HIV's Bisexual Bridge to Women
Risk Posed By 'Down Low' Men Still Unknown
Sex, Risky Sex, and Very Risky Sex continued...
"In previous studies, those with mainly female partners
engaged in far fewer sex behaviors with men than men with no female
partners," Millet says. "So we have to be careful about how we
characterize these men. The little data we have is that is not the case -- they
don't have the same risks."
Secret affairs put the unwary partner at risk of HIV and STDs.
But there are different levels of risk. Not all sex behaviors carry the same
risk of spreading HIV, says Joseph P. Stokes, PhD, professor emeritus at the
University of Illinois in Chicago. Stokes is well known for his studies of
"We found a long time ago that two-thirds of the time, the
female was not aware of the extracurricular sex the behaviorally bisexual man
was doing," Stokes tells WebMD. "But it is a stretch to say this always
puts the women at risk of HIV infection."
Stokes says not all bisexual men engage in high-risk sex with
both their male and female partners.
"We have to ask what kind of sex are these men having, or
to what risk factors are they exposing their partners?" he says. "Are
they doing unprotected anal and vaginal sex? There's little reliable
information, but I doubt that this is common. Most of these guys aren't having
receptive anal sex with a man and insertive vaginal sex with a woman. The
degree to which they engage in anal sex with men isn't known, but with a lot of
these guys, when there is anal sex, it is insertive, and probably safer than
receptive anal intercourse."
The trouble with this information is that it's not definitive.
And it's not comforting either to women or to health professionals working in
AIDS and STD prevention.
New Studies, New Ideas, New Generation
The problem is that too little is known. Men who have sex with men and women
may see themselves as bisexual, as heterosexual, or as homosexual. Black and
Latino men face particular stigma from their communities if they admit to
having sex with other men. This makes it difficult to reach them with HIV/STD
prevention messages -- and to study them.
"The perfect study would be one just done with
heterosexual-identified black men, on a large scale, where the premise is not
just HIV or STDs but black men's health in general," Millet says. "It
would look at diabetes testing and cancer: HIV would be just one component. A
study like that would be far less threatening to men not identified as gay.
There's a lot of interest in a study like this to reach non-gay men who have
sex with men."
Meanwhile, people like Raymond Perez are working with bisexual
men who don't see themselves as gay. Perez is assistant director of the
counseling and support center at the Michael Palm Center for AIDS Care in New