Medical Blog - Part 168

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.

Prevalence of Bisexuality among Black Men
Studies clearly show that black MSM are more likely than MSM of other races and ethnicities to identify themselves as bisexual and to be bisexually active.101217 Most studies that recruited black bisexual men assessed bisexuality according to self-reported behavior rather than self-identifica-tion. Among black MSM in 18 studies, from 2% to 71% reported bisexual behavior, and from 11% to 40% self-identified as bisexual. These estimates varied based upon whether studies recruited only MSM or a general population of men. Time periods during which bisexual behavior was assessed varied from proximal estimates (e.g., past three months, six months or a year), to extended periods of time (e.g., five years, since 1977, lifetime). Others did not specify a time period. In two studies that provided estimates for both recent and historical bisexual behavior, the prevalence of bisexual behavior was higher when evaluated over a longer (>5 years) period of time than a shorter (within the past year) timeframe.

An extensive review of three databases (Psychlnfo, MEDLINE and AIDSLINE) available on the Internet was conducted. An initial search limited the data to articles on black populations (i.e., “black or African-American or Afro-American”) that mentioned sexual identity or behavior, specifically heterosexuality (i.e., “straight or heterosexual or men who have sex with women”) or homosexuality (i.e., “MSM or men who have sex with men or gay or bisexual or homosexual or down-low or DL”). Citations were then narrowed to studies conducted in the United States from 1980 through June 2004. Only one article per a given study was chosen for inclusion in the review. Four scientific publications mentioned the down-low, but only one collected data and was included in the review.

Down Low

Black men “on the down-low” have gained considerable attention from both mainstream media and public health officials over the past few years as climbing rates of HIV infection (еreating HIV infection when used along with other medicines) among black women have come under increasing focus. Several nuances of the term “down-low” have been in use in the African-American community since the early 1990s. However, it was not until the release of statistics citing high HIV (еreating HIV infection when used in combination with other medicines) incidence among black MSM and the fact that a significant proportion of black MSM identify as heterosexual that the term in the popular media became synonymous with heterosexually identified men who have sex with other men without the knowledge of their main female sex partners.


The results of this study suggest that while HIV prevention messages have been seen by APIs at risk of HIV (treating HIV infection when used along with other medicines), additional efforts may be needed specifically for APIs. Cultural norms prohibiting discussion of sexuality and discomfort regarding drug use and homosexuality may prevent standard HIV messages from reaching at-risk APIs. Further, foreign-born APIs may have language barriers and fear of deportation if they are infected or even at risk of HIV

Of the 187 individuals who responded to the HITS-API survey, 165 (88%) met the inclusion criteria. HITS-2000 recruited 314 participants, of whom 235 (75%) were included. Table 1 shows the demographic characteristics of both cohorts. HITS-API respondents were younger, had higher incomes and were less likely to be homeless or IDU. API respondents in HITS-2000 were comparable to those in HITS-API except that more HITS-API participants were of multiple race/ethnicity (data not shown). The most common API ancestries of participants in HITS-API were Filipinos (33%), followed by Chinese (19%), Vietnamese (17%) and Japanese (15%). Most (96%) HITS-API respondents had heard or seen HIV (treating HIV infection) prevention messages within a year of the survey; the most common venues were newspapers/magazines (72%), health centers (72%), television (68%), bus/bus stop (61%), billboards (58%) and radio (50%). Questions about prevention messages were not asked in the HITS-2000 survey.

The questionnaire for HITS-API was primarily that used nationally for HITS in 2000. Participants were recruited from three populations at highest risk for HIV (cialis professional treating HIV infection when used in combination with other medicines) men who have sex with men (MSM) who have had sexual contact with other men in the past 12 months; higher-risk heterosexuals (HRH) who had two or more opposite sex partners in the past 12 months; and injection drug users (IDU) who had injected in the past 12 months. The eligibility requirements for both studies included being >18 years of age, a resident of Washington State for at least six months, English speaking and meeting the risk criteria (MSM, IDU and/or HRH, as above). HITS-API also required subjects to self-identify as APIs. Formative research was conducted to select venues for both projects and to identify other recruitment methods for HITS-API, including advertising, use of outreach workers and respondent-driven sampling (RDS). All participants provided informed consent prior to the interview. Trained staff conducted the interviews and respondents received monetary incentive for participation. Analyses were done using SAS v.8.2 software (Cary, NC, 1999-2001). Survey methods were reviewed and approved by CDC and Washington State Institutional Review Boards.