The popular media in the U.S. have focused too much on moral issues surrounding black bisexual men who do not disclose their same-sex behaviors to female lovers, otherwise known as men "on the Down Low," with this focus creating a stigma that interferes with effective public health strategies, says Indiana University sexual health expert Brian Dodge.
"The media and general public are obsessed with disclosure, but there is no evidence that disclosing leads to safer behaviors -- or, indeed, that not disclosing leads to riskier sexual behaviors," said Dodge, associate director of the Center for Sexual Health Promotion in the School of Health, Physical Education and Recreation.
"And what benefit do men have for disclosing their bisexuality in a society where positive support and affirming resources for bisexual men are all but non-existent, and negative stereotypes prevail? This is another example of an ongoing debate between public health and public morality. Sexual risk behavior is a public health issue; disclosure of sexual behavior is, in large part, a personal and moral issue."
In a study published this month in the Archives of Sexual Behavior, Dodge and his research colleagues suggest that broader social awareness and acceptance of male bisexuality is a necessary component of HIV prevention efforts targeted at men who have sex with both men and women. This would be in addition to traditional individual-level behavior programs.
The study was based on interviews with 30 black men in New York City who have sex with both men and women. Researchers found that the men in the study feared the consequences of disclosing their bisexuality, especially to their female partners. In addition, some men feared that disclosing put them at risk for physical harm and emotional harm.
According to Dodge and David Malebranche, assistant professor of medicine at Emory University's School of Medicine and also a contributor to this month's Archives of Sexual Behavior, black bisexual men have been largely blamed for the high rates of HIV among heterosexual black women.
"There are bisexually active black men who are contributing to the epidemic in the black community, but there are also heterosexual men and women, and homosexual men who are contributing," said Malebranche. "With little evidence to support it, the idea that such a small population is causing all or the majority of infections among heterosexual black women is a fallacy at best."
Both researchers agree that larger social, economic and structural issues are playing a role in the epidemic.
"Black men aren't having unprotected sex more so than other racial/ethnic groups, so it's more than individual behaviors that are driving this disparity alone," says Malebranche.
The IU study "Beyond the Down Low: Sexual Risk, Protection, and Disclosure Among At-Risk Black men Who Have Sex with Both Men and Women (MSMW)" is part of a special section dedicated to research on black and Latino bisexual men. The special section was guest-edited by Dodge and Theo Sandfort, research scientist at the HIV Center for Clinical and Behavioral Studies at Columbia University and the New York State Psychiatric Institute.
"The section includes nearly a dozen original papers on diverse studies of bisexual men from across the United States, as well as one from the Dominican Republic. The special section provides much-needed scientific information from both public health and theoretical perspectives," said Dodge.
Malebranche and Dodge both agree that while disclosure may be important in some respects, it is not an essential factor in curbing the spread of HIV.
"We need more common messages about human behavior and motivations for condom use that don't use moral judgments against homosexuality or bisexuality as the crux of the analysis," said Malebranche. "The science and literature backs us up on that."
Source: Indiana University
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