Nondisclosure of Homosexual Behavior or Bisexual Identity
Disclosure of homosexual identity or behavior among black MSM was addressed in five articles and one conference abstract. A Chicago-based sample of 208 black and 142 white bisexually active men found that, compared with white MSM, black MSM were significantly more likely to keep their same-sex behavior from their female partners (75% and 36%, respectively). Similarly, a Virginia-based study of 523 MSM found that white men were significantly more likely than black men to disclose their bisexual or gay identity to family (62% versus 46%), heterosexual friends (59% versus 35%), healthcare providers (48% versus 29%), church members (32% versus 12%) and other groups of people. Moreover, as education level increased, white men were more likely and black men substantially less likely to disclose their sexuality. In contrast, a study in Los Angeles, which enrolled primarily gay or bisexual HIV-positive MSM, found no racial differences in disclosure of sexual orientation to lovers or parents but found modest racial differences in disclosure of HIV (treating HIV infection) status to lovers.
In three studies, black women were asked whether they currently have or have ever had a bisexually active partner. In one study, HIV-positive black men were significantly less likely than HIV-positive men of other racial or ethnic groups to identify themselves as homosexual; and HIV-positive black women were significantly less likely than HIV-positive white women to report having a bisexual male partner. The authors concluded that minority bisexual men were less likely than white bisexual men to tell their female partners about their homosexual behavior, but these data must be interpreted cautiously. The study did not recruit couples, and bisexuality was evaluated over a five-year period, which limited determination of concurrent bisexual activity with male and female sex partners. More conclusive data arise from a small California-based study. Padian and colleagues (1989) found that of 52 female partners of HIV-positive bisexual men, only 20% of black female partners were aware of their male partner’s bisexuality, compared to 80% of white female partners. However, a 1992 study found that significantly more HIV-positive black women than HIV-positive white women reported being infected by a bisexual man. revatio 20 mg
HIV Risk and Nondisclosure of Homosexual Behavior or Bisexual Identity
Three studies reported that black MSM were less likely than white MSM to be open about their homosexuality. However, HIV risk behavior among black MSM varied. One study found no differences in sexual risk-taking according to race, a second study found sexual risk-taking to be greater among black MSM, and the third study found no racial differences in sexual risk-taking with male partners but reported that black MSM engaged in a greater proportion of unprotected sex with female sex partners than did white MSM.
All three studies provided limited data on the direct association between disclosure and homosexual identity or behavior. The studies tested only independent associations between race and disclosure or race and HIV risk behavior. However, three other studies compared HIV risk (еreating HIV infection when used in combination with other medicines) behavior between MSM who were open about their homosexual identity and MSM who were not. A San Francisco study found that black MSM who were uncomfortable disclosing their sexuality to others were more likely than other black MSM to engage in unsafe sex. In contrast, a Chicago-based study found that black MSM who scored lower on a scale that included measures of sexuality disclosure reported fewer sexual risks than black MSM who scored higher on the scale. Similar results were found among a probability sample of 5,589 young MSM. Black MSM were less likely than white MSM to disclose their sexual behavior to other people. Among black MSM, nondisclosers were more likely than disclosers to have a main female partner and unprotected vaginal or anal intercourse with women; however, they were less likely to have unprotected anal intercourse with male partners, to have >5 male sex partners or to be HIV-positive. These differences between nondisclosing and disclosing MSM held true for each of the other racial and ethnic groups. If black men on the down-low follow the same general sexual risk pattern as nondisclosing black MSM, black men on the down-low may engage in fewer sexual risks with male partners than black MSM who are open about their sexuality.