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83
Men on the ‘Down Low’: More Questions than Answers
Greg Millett
CDC, Atlanta, GA, USA
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Background: Men “on the ‘down low,’” a subgroup of
bisexually active black men has become a focal point of interest in the HIV prevention
community in the past several years. One of the primary reasons for this is the
question of whether men on the down low function as an HIV transmission bridge
to the heterosexual population.
Methods: There are
several popular characterizations of men on the down low, some of which may have a basis in truth, while others
have no empirical foundation. These include: hypermasculinity that masks any suspicion of homosexual behavior; a man
with a steady female partner who will sleep with, but not date, other men; a
disdain for being labeled “gay” or “bisexual” and a distancing from the
primarily white mainstream gay subculture; someone who has unprotected sex with
both female and male sex partners; and someone who has either not been tested
for HIV, or who has been tested but does not disclose his HIV status to his
sexual partners.
Results: While
men on the down low are an emerging topic of public discourse and speculation,
no scientific data have been published on this specific population. However,
several studies of heterosexually or bisexually identified black men who have
sex with men (MSM) indicate that there is a complex interplay of sexual identity, orientation, and
behavior that merits further study.
Conclusions: Both
qualitative and quantitative studies should be undertaken specifically to examine the HIV behavioral risks of men of
color on the down low. Future research should
standardize what characterizes the down low, examine the sexual networks of men
on the down low, and determine the role
of such HIV-positive men in ongoing HIV transmission.
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