality in homophobic communities. It was concluded that bisexual activity is highly correlated with secrecy and unprotected sex. The risks of bisexuality among black men are exacerbated by incarceration, homophobia, drug use, and the prison and public health focus on surveillance rather than prevention."