Table of Contents
- Where's The Data?
- What Is Known About MSMW?
- Sexual Identity
- Sexual Behaviors
- HIV Risk and Transmission
- Social and Cultural Factors
- Moving Forward
Men who have sex with both men and women but who do not identify as gay or bisexual have been the subject of much media attention. But the media have not always presented the most accurate information about these men and their experiences and, as a result, there remain many misconceptions.
While the term "on the down low" (also known as "the DL") may be a relatively new way to describe these men, the concept is not. A 2008 Archives of Sexual Behavior special issue on African-American and Latino bisexuality traces the term to its origins in African-American slang where it originally described "secretive behavior," usually by African-American men. By the late 1990s, the term was mainstreamed through usage in R&B and rap songs indicating infidelity.
A high-profile 2003 New York Times Magazine article described the phenomenon as "an organized, underground subculture largely made up of black men who otherwise live straight lives." One year later, The Oprah Winfrey Show dedicated an entire episode to "blow[ing] the lid off this sexual underground," with Winfrey interviewing J.L. King, author of the autobiographical On the Down Low: A Journey into the Lives of "Straight" Black Men Who Sleep with Men. Numerous self-help books followed, including a "survival guide" for women written by King's former wife. Despite this widespread media coverage, no consistent definition of these men exists.
However, many of the reports by these media outlets -- including the New York Times Magazine article and the Oprah episode -- have one thing in common: they explicitly link what they term "men on the down low" to the spread of HIV, without providing any evidence to support this claim. Furthermore, they specifically identify African-American and Latino men within this group as high-risk vectors of HIV transmission.
During a June 2010 segment of ABC's The View, D. L. Hughley stated, "HIV in the African-American community [is primarily affecting] young women who are getting it from men who are on the down low." Co-host Sherri Shepherd described men on the down low as "black men who've been going out. They are having sex with men and they're not telling their girlfriends or their wives that they're gay. ... It's so big in the black community with women because they're having unprotected sex with men who have been having sex with men."
Several gay rights advocates and organizations immediately issued statements criticizing the comments as inaccurate and misrepresentative. The Gay & Lesbian Alliance Against Defamation (GLAAD) issued a statement condemning the comments as "inaccurate and dangerous" and "fuel[ing] a climate of homophobia and racism." GLAAD cited a 2009 CDC statement indicating that the proportion of HIV infections in African-American women that come from bisexual male partners is "relatively few" and that more are from "male partners who are ... injecting drugs or ... have other risks that may put those female partners at risk of acquiring HIV."
The public health field has had difficulty obtaining data regarding men who have sex with both men and women but who do not identify as gay or bisexual, and only a few notable studies exist. A 2005 report published in the Journal of the National Medical Association reviews relevant data on this behavior among African-American men, how it does not always align with sexual identity, and how it relates to HIV risk. These studies refer to this behavior in a variety of ways, including "men on the down low," "men on the low low," "non-gay-identified men who have sex with men and women (MSMW) who do not disclose their same-sex behavior to their female partners," "secretive bisexuality," and others. For the purpose of presenting available data most efficiently, this article will use MSMW to describe non-gay-identified men who have sex with men and do not disclose their same-sex behavior to others, including their primary female partners.
Research on this group is limited in several ways. Most studies do not separate analyses of MSMW from those of men who have sex only with men. Studies that focus on MSMW tend to examine either their relationships with male partners or their relationships with female partners, with few discussing how the two may overlap and affect each other. Further, most studies focus on men who openly identify as bisexual, thus leaving out those who do not. Most research on MSMW focuses on African-American and Latino men, with little attention paid to the experiences of white Anglo MSMW.
While these limitations are often due to the researchers' methods, the most significant barrier to studying MSMW is the very nature of their behaviors. Men who do not reveal their same-sex behavior to friends, family, or primary partners are less likely to make themselves available to researchers. They are also less likely to be exposed to public health information addressing this behavior, and are even less likely to seek it out themselves.
As mentioned, the majority of research on MSMW focuses on African-Americans and, to a lesser extent, Latinos. Very little work has been done regarding the behaviors, attitudes, and sexual identities of white MSMW, and even less on that of Asian-Americans and Native Americans. There is little reliable information on the prevalence of bisexual behavior among white men who do not disclose their same-sex behavior. Research shows only that the prevalence of bisexual behavior is much higher among ethnic minority men than it is among white men. The 2005 Journal of the National Medical Association review found that, across 18 studies of African-American MSM, up to 71% report bisexual behavior and up to 40% identify as bisexual.
