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HIV's Bisexual Bridge to Women

Risk Posed By 'Down Low' Men Still Unknown
WebMD Health News

July 13, 2004 -- Men who have sex with men and women are a "significant bridge for HIV to women," the CDC's new data suggest.

The findings come in a presentation to the XV International AIDS Conference in Bangkok by CDC researcher Linda Valleroy, PhD. The CDC's Young Men's Survey shows that about one in 10 men reporting sex with men also has sex with women. And more than one in four of these bisexual men has unsafe sex with both kinds of partners.


"Men who also had sex with women had similar levels of HIV and STDs [as exclusively homosexual men] and higher levels of many risk behaviors," Valleroy and colleagues note in their presentation abstract.


Another study presented at the AIDS conference -- based on interviews with nearly 2,500 bisexual men by the San Francisco Department of Health -- shows that 14% of men who have sex with men also has sex with women. But the study, led by Willi McFarland, MD, PhD, suggests that these men may have fewer risk behaviors than exclusively homosexual men.



"In San Francisco a few years back, we detected this rise in risk behavior in men who have sex with men," McFarland tells WebMD. "That raises the question of whether this will spill over into the general population, with the bridge being men who have sex with men and women. Despite dire predictions, San Francisco does not have a large heterosexual HIV epidemic."


What's going on? The reality is that nobody really knows.

The Down Low: Not Just Black Men

Black men call it the DL: the down low. Fearing loss of community support, men living this lifestyle keep their bisexuality -- and their sexual relationships with other men -- secret from their female partners.


Whether they call it the DL or not, many white and Latino men also keep their sexual affairs with men secret from their female sex partners.


"Most people believe this is only something happening with black men," CDC scientist Greg Millet, MPH, tells WebMD. "We see it in Latino and white men, too. They say they are heterosexual but report sex with other men in the last three months, in the last year, in the last five years. Sexual identity is not destiny."

John Peterson, PhD, professor of psychology at Atlanta's Georgia State University, has studied the issue for a long time.


"The DL is a new name for an old issue," Peterson tells WebMD. "Bisexual men not telling their female partners about their male relationships takes place across all races and ethnicities. But what we really don't know is how these men behave when they have primary male or female partners."


Sex, Risky Sex, and Very Risky Sex

What is known about bisexual men suggests that those who have long-term relationships with women may have different HIV risks than those who do not.

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