Behavior, identity and attraction discordance among African-American men who have sex with men

While minorities only account for 13% of the U.S. population, they account for 50% of the HIV/AIDS cases (CDC, 2004; U.S. Census Bureau, 2001). As a group, young African-American men who have sex with men (MSM) and those on the “down low (DL)” are suspected of bringing HIV into the heterosexual population. We hypothesized that behavior-identity discordant MSM -- who do not self-identify as gay, but are sexually attracted to or active with other men -- are more likely than their self-gay-identified -- or behavior-identity concordant -- counterparts, to engage in risky sexual behaviors. In this study of 61 African-American MSM, we investigated the relationship between risky sexual behaviors and the discordance between sexual behavior, attraction, and identity. Using the Sexual Behavior Checklist, Discovery of Same Sex Attraction and Background Questionnaire, and the Body-Mind-Spirit Well-Being Inventory, we found significant difference in the levels of risky sexual behaviors among gay identified (concordant) and non-gay-identified (DL or discordant) MSM of African descent (z: -3.988, p<.001), given no significant difference in spiritual well-being among the two groups (z: -0.961, p>.05). Our results suggest that the discordance between sexual identity, attraction and behavior contributes to risky sexual behaviors of African-American MSM. Overall, both groups show high prevalence of specific risky sexual behaviors, including significant prevalence of unprotected anal sex with men. Implications for HIV prevention and future research on African American MSM are discussed.