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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 bisexual men.

 

"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 York.

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