AIDS and Behavior

, Volume 10, Issue 5, pp 519–529 | Cite as

Self-Identification as “Down Low” Among Men Who Have Sex with Men (MSM) from 12 US Cities

  • Richard J. Wolitski
  • Kenneth T. Jones
  • Jill L. Wasserman
  • Jennifer C. Smith
Original Paper

Abstract

Men who have sex with men (MSM) who are on the “down low” (DL) have been the subject of considerable media attention, but few data on this population exist. This exploratory study (N=455) compared MSM who considered themselves to be on the DL with MSM who did not (non-DL MSM). 20% self-identified as DL. Blacks and Hispanics were more likely than Whites to self identify as DL. MSM who did not identify as gay were more likely than gay-identified MSM to describe themselves as DL. DL-identified MSM were less likely to have had seven or more male partners in the prior 30 days, but were more likely to have had a female sex partner and to have had unprotected vaginal sex. DL-identified MSM were less likely to have ever been tested for HIV than were non-DL MSM. Prevention agencies should expand existing programs for MSM to include specific efforts to reach DL MSM.

Key Words

HIV prevention Homosexuality Bisexuality Sexual behavior Sexual orientation Labeling Self concept Risk factors African Americans Hispanics 

Notes

Acknowledgments

This research was supported by the Centers for Disease Control and Prevention and awarded to RTI International (contract number 200–2001–00123). The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention.The authors would like to acknowledge the following individuals for their contributions to the development and implementation of this study: Carolyn Guenther-Grey, Jennifer Uhrig, Jeff Henne, Barbara Burbridge, Lisa Belcher, Dogan Eroglu, Cari Courtenay-Quirk, Kristine Fahrney, and Laxminarayana Ganapahti. We would also like the thank Steve Flores, Alan Greenberg, Greg Millett, Pilgrim Spikes, and Ron Stall for their critical review of this manuscript.

