Reframing the Down Low: The Context of HIV Risk among African American Men

Cynthia Gomez, San Francisco State University, San Francisco
Social and Behavioral Sciences
Thematic Priority Area: Contextual, Cultural, and Structural Issues in HIV Prevention and Care
Innovative, Developmental, Exploratory Award (IDEA)

Rates of HIV infection among African American gay and bisexual men nationally and in California continue to increase at alarming rates. Rates of HIV are estimated to be almost 50% among men who have sex with men (MSM) in some urban areas of the United States, a seroprevalence greater than any other subpopulation in the United States. The “Down Low” is a term that refers to African American men who identify as heterosexual but secretly have sex with men without disclosing to their female sexual partners. The Down Low has been considered as a potential explanation for rates of HIV/AIDS among African Americans in public health research, despite the fact that research has not confirmed that sex on the Down Low is related to rates of HIV among African American women, and research has found that men who do not have gay identities are not more likely to have risky sex than men who have gay identities. It is critical that we address the HIV prevention needs of African American men who are bisexually active but not gay-identified.

Higher rates of HIV among bisexually active African American men have been linked to conditions related to low socioeconomic status (such as poverty, lower paying jobs, and less education), suggesting that these factors may be as important as understandings based on individual behaviors. Given that, in the United States, one in 9 African American men aged 25-34 are currently incarcerated, and one in three (1/3) have ever been incarcerated – it is critical to examine the ways in which incarceration serves as a factor for sex between men, in particular sex on the Down Low. We must also understand the role of culture among African Americans - alongside the societal factors of incarceration, racism and economic inequalities - in creating the Down Low. The phenomenon of the Down Low indicates that there is clearly more to sexual identity and practice among populations of bisexually active African American men than is currently understood.

This study will examine understandings, meanings, and experiences of the Down Low through in-depth personal interviews. We will interview a sample of sixty bisexually active HIV-negative and HIV-positive African American men who have histories of incarceration and live in the Bay Area in order to: 1) advance our theoretical understanding of the structural and cultural conditions contributing to the Down Low; and 2) better understand the role of places such as prison and their relationship to the Down Low by exploring the relationships between sexual practice and sexual identity during and after incarceration. By hearing personal stories about people’s social and sexual lives, we can better understand how to develop HIV prevention programs that consider the complicated context of people’s lives as we address HIV among bisexually acting African American men.