Double jeopardy with men's sexual behavior and drug use: Down low and high

Background: Male bisexual behavior is thought to be driving the HIV epidemic among African-American women. We examined the prevalence and correlates of bisexual behavior among a predominantly African-American population of high-risk men in North Carolina. Method: As part of a NIDA-funded study, drug users, MSM and their sexual partners were recruited using respondent driven sampling between 2005 and 2006. Data were collected using ACASI, and participants were tested for HIV. Results: Of 596 males, 188 (32%) reported a history of sex with men and women. These men were significantly more likely to be HIV-positive (17% vs. 10%, p < .05) and to report unprotected intercourse in the past 6 months (52% vs. 39%, p <.01). They were more likely to report trading sex, being homeless and injection drug use (IDU). They were no more likely than other men to report a history of incarceration. Compared to men who reported having sex with only women in the past six months, bisexually active men reported significantly more sexual partners and were significantly more likely to report anal sex with their female partners (29% vs. 9%, p < 0.0001). Conclusions: Bisexually active men reported behaviors that may place themselves and their female partners at higher risk of acquiring or transmitting HIV. Given the links between bisexual activity and sex trading, homelessness and IDU, future research should address how economics and substance use contribute to these behaviors.