Knowing and disclosing in relationships of behaviorally bisexual African American men and their female partners

Background: The highest rates of HIV infection in the U.S. are currently found among urban Black men who have sex with men, including bisexually active men. Sexual risk behaviors are high between Black bisexually active men and their female partners, yet these relationships remain understudied.

Methods: As part of a 5 year study, we analyzed data from in-depth qualitative interviews with a mixed HIV status group of African American behaviorally bisexual men (N=59) and women who were in a relationship with a behaviorally bisexual African American man (N=20).Three trained analysts conducted open coding with ATLAS.ti and analyzed “disclosure” and “knowing” codes.

Results: Men described a spectrum of disclosure of sexual relationships with men to female partners, from men who said they always disclosed, to those who disclosed based on trust to select people. Non disclosure was described in two ways: 1) men who felt that their sexuality should not be public knowledge, and who wanted to remain anonymous because of potential repercussions of disclosure, and 2) men did not consider themselves bisexual or want their sexuality labeled. HIV-negative women were concerned about their HIV risk, but felt that communication with partners was not possible. Women discussed dimensions of 'knowing': physical absence; physical traits; sexual behavior preference; intuition; rumor; men’s prison history; and communication.

Conclusion: Women and men described the importance of disclosure in their relationships, and the need to feel safe to discuss sexual intimacies. HIV prevention interventions must address the relationship context of HIV and support gender-based communication strategies.