The Hidden Epidemic

July 9, 2001 -- America has a new AIDS demon, but it's understanding, not exorcism, that's needed.

They are men on the down-low, or DL -- bisexual black men whose sexuality is kept secret. And it can be a deadly secret. The latest CDC figures show that the AIDS virus infects nearly a third of young, urban, black men who have sex with other men. But it's not that they can't get the safe-sex message. The safe-sex message is not getting to them.

That's the view of Jamal Bey, manger of the Black Brothers Esteem project of the San Francisco AIDS Foundation, which offers support and education to gay and bisexual black men.

"Down low means under the radar screen; it means not on the surface -- so the fact that you have to go down low to find some kind of connection that you can't find in your day-to-day life speaks for itself," Bey tells WebMD. "The debate about men on the DL is creating even more of a wedge of homophobia between these men and their community."

A Vicious Cycle

Homophobia is the fear that underlies discrimination against homosexual men and women. How could homophobia be to blame for the way a man chooses to lead his sex life? Actually, it's at the heart of the issue, says Georgia State University psychologist John Peterson, PhD.

"African-American men can engage in same-sex behavior as long as they remain closeted," says Peterson, who has conducted extensive studies on the AIDS-related attitudes and behaviors of gay and bisexual black Americans.

"These men feel they must remain a part of the African American community but face stigma if they come out. So they continue to feel negatively about themselves regarding this part of their life. This constant anti-gay sentiment -- without any alternative to live out their lives in another community -- creates enormous self-denigration and poor self-esteem. This is very different from what white men experience," he says.

Community support is vital to an African-American man's sense of identity, Peterson says. But gay and bisexual black men are caught on the horns of a dilemma -- they risk losing that vital community support if they reveal their sexual identity. Peterson stresses that there is no more homophobia among black Americans than among white Americans, but his studies show that black men suffer far more from this loss of community than do their white counterparts.

"So these men really have these very poor feelings about themselves because their community will not accept that part of them," he says. "This leads to the likelihood that if they need support around HIV they will not receive it from the very community they want to remain a part of. That leads to the likelihood they will not receive a proper HIV message. It leads them to feel further denigrated and alienated from the community and leaves it more likely that they will engage in high-risk behavior."