Search tips
Search criteria 


Logo of jnmaLink to Publisher's site
J Natl Med Assoc. 2005 July; 97(7 Suppl): 52S–59S.
PMCID: PMC2640641

Focusing "down low": bisexual black men, HIV risk and heterosexual transmission.


INTRODUCTION: Black men who have sex with men (MSM) and women but who do not identify as gay or disclose their bisexual activities to main female partners, also known as men "on the down-low," have been cited as the main reason for the increase in HIV infections in black women. METHODS: Three online databases (PsychInfo, MEDLINE and AIDSLINE) were searched for scientific articles related to men on the down-low. A total of 24 articles and two conference abstracts were selected for review. RESULTS: Data from existing studies of MSM reveal low agreement between professed sexual identity and corresponding sexual behavior among black and other MSM; show that black MSM are more likely than MSM of other racial or ethnic groups to be bisexually active or identified; and, compared with white MSM, are less likely to disclose their bisexual or homosexual activities to others. However, black MSM who do not disclose their homosexual or bisexual activities engage in a lower prevalence of HIV risks than black MSM who do disclose; and black men who are currently bisexually active account for a very small proportion of the overall population of black men (2%). CONCLUSION: The high prevalence of HIV in the black community and the greater likelihood of bisexuality among black men place heterosexual black women at risk for HIV infection. However, the contribution of high-risk heterosexual black men to the rising HIV caseload among black women has been largely ignored. Future research must evaluate the relative contributions of bisexual men and exclusively heterosexual black men to HIV cases among black women.

