"Down low" myth distorts HIV research, prevention

NEW YORK (Reuters Health) - Mistaken assumptions about black sexuality are finding their way into scientific research on the spread of HIV, and this could do more to fuel risky behavior than prevent it, authors of a new commentary warn.

Reports on African-American men who identify themselves as straight but secretly have sex with men -- dubbed the “down low” lifestyle -- first appeared when men who said they were part of this subculture wrote books about it and the media picked up the story, Dr. Chandra L. Ford of Columbia University in New York City, the commentary’s lead author, told Reuters Health.

“Part of what has happened as a result of that initial burst of stories reporting the ‘down low’ is that those stories often tied the down low to high rates of HIV infection among African-American women, which was not supported by epidemiological data,” Ford added. “There were a lot of assumptions, there were a lot of leaps of faith that led to that.”

Despite the non-scientific source, epidemiologists began doing research based on the idea that black men living the down low lifestyle were driving the spread of HIV, she and her colleagues note in their article in the Annals of Epidemiology.

This assumption was mistaken in many ways, they explain. First of all, the practice of straight men secretly having sex with men is seen across all ethnic groups.

Also, Ford notes, while black men and women have higher rates of HIV infection than other ethnic groups, they also report fewer risk behaviors, suggesting researchers should look elsewhere to understand the disparity.

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For example, she adds, having a bacterial sexually transmitted infection can increase the risk of both transmitting and contracting HIV, and it is possible such infections may be more common among blacks than whites due to poorer access to health care.

Research has refuted the claim that black men living the down low lifestyle are driving the spread of HIV, Ford said, but the perception that this is the case remains, even in the epidemiology community. She points to a dean at a colleague’s school who urged researchers to study “the down low” after seeing a TV segment on it.

The view of black sexuality as deviant and diseased has deep roots, Ford noted, pointing to the way the public and the medical community viewed syphilis in the early 20th century as a disease of the black community.

Not only could perceptions of the down low drive the men actually pursuing such a lifestyle further underground, making them less likely to get care, said Ford, it also draws attention away from interventions that could be truly effective, such as routine HIV testing of all adults.

“HIV-AIDS is a social disease, so that means that there are social phenomena that influence the spread of the disease,” Ford said. “We have to be as rigorous about understanding the social phenomena as we would be if we were studying how a microbe influences disease progression.”

SOURCE: Annals of Epidemiology, March 2006.