June 15, 2005 -- Media attention has recently lighted on men who have sex with other men "on the down low" (without telling their primary female partner about it). Now, researchers say the reality doesn't always match the stereotypes.
Mainstream coverage of down low, or DL, behavior has often featured the black community. For instance, author J.L. King's 2004 book On the Down Low: A Journey Into the Lives of "Straight" Black Men Who Sleep With Men hit The New York Times' best-seller list and was featured on Oprah Winfrey's TV talk show.
But the DL also exists in other communities, as CDC researchers told the 2005 National HIV Prevention Conference in Atlanta.
More than a million people in the U.S. are living with HIV, according to another report presented at the conference. Nearly half (47%) are black, 34% are white, and 17% are Hispanic. Men account for about three-quarters of HIV cases. By risk group, men who have sex with men represent the largest population living with HIV (45%) followed by high-risk heterosexual contact (27%).
New HIV infections are rising among blacks, women, and people who get the virus through heterosexual contact, says the report.
"As a society, we need to challenge our assumptions about why African-Americans, men who have sex with men, and other populations are at high risk for HIV," says Phil Wilson, executive director of the Black AIDS Institute, in a news release.
"Broad labels like 'down low' and misdirected attention on small subsets of the population do little to advance HIV prevention," he continues. "Instead, we need to focus on reducing specific behaviors that place both men and women at continued risk."
Down Low Data
The CDC's R.J. Wolitski and colleagues studied 455 men from 12 cities. All of the men said they had sex with other men and had had unprotected anal sex within the last year. The men also said they were HIV-negative or had not been tested for HIV.
First, the men were asked if they knew what "DL" meant and if it described them. Almost three-fourths knew the term; of those men, more than a quarter (28%) said they were on the down low.
Analyses showed that the study's black men were most likely to identify with the term, followed by Hispanics and whites. Men who called themselves gay were less likely to be on the DL than those who did not describe themselves as gay.
Men who have sex with men on the DL are a "significant minority" of at-risk men who have sex with men, especially among blacks and Hispanics, say the researchers.
Many of the men were at considerable risk for contracting and spreading HIV, whether or not they were on the DL, say the researchers. They call for HIV prevention programs aimed specifically at men on the DL.
Two-thirds of the men said they had had unprotected anal sex with either a male or female partner. Those numbers were similar for men on the DL and those not on the DL. However, men on the DL were more likely to have had unprotected anal sex without knowing their partner's HIV status.
Men on the DL were also more likely to have had female sex partners and to have had vaginal sex. Most of the 49 men reporting vaginal sex said they didn't always use a condom.
Only 18 men said a woman was their main sex partner. Most (12 out of 18) said that woman did not know that they were having sex with other men.