Full text

Full text is available as a scanned copy of the original print version. Get a printable copy (PDF file) of the complete article (1.7M), or click on a page image below to browse page by page. Links to PubMed are also available for Selected References.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • HIV incidence among young men who have sex with men--seven U.S. cities, 1994-2000. MMWR Morb Mortal Wkly Rep. 2001 Jun 1;50(21):440–444. [PubMed]
  • HIV/AIDS among racial/ethnic minority men who have sex with men--United States, 1989-1998. MMWR Morb Mortal Wkly Rep. 2000 Jan 14;49(1):4–11. [PubMed]
  • Lehner T, Chiasson MA. Seroprevalence of human immunodeficiency virus type 1 and sexual behaviors in bisexual African-American and Hispanic men visiting a sexually transmitted disease clinic in New York City. Am J Epidemiol. 1998 Feb 1;147(3):269–272. [PubMed]
  • Malebranche David J. Black men who have sex with men and the HIV epidemic: next steps for public health. Am J Public Health. 2003 Jun;93(6):862–865. [PubMed]
  • Montgomery JP, Mokotoff ED, Gentry AC, Blair JM. The extent of bisexual behaviour in HIV-infected men and implications for transmission to their female sex partners. AIDS Care. 2003 Dec;15(6):829–837. [PubMed]
  • Easterbrook PJ, Chmiel JS, Hoover DR, Saah AJ, Kaslow RA, Kingsley LA, Detels R. Racial and ethnic differences in human immunodeficiency virus type 1 (HIV-1) seroprevalence among homosexual and bisexual men. The Multicenter AIDS Cohort Study. Am J Epidemiol. 1993 Sep 15;138(6):415–429. [PubMed]
  • Kramer MA, Aral SO, Curran JW. Self-reported behavior patterns of patients attending a sexually transmitted disease clinic. Am J Public Health. 1980 Sep;70(9):997–1000. [PubMed]
  • Torian Lucia V, Makki Hadi A, Menzies Isaura B, Murrill Christopher S, Weisfuse Isaac B. HIV infection in men who have sex with men, New York City Department of Health sexually transmitted disease clinics, 1990-1999: a decade of serosurveillance finds that racial disparities and associations between HIV and gonorrhea persist. Sex Transm Dis. 2002 Feb;29(2):73–78. [PubMed]
  • Chu SY, Peterman TA, Doll LS, Buehler JW, Curran JW. AIDS in bisexual men in the United States: epidemiology and transmission to women. Am J Public Health. 1992 Feb;82(2):220–224. [PubMed]
  • Wohl Amy Rock, Johnson Denise F, Lu Sharon, Jordan Wilbert, Beall Gildon, Currier Judith, Simon Paul A. HIV risk behaviors among African American men in Los Angeles County who self-identify as heterosexual. J Acquir Immune Defic Syndr. 2002 Nov 1;31(3):354–360. [PubMed]
  • Diaz T, Chu SY, Frederick M, Hermann P, Levy A, Mokotoff E, Whyte B, Conti L, Herr M, Checko PJ, et al. Sociodemographics and HIV risk behaviors of bisexual men with AIDS: results from a multistate interview project. AIDS. 1993 Sep;7(9):1227–1232. [PubMed]
  • Foxman B, Aral SO, Holmes KK. Interrelationships among douching practices, risky sexual practices, and history of self-reported sexually transmitted diseases in an urban population. Sex Transm Dis. 1998 Feb;25(2):90–99. [PubMed]
  • Ross Michael W, Essien E James, Williams Mark L, Fernandez-Esquer Maria Eugenia. Concordance between sexual behavior and sexual identity in street outreach samples of four racial/ethnic groups. Sex Transm Dis. 2003 Feb;30(2):110–113. [PubMed]
  • Rotheram-Borus MJ, Marelich WD, Srinivasan S. HIV risk among homosexual, bisexual, and heterosexual male and female youths. Arch Sex Behav. 1999 Apr;28(2):159–177. [PubMed]
  • Crawford Isiaah, Allison Kevin W, Zamboni Brian D, Soto Tomas. The influence of dual-identity development on the psychosocial functioning of African-American gay and bisexual men. J Sex Res. 2002 Aug;39(3):179–189. [PubMed]
  • Myers Hector F, Javanbakht Marjan, Martinez Mariana, Obediah Sunil. Psychosocial predictors of risky sexual behaviors in African American men: implications for prevention. AIDS Educ Prev. 2003 Feb;15(1 Suppl A):66–79. [PubMed]
  • Turner CF, Danella RD, Rogers SM. Sexual behavior in the United States 1930-1990: trends and methodological problems. Sex Transm Dis. 1995 May-Jun;22(3):173–190. [PubMed]
  • Fay RE, Turner CF, Klassen AD, Gagnon JH. Prevalence and patterns of same-gender sexual contact among men. Science. 1989 Jan 20;243(4889):338–348. [PubMed]
  • Mercer Catherine H, Fenton Kevin A, Copas Andrew J, Wellings Kaye, Erens Bob, McManus Sally, Nanchahal Kiran, Macdowall Wendy, Johnson Anne M. Increasing prevalence of male homosexual partnerships and practices in Britain 1990-2000: evidence from national probability surveys. AIDS. 2004 Jul 2;18(10):1453–1458. [PubMed]
  • McKirnan DJ, Vanable PA, Ostrow DG, Hope B. Expectancies of sexual "escape" and sexual risk among drug and alcohol-involved gay and bisexual men. J Subst Abuse. 2001;13(1-2):137–154. [PubMed]
  • Kennamer JD, Honnold J, Bradford J, Hendricks M. Differences in disclosure of sexuality among African American and White gay/bisexual men: implications for HIV/AIDS prevention. AIDS Educ Prev. 2000 Dec;12(6):519–531. [PubMed]
  • Heckman TG, Kelly JA, Bogart LM, Kalichman SC, Rompa DJ. HIV risk differences between African-American and white men who have sex with men. J Natl Med Assoc. 1999 Feb;91(2):92–100. [PMC free article] [PubMed]
  • Ostrow DG, Whitaker RE, Frasier K, Cohen C, Wan J, Frank C, Fisher E. Racial differences in social support and mental health in men with HIV infection: a pilot study. AIDS Care. 1991;3(1):55–62. [PubMed]
  • Peterson JL, Coates TJ, Catania JA, Middleton L, Hilliard B, Hearst N. High-risk sexual behavior and condom use among gay and bisexual African-American men. Am J Public Health. 1992 Nov;82(11):1490–1494. [PubMed]
