Archives of Sexual Behavior

, Volume 37, Issue 5, pp 683–696 | Cite as

Beyond the Down Low: Sexual Risk, Protection, and Disclosure Among At-Risk Black Men Who Have Sex with Both Men and Women (MSMW)

  • Brian DodgeEmail author
  • William L. JeffriesIV
  • Theo G. M. Sandfort


Little information is available about sexual risk, protective, and disclosure practices among Black bisexually active men and how these may be amenable to intervention when necessary. In-depth interviews were conducted with 30 at-risk urban Black men who have sex with both men and women (MSMW). Participants reported protecting themselves and their partners through routine HIV testing, using condoms consistently, engaging in strategic positioning during sexual activity, and limiting the number of sexual partners. In addition, they described several reasons for not using protection, including not having condoms available, enjoying sexual activity more without condoms, and perceiving female partners to be “safer” than male partners. Disclosure of bisexuality was complex and reportedly difficult, in particular to female and gay-identified male partners. Future interventions must not only build protection and disclosure skills among MSMW, but also increase broader social awareness and acceptance of male bisexuality.


Bisexuality MSMW African-American Black HIV/AIDS 



We sincerely thank the bisexual men who participated in our study. This research project was supported by the HIV Center Pilot Studies Program Award to the first author from the HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute and Columbia University (P30 MH43520, Anke A. Ehrhardt, Ph.D., Principal Investigator). In addition, during the conduct of the study, the first author acknowledges support in the form of the Behavioral Sciences Research Training in HIV Infection postdoctoral fellowship (NRSA T32 MH19139, Anke A. Ehrhardt, Ph.D., Program Director). Last, we express our deepest appreciation to Toby Anekwe, M.P.H., and Ms. Leslie Campbell for their invaluable assistance with the recruitment of participants.