The few studies that include more diverse racial and ethnic communities suggest that bisexual behavior without disclosure is more common among African-American and Latino men than among white men. A 2000 Virginia-based study published in AIDS Education & Prevention found that, among its participants, white MSMW are significantly more likely than African-American MSMW (62% versus 46%) to disclose their bisexual or gay behavior to their families, heterosexual friends, health care providers, fellow churchgoers, and others.
The 2005 Journal of the National Medical Association review indicated that, like African-American and Latino men who have sex only with men, ethnic minority MSMW are less likely than white men to identify as "gay." They are similarly less likely to join gay-related organizations and read gay-related media. Numerous studies show that men who disclose their same-sex behavior are more likely to consider themselves part of the "gay community" than men who do not.
A 2006 12-city study published in AIDS & Behavior found that, among its participants, not revealing same-sex behavior was associated with higher levels of internalized homophobia, suggesting that these men may conceal this behavior due to shame, guilt, and other negative associations with a gay or bisexual identity.
A 2008 review in Archives of Sexual Behavior found that MSMW report significant numbers of both male and female partners, with almost twice as many male partners as female partners. In addition to reviewing other data, the study collected separate data from MSMW in New York City. There, MSMW reported 6.7 male partners in the past year compared with 3.2 female partners. At the same time, these men reported more frequent sex with female partners than with male partners in the past year. More reported having anal sex with their male partners than with their female partners, and significantly more reported vaginal sex with their female partners than anal sex with either their male or female partners. This may be partly due to the fact that many of these men are more likely to be in relationships with or married to their female partners, thus increasing the opportunities to have sex with them. Their desire to keep their sexual activity with male partners hidden may contribute to its lower frequency.
The MSMW in this study were much more likely to report having insertive sex (topping) than receptive sex (bottoming) with their male partners, unlike openly gay men who report both topping and bottoming equally. This may be because these men view bottoming as a higher risk activity or too threatening to their heterosexual identity.
In terms of high-risk behaviors, 18% to 31% of MSMW reported unprotected anal sex with male partners in the past year, and 42% to 67% reported unprotected vaginal sex with female partners. This may be because these men perceive sex with their female partners to be inherently less risky, and because insisting on condoms may cause their female partners to doubt their fidelity.
This study also found that, contrary to widely held beliefs, MSMW report having both male and female partners in addition to their primary female partners. They did not report only one-time, anonymous sexual encounters; many were involved in regular, ongoing relationships with multiple steady partners. It is possible that many MSMW opt for ongoing relationships because of the difficulty in finding reliable, discreet partners, as well as a desire to limit the risk of unintended pregnancies and HIV.
Given the higher rates of unprotected sex, HIV among MSMW is of particular concern, and most studies on this community are done within the context of HIV. The introduction to the 2008 Archives of Sexual Behavior special issue states that numerous studies have found that African-American and Latino MSMW are at significantly greater risk for HIV than their exclusively homosexual or exclusively heterosexual counterparts. This mirrors the fact that HIV continues to affect ethnic minority communities, especially African-Americans, disproportionately.
It is obvious that the public health field continues to struggle to learn more about MSMW who do not disclose their same-sex behavior. These men are difficult to reach and do not respond to conventional outreach methods. The glaring lack of research is of particular concern given the high rates of unprotected sex and elevated risk of HIV and STIs.
Many researchers have sought to understand MSMW better in terms of sexual identity, sexual decision-making and risk-taking, and acceptance within heterosexual and racial/ethnic communities, to reach out more successfully to this community and dispel the myths put forth by the media. In particular, researchers have focused on the social and cultural barriers in African-American and Latino communities that may inhibit disclosure of same-sex behavior.
A 2008 study in Archives of Sexual Behavior reviewed several other studies indicating that, among African-American men, the heterosexual and hypermasculine gender norms exhibited by religious and family networks may encourage MSMW to hide their same-sex behavior. These men may fear social rejection, humiliation, and possibly physical assault as consequences of coming out. Worse, they may also experience a lack of social support networks to aid them in exploring their sexuality and disclosing their samesex behavior to others. While white MSMW face these difficulties too, studies indicate that African-Americans and Latinos are disproportionately affected by these barriers.
The public health field has a responsibility to continue to reach out to and learn more about MSMW. Its work must incorporate the complex social and cultural issues affecting MSMW from all walks of life, and examine the barriers they face in exploring their sexuality. Further, misrepresentations about the HIV epidemic and MSMW -- particularly African-American and Latino MSMW -- persist among the general public. The media have a responsibility to report accurately and sensitively on the information collected thus far by public health researchers. Finally, the LGBT community and its allies must work together to create safe, open spaces that allow for further discussion of these issues.
Adrian Guzman is Executive Editor of the Public Interest Law Journal_._