References

  1. Boykin, K. (2005). Beyond The Down Low: Sex, Lies, and Denial in Black America. New York: Carroll and Graf.Google Scholar
  2. Centers for Disease Control and Prevention. (2001). Compendium of HIV prevention interventions with evidence of effectiveness. HIV/AIDS Prevention Research Synthesis Project. Retrieved from: http://www.cdc.gov/hiv/pubs/hivcompendium/HIVcompendium.htm.Google Scholar
  3. Centers for Disease Control and Prevention. (2002). Sexual transmitted diseases treatment guidelines 2002 (Rep. No. RR-6). Atlanta: US Department of Health and Human Services, Centers for Disease Control and Prevention.Google Scholar
  4. Centers for Disease Control and Prevention. (2003a). HIV/STD risks in young men who have sex with men who do not disclose their sexual orientation–Six U.S. cities, 1994-2000. MMWR, 52, 81–86.Google Scholar
  5. Centers for Disease Control and Prevention. (2003b). Incorporating HIV prevention into the medical care of persons living with HIV: Recommendations of CDC, the Health Resources and Services Administration, the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America (Rep. No. RR-12). Atlanta: US Department of Health and Human Services, Centers for Disease Control and Prevention.Google Scholar
  6. Centers for Disease Control and Prevention. (2004). HIV/AIDS Surveillance Report, 2003 (Vol. 15) (Rep. No. 14). Atlanta: US Department of Health and Human Services, Centers for Disease Control and Prevention.Google Scholar
  7. Chng, C. L., and Geliga-Vargas, J. (2000). Ethnic identity, gay identity, sexual sensation seeking and HIV risk taking among multiethnic men who have sex with men. AIDS Education and Prevention, 12, 326–339.PubMedGoogle Scholar
  8. Courtenay-Quirk, C., Wolitski, R. J., Hoff, C., Parsons, J. T., and Seropositive Urban Men’s Study Group. (2003). Interests of HIV-seropositive men who have sex with men in prevention and support services. AIDS Education and Prevention, 15, 401–412.PubMedCrossRefGoogle Scholar
  9. Crawford, I., Allison, K. W., Zamboni, B. D., and Soto, T. (2002). The influence of dual-identity development on psychological functioning of African American gay and bisexual men. Journal of Sex Research, 39, 179–189.PubMedGoogle Scholar
  10. David, A. K., and Boldt, J. S. (1980). A study of preventive health attitudes and behaviors in a family practice setting. Journal of Family Practice, 11, 77–84.PubMedGoogle Scholar
  11. Denizet-Lewis, B. (2003, August 3). Double Lives on the Down Low. The New York Times Magazine, pp. 6.Google Scholar
  12. Dodge, W. T., BlueSpruce, J., Grothaus, L., Rebolledo, V., McAfee, T. A., Carey, J. W. et al. (2001). Enhancing primary care HIV prevention: A comprehensive clinical intervention. American Journal of Preventive Medicine, 20, 177–183.PubMedCrossRefGoogle Scholar
  13. Doll, L. S., and Beeker, C. B. (1996). Male bisexual behavior and HIV risk in the United States: Synthesis of research with implications for behavioral interventions. AIDS Education and Prevention, 8, 205–225.PubMedGoogle Scholar
  14. Doll, L. S., Petersen, L. R., White, C. R., Johnson, E. S., Ward, J. W., and the Blood Donor Study Group (1992). Homosexually and nonhomosexually identified men who have sex with men: A behavioral comparison. Journal of Sex Research, 29, 1–14.CrossRefGoogle Scholar
  15. Fernandez, M. I., Bowen, G. S., Perrino, T., Royal, S., Mattson, T., Arheart, K. L. et al. (2003). Promoting HIV testing among never-tested Hispanic men: A doctor’s recommendation may suffice. AIDS and Behavior, 7, 253–262.PubMedCrossRefGoogle Scholar
  16. Gerbert, B., Maguire, B. T., and Coates, T. J. (1990). Are patients talking to their physicians about AIDS? American Journal of Public Health, 80, 467–468.PubMedGoogle Scholar
  17. Goldbaum G., Perdue, T., Wolitski, R., Rietmeijer, C., Hedrich, A., and Wood, R. et al. (1998). Differences in risk behavior and sources of AIDS information among gay, bisexual, and straight-identified men who have sex with men. AIDS and Behavior, 2, 13–21.CrossRefGoogle Scholar
  18. Huebner, D. M., Davis, M. C., Nemeroff, C. J., and Aiken, L. S. (2002). The impact of internalized homophobia on HIV prevention interventions. American Journal of Community Psychology, 30, 327–348.PubMedCrossRefGoogle Scholar
  19. Jones, K. T., Wolitski, R. J., Wasserman, J. L., and Smith, J. (2005, June). Is HIV prevention reaching men on the down low? Results from 12 US cities. Paper presented at the 2005 National HIV Prevention Conference, Atlanta, GA.Google Scholar
  20. Kay, L. S., Lyles, C. M., Crepaz, N., Herbst, J. H., Britton, J., and the HIV/AIDS Prevention Research Synthesis Team. (2005, June). Evidence-based interventions: Results from a systematic review of HIV prevention interventions for high-risk populations. Paper presented at the 2005 National HIV Prevention Conference, Atlanta, GA.Google Scholar
  21. Kennamer, J. D., Honnold, J., Bradford, J., and Hendricks, M. (2000). Differences in disclosure of sexuality among African American and White gay/bisexual men: implications for HIV/AIDS prevention. AIDS Education and Prevention, 12, 519–531.PubMedGoogle Scholar
  22. King, J. L. (2004). On the down low: A journey into the lives of “straight” black men who sleep with men. New York: Broadway Books.Google Scholar
  23. Malebranche, D. J. (2003). Black men who have sex with men and the HIV epidemic: Next steps for public health. American Journal of Public Health, 93, 862–865.PubMedGoogle Scholar
  24. Margolis, A. D., Wolitski, R. J., Parsons, J. T., and Gomez, C. A. (2001). Are healthcare providers talking to HIV-seropositive patients about safer sex?. AIDS, 15, 2335–2337.PubMedCrossRefGoogle Scholar
  25. Marks, G., Richardson, J. L., Crepaz, N., Stoyanoff, S., Milam, J., Kemper, C. et al. (2002). Are HIV care providers talking with patients about safer sex and disclosure? A multi-clinic assessment. AIDS, 16, 1953–1957.PubMedCrossRefGoogle Scholar