  1. Adimora, A. A., & Schoenbach, V. J. (2003). Contextual factors and the black-white disparity in heterosexual HIV transmission. Epidemiology, 13, 707–712.CrossRefGoogle Scholar
  2. Aggleton, P. (Ed.). (1996). Bisexualities and AIDS: International perspectives. Bristol, PA: Taylor.Google Scholar
  3. Amaro, H. (1995). Love, sex, and power: Considering women’s realities in HIV prevention. American Psychologist, 50, 437–447.PubMedCrossRefGoogle Scholar
  4. Ballard, S. (2001, July 23). Why AIDS is rising in Black women. Jet, pp. 22–28.Google Scholar
  5. Bleich, S., & Taylor-Clark, K. (2005). Black men on the down low and the HIV epidemic: The need for research and intervention strategies. Harvard Journal of African American Public Policy, 11, 13–20.Google Scholar
  6. Browder, B. S., & Hunter, K. (2005). On the up and up: A survival guide for women living with men on the down low. New York: Dafina Books.Google Scholar
  7. Brooks, R., Rotheram-Borus, M. J., Bing, E. C., Ayala, G., & Henry, C. L. (2003). HIV and AIDS among men of color who have sex with men and men of color who have sex with men and women: An epidemiological profile. AIDS Education and Prevention, 15(Suppl. A), 1–6.PubMedCrossRefGoogle Scholar
  8. Centers for Disease Control and Prevention. (2003). HIV/STD risks in young men who have sex with men who do not disclose their sexual orientation—six U.S. cities, 1994–2000. Morbidity and Mortality Weekly Report, 52(5), 81–85.Google Scholar
  9. Chu, S. Y., Peterman, T. A., Doll, L. S., Buehler, J. W., & Curran. J. W. (1992). AIDS in bisexual men in the United States: Epidemiology and transmission to women. American Journal of Public Health, 82, 220–224.PubMedCrossRefGoogle Scholar
  10. Creswell, J. W. (2003). Research design: Qualitative, quantitative, and mixed methods approaches (2nd ed.). Thousand Oaks, CA: Sage Publications.Google Scholar
  11. Crosby, R. A., Sanders, S. A., Yarber, W. L., Graham, C. A., & Dodge, B. (2002). Condom use errors and problems among college men. Sexually Transmitted Diseases, 29, 552–557.PubMedCrossRefGoogle Scholar
  12. Denizet-Lewis, B. (2003, August 3). Down low: Double lives, AIDS, and the Black homosexual underground. New York Times Magazine, pp. 8–53.Google Scholar
  13. Doll, L. S., & Beeker, C. (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., Myers, T., Kennedy, M., & Allman, D. (1997). Bisexuality and HIV risk: Experiences in Canada and the United States. Annual Review of Sex Research, 8, 102–147.PubMedGoogle Scholar
  15. Doll, L. S., Petersen, L. R., White, C. R, Johnson, E. S., Ward, J. W., & 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.Google Scholar
  16. Ekstrand, M. L., Coates, T. J., Guydish, J. R., Hauck, W. W., Collette, L., & Hulley, S. B. (1994). Are bisexually identified men in San Francisco a common vector for spreading HIV infection to women. American Journal of Public Health, 84, 915–919.PubMedGoogle Scholar
  17. Goldbaum, G., Perdue, T., Wolitski, R., Rietmeijer, C., Hedrich, A., 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 & Behavior, 2, 13–21.CrossRefGoogle Scholar
  18. Goodenow, C., Netherland, J., & Szalacha, L. (2002). AIDS-related risk among adolescent males who have sex with males, females, or both: Evidence from a statewide study. American Journal of Public Health, 92, 203–210.PubMedGoogle Scholar
  19. Halkitis, P. N., Green, K. A., & Wilton, L. (2004). Masculinity, body image, and sexual behavior in HIV-seropositive gay men: A two-phase formative behavioral investigation using the Internet. International Journal of Men’s Health, 3, 27–42.CrossRefGoogle Scholar
  20. Heckman, T. G., Kelly, J. A., Sikkema, K. J., Roffman, R. R., Solomon, L. J., Winett, R. A., et al. (1995). Differences in HIV risk between bisexual and exclusively gay men. AIDS Education and Prevention, 7, 504–512.PubMedGoogle Scholar
  21. Kahn, J. G., Gurvey, J., Pollack, L. M., Binson, D., & Catania, J. A. (1997). How many HIV infections cross the bisexual bridge?: An estimate from the United States. AIDS, 11, 1031–1037.PubMedCrossRefGoogle Scholar
  22. Kalichman, S. C., Roffman, R. A., Picciano, J. F., & Bolan, M. (1998). Risk for HIV infection among bisexual men seeking HIV-prevention services and risks posed to their female partners. Health Psychology, 17, 320–327.PubMedCrossRefGoogle Scholar
  23. Kennedy, M., & Doll, L. S. (2001). Male bisexuality and HIV risk. Journal of Bisexuality, 1(2/3), 109–135.Google Scholar
  24. Kennamer, J. D., Honnold, J., Bradford, J., & Hendricks, M. (2000). Differences in the disclosure of sexuality among African American and White gay/bisexual men: Implications for HIV/AIDS prevention. AIDS Education & Behavior, 12, 519–531.Google Scholar
  25. 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
  26. King, J. L., & Carreras, C. (2005). Coming up from the down low: The journey to acceptance, healing, and honest love. New York: Three Rivers Press.Google Scholar
  27. Korte, J. E., Shain, R. N., Holden, A. E. C., Piper, J. M., Perdue, S. T., Champion, J. D., et al. (2004). Reduction in sexual risk behaviors and infection rates among African Americans and Mexican Americans. Sexually Transmitted Diseases, 31, 166–173.PubMedCrossRefGoogle Scholar
  28. Laumann, E. O., & Youm, Y. (2001). Racial/ethnic group differences in the prevalence of sexually transmitted diseases in the United States: A network explanation. In E. O. Laumann & R. T. Michael (Eds.), Sex, love, and health in America: Private choices and public policies (pp. 127–151). Chicago: University of Chicago Press.Google Scholar
  29. Leaver, C. A., Allman, D., Myers, T., & Veugelers, P. J. (2004). Effectiveness of HIV prevention in Ontario, Canada: A multilevel comparison of bisexual men. American Journal of Public Health, 94, 1181–1185.PubMedGoogle Scholar
