Almost One in 10 Straight Men on the "Down-Low," Study Finds
September 20, 2006
A 2003 random telephone survey sample of 4,193 male New York City residents found a high proportion of men self-identifying as heterosexual nevertheless also reporting sex with men. The study is a wake-up call for doctors not to make assumptions about their patients' sexual behavior -- or rely upon self-reported identities -- but rather to focus on behavior, said researchers.
The annual New York City Department of Health and Mental Hygiene (MHH) survey found the majority of heterosexual-identifying men who have sex with men (MSM) did not use condoms, and 70 percent were married. Most heterosexual-identifying MSM were racial and ethnic minorities or foreign-born persons.
"We found that those who identified as straight but had sex with men were also less likely to be HIV tested within the last year and less likely to use a condom" than men who identified as gay, said Preeti Pathela, an MHH research scientist.
Among straight respondents, 9.4 percent had sex with a man in the previous year. Many reported having only one male sex partner, but the survey did not ask whether the relation was one of long duration. The survey also did not ask whether the men revealed their sexual behavior to female partners.
Researchers said the strong stigma associated with homosexuality in minority communities, as well as culturally different ways of defining "heterosexual," might be among reasons why more heterosexual-identifying MSM were minorities. In addition, African-American MSM may fear being targeted as the main source of HIV spreading in their communities, said Dorena Kearney, executive director of COLOURS, a Philadelphia-based HIV prevention group targeting African-American men.
Only 22 percent of "down-low" men used condoms compared with 55 percent of gay men, the survey found. "It may sound simple to just use a condom, but if men are having sex on the sly, they may not want to carry condoms with them because their partners may find them," said Thomas Coates, a University of California-Los Angeles psychologist specializing in sexual behavior. "It's probably above [9.4 percent], because it's hard to get people to admit to this kind of behavior."
The full report, "Discordance Between Sexual Behavior and Self-Reported Sexual Identity: A Population-Based Survey of New York City Men," was published in Annals of Internal Medicine (2006;145(6):416-425).
09.19.2006; Dawn Fallik