Gay black men in denial may be giving HIV/AIDS to black women

Jason B. Johnson:

Health officials have worried for years about the high rate of HIV among African Americans. Now the federal Centers for Disease Control is examining how one group, known as men on the "down low," could be spreading the disease among black women.

Men on the down low have sex with other men while keeping a heterosexual public identity. Recent books and articles about black men on the DL, as it is also called, have raised concerns that they pass HIV to unsuspecting wives and girlfriends.

But because the down low is defined by secrecy, almost nothing is known about the number of men of any race who are on the down low, how many have HIV or AIDS, or their sexual activity.

At a time when black women are being diagnosed with HIV at a rate 20 times that of white women, five CDC studies will be among the first to try to learn how many white, black, Asian and Latino men fit the down-low profile; identify how, if at all, being on the down low differs from being "in the closet," and determine whether down-low men have a role in infecting women with HIV.

Most black women with HIV say they were infected through heterosexual contact, but it isn't known how their male partners were infected -- by sex with other men, or by using contaminated needles to inject drugs.

"We need to take a step back when we look at the down-low phenomenon," said Gregg Millett, a behavioral scientist with the CDC division on HIV/AIDS. "There's very little that is known."

The definition of down low depends on who does the defining. The term comes from the world of hip-hop and R&B music, where it means an illicit relationship. As adapted by a subculture of black men, being on the down low describes men who have sex with other men but appear straight, have relationships with women, and don't acknowledge being gay or even bisexual.

Many down low men find it difficult to see themselves as gay because of the stigma attached to homosexuality in the black community, said Phil Wilson, executive director of the Black AIDS Institute in Los Angeles. Being gay risks rejection by family and friends.

They don't identify with gay culture, which they see as white and effeminate. And when they do venture into gay communities like San Francisco's, which are predominantly white, they feel unwelcome, according to several studies of gay men of color.

Because these men have so much at stake in keeping their sexual activity secret, it is unknown how many there are and it is difficult to trace the sexual history of their female partners.

The longer these men lead double lives, health officials say, the higher the risk for their partners.

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