  30. Lever, J., Kanouse, D. E., Rogers, W. H., Carson, S., & Hertz, R. (1992). Behavior patterns and sexual identity of bisexual males. Journal of Sex Research, 29, 141–167.CrossRefGoogle Scholar
  31. Malebranche, D. (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
  32. Mao, L., Crawford, J. M., Hospers, H. J., Prestage, G. P., Grulich, A. E., Kaldor, J. M., & Kippax, S. C. (2006). ‘Serosorting’ in casual anal sex of HIV-negative gay men is noteworthy and is increasing in Sydney, Australia. AIDS, 20, 1204–1206.PubMedCrossRefGoogle Scholar
  33. Marshall, C., & Rossman, G. (1995). Designing qualitative research (2nd ed.). Thousand Oaks, CA: Sage Publications.Google Scholar
  34. Martinez, J., & Hosek, S. G. (2005). An exploration of down-low identity: Nongay-identified young African-American men who have sex with men. Journal of the National Medical Association, 97, 1103–1112.PubMedGoogle Scholar
  35. Mays, V. M., Cochran, S. D., & 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
  36. McKirnan, D. J., Stokes, J. P., Doll, L. S., & Burzette, R. G. (1995). Bisexually active men: Social characteristics and sexual behavior. Journal of Sex Research, 32, 65–76.Google Scholar
  37. Millett, G., Malebranche, D., Mason, B., & Spikes, P. (2005). Focusing “down low”: Bisexual black men, HIV risk and heterosexual transmission. Journal of the National Medical Association, 97(Suppl. 7), 52S–59S.PubMedGoogle Scholar
  38. Montgomery, J. P., Mokotoff, E. D., Gentry, A. C., & Blair, J. M. (2003). The extent of bisexual behaviour in HIV-infected men and implications for transmission to their female partners. AIDS Care, 15, 829–837.PubMedCrossRefGoogle Scholar
  39. Muñoz-Laboy, M. A. (2004). Beyond MSM: Sexual desire among bisexually-active Latino men in New York City. Sexualities, 7, 55–80.CrossRefGoogle Scholar
  40. Muñoz-Laboy M. A., & Dodge, B. (2005). Bisexual practices: Patterns, meanings, and implications for HIV/STI prevention among bisexually active Latino men and their partners. Journal of Bisexuality, 5, 81–100.CrossRefGoogle Scholar
  41. Muñoz-Laboy, M. A., & Dodge, B. (2007). Bisexual Latino men and HIV and sexually transmitted infections risk: An exploratory analysis. American Journal of Public Health, 97, 1102–1106.PubMedCrossRefGoogle Scholar
  42. Peterson, J. L., Coates, T. J., Catania, J. A., Middleton, L., Hilliard, B., & Hearst, N. (1992). High-risk sexual behavior and condom use among gay and bisexual African-American men. American Journal of Public Health, 82, 1490–1494.PubMedGoogle Scholar
  43. Prabhu, R. A., Owen, C. L., Folger, K. B., & McFarland, W. A. (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
  44. Reece, M., & Dodge, B. (2003). Exploring the physical, mental and social well-being of gay and bisexual men who cruise for sex on a college campus. Journal of Homosexuality, 46(1/2), 111–126.PubMedCrossRefGoogle Scholar
  45. Rhodes, T., & Cusick, L. (2000). Love and intimacy in relationship risk management: HIV positive people and their sexual partners. Sociology of Health & Illness, 22, 1–26.CrossRefGoogle Scholar
  46. Sandfort, T. G. M., Dodge, B., Fontaine, Y. M., Udoh, I., & Jeffries, W. L. (2007). Black bisexual men’s sexual self-identifications and their perceptions of the down low. Unpublished manuscript, New York State Psychiatric Institute.Google Scholar
  47. Shidlo, A., Yi, H., & Dalit, B. (2005). Attitudes toward unprotected anal intercourse: Assessing HIV-negative gay or bisexual men. Journal of Gay and Lesbian Psychotherapy, 9(3/4), 107–128.CrossRefGoogle Scholar
  48. Sikkema, K. J., Koob, J. J., Cargill, V. C., Kelly, J. A., Desiderato, L. L., Roffman, R. A., et al. (1995). Levels and predictors of HIV risk behavior among women in low-income public housing developments. Public Health Reports, 110, 707–713.PubMedGoogle Scholar
  49. Stokes, J. P., McKirnan, D. J., & Burzette, R. G. (1993). Sexual behavior, condom use, disclosure of sexuality, and stability of sexual orientation in bisexual men. Journal of Sex Research, 30, 201–213.Google Scholar
  50. Stokes, J. P., McKirnan, D. J., Doll, L. S., & Burzette, R. G. (1996). Female partners of bisexual men: What they don’t know might hurt them. Psychology of Women Quarterly, 20, 267–284.CrossRefGoogle Scholar
  51. Stokes, J. P., Vanable, P., & McKirnan, D. J. (1997). Comparing gay and bisexual men on sexual behavior, condom use, and psychosocial variables related to HIV/AIDS. Archives of Sexual Behavior, 26, 383–397.PubMedCrossRefGoogle Scholar
  52. Tielman, R. A. P., Carballo, M., & Hendriks, A. C. (Eds.). (1991). Bisexuality and HIV/AIDS: A global perspective. Buffalo, NY: Prometheus Books.Google Scholar
  53. Venable, M. (2001). A question of identity. Vibe 9(7), 98–106.Google Scholar
  54. Weatherburn, P., Hickson, F., Reid, D. S., Davies, P. M., & Crosier, A. (1998). Sexual HIV risk behaviour among men who have sex with men and women. AIDS Care, 10, 463–471.PubMedCrossRefGoogle Scholar
  55. Wold, C., Seage, G. R., Lenderking, W. R., Mayer, K. H., Cai, B., Heeren, T., et al. (1998). Unsafe sex in men who have sex with both men and women. Journal of Acquired Immune Deficiency Syndrome & Human Retrovirolology, 17, 361–367.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • Brian Dodge
    • 1
    Email author
  • William L. JeffriesIV
    • 2
  • Theo G. M. Sandfort
    • 3
  1. 1.Center for Sexual Health Promotion, Department of Applied Health ScienceIndiana UniversityBloomingtonUSA
  2. 2.Department of SociologyUniversity of FloridaGainesvilleUSA
  3. 3.HIV Center for Clinical and Behavioral StudiesNew York State Psychiatric Institute/Columbia UniversityNew YorkUSA

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