Researchers from the Public Health Management Corporation recently completed a study that found that men who identify as “down low” do not pose any higher risk of spreading HIV to female partners than openly bisexual men.
The study, published in this month’s issue of the American Journal of Public Health, was created to assess the sexual practices of African-American men who identify with the down low — commonly thought of as those who engage in sex with other men without their female partners’ knowledge — and if this practice affects the high rates of HIV in the black community.
“Scientifically speaking, there’s very little known about the down low,” said Dr. Lisa Bond, PHMC senior researcher. “Almost everything we know has come from personal accounts of a handful of individuals and the stories we’ve heard on TV and read about in the mainstream news. The impetus of this was to learn more about what it means to be on the DL and, in particular, whether or not being on the DL is associated with engaging in a greater risk for HIV transmission.”
The study, funded by the Centers for Disease Control, included interviews with more than 1,100 gay, bisexual and heterosexual-identified men of color who have sex with men — 361 of whom identify as DL — in the Philadelphia and New York City areas. Bond said researchers recruited participants through respondent-driving sampling, in which each interviewee was asked to refer several other men for the study.
Researchers found that using the DL label did not affect the rate at which men engaged in risky sexual behavior with female partners: Although more DL than other men in the study reported having sex with a woman in the three months prior to the interview, some 60 percent of both groups of men who had engaged in sexual contact with a female did so without protection.
“The overall rate of unsafe sex between bisexual men and females was the same whether or not the men were on the DL,” Bond said.
About 43.7 percent of DL men in the study tested positive for HIV, while 56.3 of non-DL-identified men were infected.
Bond noted the research also revealed that the term DL may not have a universal meaning.
Nearly 56 percent of DL men identified themselves as bisexual and 28 percent reported they were homosexual. Approximately 11 percent said they were heterosexual and 5 percent reported another identity.
About 46 percent of men who identified as DL reported that they had not had sex with a woman in the previous three months, while about 23 percent of openly bisexual men had engaged in sex with a female.
The majority of men who identified with the DL fell between ages 40-49 and had a gross annual income of less than $5,000.
When asked what DL means, approximately 49 percent of DL men responded that it describes men who have wives or girlfriends, while 24 percent associated the term with very masculine men and 22.7 percent reported that it reflects men who are always the top partner or who have fewer male partners than gay men.
About 46 percent of DL men reported that keeping their sexual relations with men secret was very important; 40 percent responded that it was somewhat important; and 14 percent said it was not at all important. Only about 24 percent of men who did not identify with the DL, however, said that keeping their sexual practices with men secret was very important, while 41 percent called it somewhat important and about 38 percent reported it was not at all important.
Bond noted that popular media outlets — such as exposés on “Oprah” or in the New York Times Magazine — have presented the DL as a term that applies only to heterosexual men in committed relationships with women, but that the research shows this is not an accurate definition.
“I think that maybe where some of the misunderstanding of what DL means started, but what we found, is that’s not how the larger community of black men who have sex with men define it for themselves,” she said. “Being on the DL doesn’t always mean that you’re a heterosexual man who has a wife or a girlfriend or is sneaking around. For many gay and bisexual men, DL could just mean the desire for privacy or discretion about their sexual life and sexual relations.”
PHMC research associate Lee Carson noted that when former New Jersey governor Jim McGreevy was revealed to be having an affair with a man several years ago, he came out as a “gay man,” and the term DL never surfaced on news reports.
Carson said the term has come to apply only to the African-American community and has gained momentum as the demographics of the HIV/AIDS community have changed.
“When it comes to the black community, the DL terminology is almost ingrained,” Carson said. “The term has been part of urban vernacular for a long time. I think it became so sensationalized because people were grasping for an explanation about why there was a rise in HIV infections among African-American women.”
Although African-American women have been contracting HIV at increasingly higher rates in recent years, Bond noted that about 50 percent of men who have sex with men in urban areas also have HIV.
She said she hopes the research illustrates that HIV-prevention efforts need to be targeted toward unsafe sexual practices, no matter how the individuals identify, and that speculating about which population has fueled the HIV/AIDS crisis is inconsequential.
“The findings of our research underscore the importance of focusing on behavior and not subjective labels like ‘down low,’” she said. “I think the study really speaks to the importance of moving beyond the DL issue and stopping the finger-pointing and wasting time, when nearly one out of every two men in this population in America’s biggest cities is living with HIV. Rather than crucifying black gay and bisexual men, it’d be more productive if we spent our time demanding further action to address this crisis.”