From copout to complexity: Emerging perspectives on the "Down Low" from young black men who have sex with men in the South

Background: Black Men Who Have Sex with Men (BMSM) in the US continue to be disproportionately impacted by the HIV epidemic. The term “Down Low” (DL) has emerged to describe BMSM who may also have sex with women. These men have been implicated as the primary cause of rising HIV infection rates in black women. Little research has been done to quantify the contribution of DL men to HIV infections among women or to describe the lives of young HIV + BMSM. A cohort study of young HIV+ BMSM (N=20) was done as part of an ongoing initiative to diagnose, link, and retain HIV+ BMSM in clinical care. Methods: Baseline interviews were conducted from 6/06-1/07 with HIV+ BMSM ages 17-24. (N=20) Participants were recruited through area HIV clinics and testing events. Data were analyzed using SPSS. Results: Sixty percent (N=12) of the men in the sample identified as Gay, 15% bisexual. None self identified as heterosexual or reported sex with women in the last 3 months. Sixty percent (N=12) reported being strongly attracted to men and not attracted to women while 40% (N=8) reported being strongly attracted to men and slightly attracted to women. Eighty-five percent reported being either comfortable or very comfortable with their sexual orientation. Conclusions: Our study findings contradict the pervasive narrative of BMSM on the DL as the primary cause of increased HIV transmission to black women. Future research should explore other social and sexual networks to explain the high HIV rates in the black community.