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.
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References
Boykin, K. (2005). Beyond The Down Low: Sex, Lies, and Denial in Black America. New York: Carroll and Graf.
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.
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.
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.
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.
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.
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.
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.
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.
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.
Denizet-Lewis, B. (2003, August 3). Double Lives on the Down Low. The New York Times Magazine, pp. 6.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
Sternberg, S. (2001, March 15). The danger of living ’down low’: Black men who hide their bisexuality can put women at risk. USA Today.
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.
Thompson, M. (2005). Studying the potential of Tenofovir to prevent sexual transmission of HIV: First steps. AIDS Patient Care and STDs, 19, 1–4.
U.S. Preventive Services Task Force (1996). Guide to Clinical Preventive Services: Second Edition. Rockville: Agency for Healthcare Research and Quality.
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.
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.
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.
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.
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.
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.
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.
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.
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Wolitski, R.J., Jones, K.T., Wasserman, J.L. et al. Self-Identification as “Down Low” Among Men Who Have Sex with Men (MSM) from 12 US Cities. AIDS Behav 10, 519–529 (2006). https://doi.org/10.1007/s10461-006-9095-5
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DOI: https://doi.org/10.1007/s10461-006-9095-5