What women don't know can hurt them: Hidden male bisexual behavior as a potential bridge for HIV transmission

Background: Men who have sex with men and women (MSMW) may serve as a bridge for the transmission of HIV from men who have sex with men (MSM) to the general population. This study examined correlates of non-disclosure of MSM behavior to female partners. Methods: We analyzed data from 100 partnerships reported by 69 MSMW who were recruited using respondent driven sampling between 2005 and 2008 in North Carolina. We conducted bivariate analyses to identify variables associated with non-disclosure. Multiple logistic regression analysis using a generalized estimating equations approach was conducted to identify variables independently associated with non-disclosure. Results: Most partnerships (87%) involved an African-American male. In 66% of partnerships, the male did not disclose MSM behavior. Non-disclosure was more common among African-American (70%) than among white (38%) men. Most men (74%) were older than 35. Current use of heroin, cocaine or methamphetamine was more common among MSMW (74%) than among their female partners (48%). Only 52% of men identified as gay or bisexual. In multivariate analyses, older age of the male, a non-gay /non-bisexual identity and having a non-drug using female partner were all independently associated with non-disclosure of MSM behavior. Discussion: Two-thirds of MSMW in this study did not disclose their behavior to their female partners. Non-disclosure was more common among African-Americans and it was linked to a non-gay/ non-bisexual identity. Drug-using MSMW were least likely to disclose their behavior to their non drug-using female partners. Efforts are needed to increase disclosure of MSM behavior to female partners.