  26. Mays, V. M., Cochran, S. D., and Zamudio, A. (2004). HIV prevention research: Are we meeting the needs of African American men who have sex with men? Journal of Black Psychology, 30, 78–105.CrossRefPubMedGoogle Scholar
  27. McKirnan, D. J., Doll, L., and Burzette, R. G. (1995). Bisexual active men: Social characteristics and sexual behavior. Journal of Sex Research, 32, 65–76.Google Scholar
  28. Metsch, L. R., Pereyra, M., del Rio, C., Gardner, L., Duffus, W. A., Dickinson, G. et al. (2004). Delivery of HIV prevention counseling by physicians at HIV medical care settings in 4 US cities. American Journal of Public Health, 94, 1186–1192.PubMedCrossRefGoogle Scholar
  29. Millett, G., Malebranche, D., Mason, B., and Spikes, P. (2005). Focusing “down low”: Bisexual Black men, heterosexual Black women, and HIV risk. Journal of the National Medical Association, 97, S52–S59.Google Scholar
  30. Montgomery, J. P. (2003). The extent of bisexual behaviour in HIV-infected men and implications for transmission to their female sex partners. AIDS Care, 15, 829–837.PubMedCrossRefGoogle Scholar
  31. Paz-Bailey, G., Meyers, A., Blank S., Brown, J., Rubin, S. et al. (2004). A case-control study of syphilis among men who have sex with men in New York City: Association with HIV infection. Sexually Transmitted Diseases, 31, 581–587.PubMedCrossRefGoogle Scholar
  32. Prabhu, R., Owen, C. L., Folger, K., and McFarland, W. (2004). The bisexual bridge revisited: Sexual risk behavior among men who have sex with men and women, San Francisco, 1998-2003. AIDS, 18, 1604–1606.PubMedCrossRefGoogle Scholar
  33. Richardson, J. L., Milam, J., McCutchan, A., Stoyanoff, S., Bolan, R., Weiss, J. et al. (2004). Effect of brief safer-sex counseling by medical providers to HIV-1 seropositive patients: a multi-clinic assessment. AIDS, 18, 1179–1186.PubMedCrossRefGoogle Scholar
  34. Rietmeijer, C. A., Wolitski, R. J., Fishbein, M., Corby, N. H., and Cohn, D. L. (1998). Sex hustling, injection drug use, and non-gay identification by men who have sex with men: Associations with high-risk sexual behaviors and condom use. Sexually Transmitted Diseases, 25, 353–360.PubMedCrossRefGoogle Scholar
  35. Ross, M. W., Essien, E. J., Williams, M. L., and Frenandez-Esquer, M. E. (2003). Concordance between sexual behavior and sexual identity in street outreach samples of four racial/ethnic groups. Sexually Transmitted Diseases, 30, 110–113.PubMedCrossRefGoogle Scholar
  36. Shidlo, A. (1994). Internalized homophobia: Conceptual and empirical issues in measurement, research, and clinical applications. In Herek, G. M. (Ed.), Lesbian and Gay Psychology: Theory, Research, and Clinical Applications., Thousands Oaks: Sage Publications, pp. 176–205.Google Scholar
  37. Sternberg, S. (2001, March 15). The danger of living ’down low’: Black men who hide their bisexuality can put women at risk. USA Today.Google Scholar
  38. Stokes, J. P., and Peterson, J. L. (1998). Homophobia, self-esteem, and risk for HIV among African American men who have sex with men. AIDS Education and Prevention, 10, 278–292.PubMedGoogle Scholar
  39. Thompson, M. (2005). Studying the potential of Tenofovir to prevent sexual transmission of HIV: First steps. AIDS Patient Care and STDs, 19, 1–4.PubMedCrossRefGoogle Scholar
  40. U.S. Preventive Services Task Force (1996). Guide to Clinical Preventive Services: Second Edition. Rockville: Agency for Healthcare Research and Quality.Google Scholar
  41. Wenrich, M. D., Carline, J. D., Curtis, J. R., Paauw, D. S., and Ramsey, P. G. (1996). Patient report of HIV risk screening by primary care physicians. American Journal of Preventive Medicine, 12, 116–122.PubMedGoogle Scholar
  42. Wolitski, R. J., Rietmeijer, C., Goldbaum, G., and the AIDS Community Demonstration Projects (1996, July). Men’s disclosure of HIV risk to their female sex partners. Poster presented at the XI International Conference on AIDS in Vancouver, British Columbia.Google Scholar
  43. Wolitski, R. J., Parsons, J. T., and Gomez, C. A. (2004). Prevention with HIV-seropositive gay and bisexual men: Lessons learned from the Seropositive Urban Men’s Study (SUMS) and the Seropositive Urban Men’s Intervention Trial (SUMIT). Journal of Acquired Immunodeficiency Syndromes, 37(Suppl 1), S101–S109.CrossRefGoogle Scholar
  44. Wolitski, R. J., Parsons, J. T., Gomez, C. A., Purcell, D. W., Hoff, C. C., Halkitis, P. N. et al. (2005). Prevention with gay and bisexual men living with HIV: Rationale and methods of the Seropositive Urban Men’s Intervention Trial (SUMIT). AIDS, 19(Suppl 1), S1–S11.PubMedCrossRefGoogle Scholar
  45. Wolitski, R. J., Wasserman, J. L., Jones, K. T., and Jenkins, J. (2005, June). Down-low identity among at-risk men who have sex with men (MSM) from 12 US cities. Paper presented at the National HIV Prevention Conference, Atlanta, GA.Google Scholar
  46. Young, R. M., and Meyer, I. H. (2005). The trouble with “MSM” and “WSW”: Erasure of the sexual-minority person in public health discourse. American Journal of Public Health, 95, 1144–1149.PubMedCrossRefGoogle Scholar
  47. Zea, M. C., Reisen, C. A., and Diaz, R. M. (2003). Methodological issues in research on sexual behavior with Latino gay and bisexual men. American Journal of Community Psychology, 31, 281–291.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, Inc. 2006

Authors and Affiliations

  • Richard J. Wolitski
    • 1
  • Kenneth T. Jones
    • 1
  • Jill L. Wasserman
    • 1
  • Jennifer C. Smith
    • 2
  1. 1.Division of HIV/AIDS PreventionNational Center for HIV, STD, and TB Prevention, Centers for Disease Control and PreventionAtlantaUSA
  2. 2.The Ginn GroupAtlantaUSA

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