Reframing the Down Low: The Social Context of HIV Risk among Bisexually Active African American Men

Background: The epidemiology of HIV among African American bisexually active men demands new theoretical frameworks. The “Down Low” is a term that typically refers to African American men who identify as heterosexual but have sex with men without disclosing to their female sexual partners. This study aims to re-frame the Down Low through focusing on the social and structural factors - including socioeconomic inequalities, racism, and incarceration – that condition vulnerability to HIV among bisexually active African American men.

Methods: Sixty in-depth qualitative interviews are being conducted with HIV- and HIV+ bisexually active African American men, with and without histories of incarceration, in the San Francisco Bay Area. To be eligible, all participants must report sex with both a man and a woman in the past twelve months. Ethnographic mapping and extensive fieldwork assist with ensuring recruitment of this hard-to-reach population. Respondents participate in a one-time open-ended interview that asks them about their sexual identity and practices, HIV risk behaviors, understandings and experiences of the Down Low, and incarceration.

Results: The Down Low encompasses a range of social and cultural identifications and practices. Men who identify as being on the Down Low strategically deploy specific social and sexual identities in the context of experiences of racism, homophobia, and gender norms that condition the possibilities of their sexual lives.

Conclusions: These data indicate the strong need to build theoretical frameworks for addressing HIV/AIDS among bisexually active African American men that consider the conjoined effects of structural, cultural and individual level factors.