Academic journal article Harvard Journal of African American Public Policy

Black Men on the "Down-Low" and the HIV Epidemic: The Need for Research and Intervention Strategies

Academic journal article Harvard Journal of African American Public Policy

Black Men on the "Down-Low" and the HIV Epidemic: The Need for Research and Intervention Strategies

Article excerpt

ABSTRACT

HIV remains a critical health issue in the Black community. Black men who have sex with men and women (BMSM/W)--also known as men on the "down-low" (or "DL")--are disproportionately affected by HIV/AIDS and have recently become the focus of scholarly and media attention. This paper synthesizes the existing empirical literature on HIV prevalence and risk factors in the BMSM/W population, discusses the shortcomings of available research, proposes recommendations for future studies, and assesses the strengths and weaknesses of existing intervention strategies for this subgroup.

INTRODUCTION

Black men who have sex with men and women (BMSM/W)--also known as men on the "down-low" (or "DL")--have recently become the focus of scholarly and media attention. (1) MSM/W are defined as men who consider themselves heterosexual but engage in homosexual behaviors, which are typically not openly discussed or acknowledged. (2)

The goal of this paper is three-fold. First, we synthesize the existing empirical literature on HIV prevalence and risk factors within the Black community, in general, and within the BMSM/W population, in particular. Next, we discuss the shortcomings of research in this area and propose several recommendations for future studies. Finally, we conclude with an assessment of the strengths and weaknesses of proposed and existing intervention strategies to deal with HIV prevention and care in the BMSM/W population.

RESEARCH ON HIV PREVALENCE AND RISK FACTORS IN AFRICAN AMERICANS: WHAT WE KNOW

Blacks compose approximately 13 percent of the U.S. population, yet they account for 39 percent of AIDS cases diagnosed since the beginning of the epidemic and over half of HIV diagnoses in 2002 (Denizet-Lewis 2003). The number of HIV/AIDS cases reported among Blacks is greater than any other racial or ethnic group (CDC 2001b, 6). In 2000, HIV was the leading cause of death for Black males aged 25 to 44 compared to the fifth leading cause of death for White males in the same age group (Anderson 2002, 21-28).

Although Black men account for most of the new HIV infections among African Americans, Black women compose a growing share. In 1991, Black women represented 22 percent of new HIV/AIDS cases reported among African Americans. By 2001, Black women represented more than one-third (CDC 2001b, 32). Empirical evidence indicates that 62 percent of HIV infections among Black women are the result of heterosexual contact (CDC 2002, 20).

Nascent literature on HIV risk among men who sleep with men (MSM) and MSM/W suggests that increased attention on the BMSM/W population is appropriate. First, research indicates that there are racial disparities in HIV infection between MSM/W populations. BMSM/W have 4.4 times higher odds of HIV infection compared to their White counterparts (CDC 2001c, 440). Second, within the Black community, the BMSM/W population has disproportionately higher rates of HIV infection compared to other Black men. In Los Angeles, one study estimates that BMSM/W are 30 times more likely to be infected with HIV than Blacks who engage only in heterosexual behavior and 13 times more likely than Black homosexuals (LACDHS 2000). Third, 64 percent of women infected with HIV are African American, and the leading cause of HIV infection among Black women is heterosexual contact (CDC 2002, 18). Popular media coverage of men on the "DL" suggests that increased infection in African American women may be linked to the BMSM/W population, yet no empirical research has been conducted to make this connection (Denizet-Lewis 2003).

A myriad of risk factors may contribute to the rising HIV rates within the BMSM/W population. Although more than a third of Blacks say HIV/AIDS is the most urgent health problem facing the nation, Blacks are much less likely than Whites to say that they are personally concerned about becoming infected (Washington Post/KFF 2002). …

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