Groundbreaking HIV/AIDS study investigates dangers of "down low" label

PHILADELPHIA – Researchers at Public Health Management Corporation published a study in the American Journal of Public Health showing that black men who have sex with men and women and identify themselves as on the "down low" engage in the same level of risk with women as behaviorally bisexual men who do not identify themselves as "down low."
PHMC senior researcher Dr. Lisa Bond explains, "The findings of our research underscore the importance of focusing on behavior and not subjective labels like 'down low.'" Bond explains,
"Our research shows that not all bisexually active men who refer to themselves as 'DL' are having sex with women, while a significant number of bisexually active men who do not call themselves 'DL' are having sex with women."
Funded by the Centers for Disease Control and Prevention, the PHMC study is the largest of its kind to investigate the link between the DL and HIV infection. Based on interviews with over 1,100 Black gay, bisexual and straight-identified MSM, the study focuses on residents from Philadelphia and New York City, including 361 men who considered themselves DL.
According to Dr. Darrell Wheeler, an Associate Dean and Professor at the Hunter College School of Social Work in New York and one of the lead investigators of this study, "Men on the down low have been characterized by the media as black men who are pretending to be straight, while secretly engaging in sex with men and possibly spreading HIV to unsuspecting female partners. This is an oversimplification of a socially constructed label that does not have a singular meaning."
The DL means different things to different people. "We found that many of the men who called themselves down low were not sexually active with women, very few said that they were straight or heterosexual, and many did not equate the DL with having a wife or girlfriend," Wheeler explained. Results of this study found that 54 percent of the men who called themselves down low reported no sex with a female in the three months prior to being interviewed, and the majority identified as bisexual (56 percent) or homosexual (28 percent), not heterosexual.
Since 2005, PHMC has been collaborating with the CDC, Hunter College School of Social Work and the NYC Department of Health and Mental Hygiene to investigate the factors contributing to the alarming rates of HIV infection among black MSM. Current estimates in the United States indicate that up to 50 percent of urban black MSM are infected with HIV today. PHMC's research conclusively shows that bisexually active men who identify as DL are not at higher risk of spreading HIV to their female partners than bisexually active men who do not identify as DL.
However, the research does not show that women who have sex with men on the DL are not at risk for contracting HIV. "What our research shows is that unsafe sex between behaviorally bisexual men and their female partners is fairly high, but this is true irrespective of whether the men identify with the DL," Wheeler said. Findings from this study indicate that nearly 60 percent of the men in this study who were bisexually active had engaged in unprotected sex with a woman in the three months prior to interview.
According to PHMC research associate Lee Carson, a black gay activist in Philadelphia, social worker and co-author of PHMC's research study, it is time to shift focus away from the down low. "The more we spend time talking about the DL, the more we continue to demonize black male sexuality and shift focus away from some of the real culprits in this epidemic, like homophobia," Carson explained. "Homophobia from family members, peers and faith community create and perpetuate social stigma that keeps some men trapped into secrecy for fear of losing everything that keeps them grounded as black men."
While black MSM continue to be disproportionately affected by HIV, this study shows that future HIV prevention programs and research should focus more on HIV risk-behaviors rather than societal perceptions of black men who identify as DL.
"If we want to have a constructive dialogue about the potential transmission bridge between black bisexually active men and heterosexual women, we need to start talking in a meaningful way about bisexuality and bisexual behavior, not the DL," says Bond. "At a time when nearly half of all Black men who have sex with men living in major U.S. cities are already infected with HIV, there is simply no more time to waste on finger-pointing and blaming."