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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...

    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.

    "What we assume is these people exist everywhere you go," Perez tells WebMD. "In all walks of society men who have sex with men are rearing children; they are weightlifting; they are tough guys."

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