Social context of same sex disclosure and sexual risk behavior among behaviorally bisexual Black men

Background: Black men who have sex with men (MSM) and heterosexual women suffer from disproportionate rates of HIV/AIDS compared to MSM and women of other ethnicities. Much media and public health attention has been paid to “down low” Black men, or men who are behaviorally bisexual but secretive about their same sex activity as the “transmission bridge” between these two subpopulations. This study sought to explore the social context of same sex disclosure and condom use among this population.

Methods: Fifty behaviorally bisexually active Black men in Atlanta, Georgia were recruited to take part in semi-structured one-on-one interviews from November 2006 through November 2007. The interview guide explored domains of formative life experiences, racial/sexual identification, social support and coping strategies, approaches to same sex disclosure, HIV testing beliefs/practices, and sexual scripts and condom use with both male and female sexual partners.

Results: Fifty behaviorally bisexual Black men residing in Atlanta, Georgia, ages 18-45 participated in the study. Thirty men reported to be HIV-negative/unknown status, while 20 reported being HIV positive. Formative experiences ranged from impoverished single parent households to middle class upbringings, while approaches to same sex disclosure depended on individual social networks/settings, personal beliefs, and the gender of the person to which one was disclosing. Condom use beliefs/practices varied among participants, influenced by both the gender of their sexual partners and the perceived nature of these relationships. HIV testing was common among the sample, and those who were HIV-positive described increased condom use after finding out their status.

Conclusions: There was a wide range of diverse personal and social experiences among this small sample of behaviorally bisexual Black men in Atlanta, Georgia. Disclosure of same sex behavior was not described as a binary construct, and was influenced by various structural, institutional, cultural and personal factors. Similarly, variables influencing HIV testing practices and condom use with female and male sexual partners were varied and not limited to discomfort with same sex behavior. Future HIV prevention interventions targeting this population must acknowledge the fluidity and diversity in bisexual experiences among Black men to be effective.