  • Kalichman SC, Roffman RA, Picciano JF, Bolan M. Risk for HIV infection among bisexual men seeking HIV-prevention services and risks posed to their female partners. Health Psychol. 1998 Jul;17(4):320–327. [PubMed]
  • Grinstead OA, Peterson JL, Faigeles B, Catania JA. Antibody testing and condom use among heterosexual African Americans at risk for HIV infection: the National AIDS Behavioral Surveys. Am J Public Health. 1997 May;87(5):857–859. [PubMed]
  • Peterson JL, Catania JA, Dolcini MM, Faigeles B. Data from the National AIDS Behavioral Surveys. III. Multiple sexual partners among blacks in high-risk cities. Fam Plann Perspect. 1993 Nov-Dec;25(6):263–267. [PubMed]
  • Cornelius LJ, Okundaye JN, Manning MC. Human immunodeficiency virus-related risk behavior among African-American females. J Natl Med Assoc. 2000 Apr;92(4):183–195. [PMC free article] [PubMed]
  • Heterosexual behaviors and factors that influence condom use among patients attending a sexually transmitted disease clinic--San Francisco. MMWR Morb Mortal Wkly Rep. 1990 Oct 5;39(39):685–689. [PubMed]
  • Buchacz K, van der Straten A, Saul J, Shiboski SC, Gomez CA, Padian N. Sociodemographic, behavioral, and clinical correlates of inconsistent condom use in HIV-serodiscordant heterosexual couples. J Acquir Immune Defic Syndr. 2001 Nov 1;28(3):289–297. [PubMed]
  • Trends in sexual risk behaviors among high school students--United States, 1991-1997. MMWR Morb Mortal Wkly Rep. 1998 Sep 18;47(36):749–752. [PubMed]
  • Santelli JS, Brener ND, Lowry R, Bhatt A, Zabin LS. Multiple sexual partners among U.S. adolescents and young adults. Fam Plann Perspect. 1998 Nov-Dec;30(6):271–275. [PubMed]
  • Norris AE, Ford K, Shyr Y, Schork MA. Heterosexual experiences and partnerships of urban, low-income African-American and Hispanic youth. J Acquir Immune Defic Syndr Hum Retrovirol. 1996 Mar 1;11(3):288–300. [PubMed]
  • Dolcini MM, Coates TJ, Catania JA, Kegeles SM, Hauck WW. Multiple sexual partners and their psychosocial correlates: the population-based AIDS in multiethnic neighborhoods (AMEN) study. Health Psychol. 1995 Jan;14(1):22–31. [PubMed]
  • Leigh BC, Temple MT, Trocki KF. The sexual behavior of US adults: results from a national survey. Am J Public Health. 1993 Oct;83(10):1400–1408. [PubMed]
  • Korte Jeffrey E, Shain Rochelle N, Holden Alan E C, Piper Jeanna M, Perdue Sondra T, Champion Jane D, Sterneckert Kyle. Reduction in sexual risk behaviors and infection rates among African Americans and Mexican Americans. Sex Transm Dis. 2004 Mar;31(3):166–173. [PubMed]
  • Adimora Adaora A, Schoenbach Victor J. Contextual factors and the black-white disparity in heterosexual HIV transmission. Epidemiology. 2002 Nov;13(6):707–712. [PubMed]
  • Norris AE, Ford K. Sexual experiences and condom use of heterosexual, low-income African American and Hispanic youth practicing relative monogamy, serial monogamy, and nonmonogamy. Sex Transm Dis. 1999 Jan;26(1):17–25. [PubMed]
  • Lewis DK, Watters JK. Sexual risk behavior among heterosexual intravenous drug users: ethnic and gender variations. AIDS. 1991 Jan;5(1):77–83. [PubMed]
  • Schwartz MA, Lafferty WE, Hughes JP, Handsfield HH. Risk factors for urethritis in heterosexual men. The role of fellatio and other sexual practices. Sex Transm Dis. 1997 Sep;24(8):449–455. [PubMed]
  • Melnick SL, Burke GL, Perkins LL, McCreath H, Gilbertson DT, Sidney S, Hulley SB. Sexually transmitted diseases among young heterosexual urban adults. Public Health Rep. 1993 Nov-Dec;108(6):673–679. [PMC free article] [PubMed]
  • Kim MY, Marmor M, Dubin N, Wolfe H. HIV risk-related sexual behaviors among heterosexuals in New York City: associations with race, sex, and intravenous drug use. AIDS. 1993 Mar;7(3):409–414. [PubMed]
  • Jaffe LR, Seehaus M, Wagner C, Leadbeater BJ. Anal intercourse and knowledge of acquired immunodeficiency syndrome among minority-group female adolescents. J Pediatr. 1988 Jun;112(6):1005–1007. [PubMed]
  • Padian N, Marquis L, Francis DP, Anderson RE, Rutherford GW, O'Malley PM, Winkelstein W., Jr Male-to-female transmission of human immunodeficiency virus. JAMA. 1987 Aug 14;258(6):788–790. [PubMed]
  • Seidlin M, Vogler M, Lee E, Lee YS, Dubin N. Heterosexual transmission of HIV in a cohort of couples in New York City. AIDS. 1993 Sep;7(9):1247–1254. [PubMed]
  • Aral SO, Mosher WD, Cates W., Jr Vaginal douching among women of reproductive age in the United States: 1988. Am J Public Health. 1992 Feb;82(2):210–214. [PubMed]
  • Stergachis A, Scholes D, Heidrich FE, Sherer DM, Holmes KK, Stamm WE. Selective screening for Chlamydia trachomatis infection in a primary care population of women. Am J Epidemiol. 1993 Aug 1;138(3):143–153. [PubMed]
  • Martino Jenny L, Vermund Sten H. Vaginal douching: evidence for risks or benefits to women's health. Epidemiol Rev. 2002;24(2):109–124. [PMC free article] [PubMed]
  • Sikkema KJ, Koob JJ, Cargill VC, Kelly JA, Desiderato LL, Roffman RA, Norman AD, Shabazz M, Copeland C, Winett RA, et al. Levels and predictors of HIV risk behavior among women in low-income public housing developments. Public Health Rep. 1995 Nov-Dec;110(6):707–713. [PMC free article] [PubMed]
  • Pulerwitz J, Amaro H, De Jong W, Gortmaker SL, Rudd R. Relationship power, condom use and HIV risk among women in the USA. AIDS Care. 2002 Dec;14(6):789–800. [PubMed]
  • Amaro H. Love, sex, and power. Considering women's realities in HIV prevention. Am Psychol. 1995 Jun;50(6):437–447. [PubMed]
  • Unexplained illness among Persian Gulf War veterans in an Air National Guard Unit: preliminary report--August 1990-March 1995. MMWR Morb Mortal Wkly Rep. 1995 Jun 16;44(23):443–447. [PubMed]

Articles from Journal of the National Medical Association are provided here courtesy of National Medical Association