What Is the Down Low?
The down low is a term used to refer to men who are in relationships with women, but who also have sex with men (MSM). This term started in the black community; however, this type of behavior is not unique to African Americans. Men across all races and cultures have been known to deny their attraction to other men.
Societal pressure is a powerful force. In a September 2007 interview, Iranian president Mahmoud Ahmadinejad said "there are no gay people in Iran." What he really meant was that, in Iran, gay people are not allowed to live their lives without fear of persecution and death.
There are many groups in the United States who would like to be able to say the same thing -- that there are no gay men here. They would like to deny the presence of homosexuality in their community. Even though most of them would not support violence, they are more than willing to encourage prayer, therapy, or simple denial. The problem though is that, whether you believe in nature or nurture, gay people, like everyone else, are still going to want love and sex. So, if you force them to hide their existence or deny their sexuality, it may put them, and their partners of both sexes, at risk.
It's Secrecy That Is the Problem, Not Homosexuality
Whenever a person is in a relationship where one partner believes the relationship is monogamous, and the other partner is having sex outside the relationship, the faithful partner is at increased risk. People who are in what they perceive to be committed relationships are often less reliable about practicing safer sex. Where a person might have been responsible about using condoms with causal partners, they may feel they can relax once in a stable relationship. If, however, their other partner is still sexually active outside the relationship, they may actually have become more at risk by "settling down."
This isn't just a problem for women who are involved with men on the down low. It's an issue for anyone in a relationship where one partner is being dishonest about their level of fidelity.
The Particular Hazards of the Down Low
So why talk about men on the down low? There are things about these men that put them, and their partners, uniquely at risk. Men on the down low are unlikely to be reached by prevention campaigns targeted at MSM who actually identify as gay or bisexual. They are also less likely to be regularly tested for HIV. Although they may have a lower frequency of high-risk behaviors with other men, the high-risk behavior men on the down low engage in has a larger potential circle of consequence - particularly since many of them have multiple female as well as male partners.
Studies have found that, in general, black MSM are far more likely than other MSM to have female partners. However, black women are less likely than women of other races to say that their male partners are bisexual. Most scientists believe that, once again, this has to do with the cultural hazards of disclosing a non-heterosexual sexual identity for men from cultures that place a high value on traditional masculine roles. Similar results, although less extreme, are also seen for Hispanic MSM.
Why Are Black MSM at Such High Risk?
African American men on the down low are at a higher than average rate of HIV infection. However, research suggests that this has less to do with "down low" activity than with 1) the high rates of other STDs that facilitate HIV infection and 2) the low rates of HIV testing in this community. Several other factors may also affect the relatively high HIV risk status of black MSM compared to MSM of other races. The first of these is the relatively low frequency of circumcision, since uncircumcised men are, in general, more susceptible to HIV. Another issue is the fact that many black MSM have poor access to health care, or partners with poor access to health care. Such people, if they're HIV infected, may have higher viral loads, which increases the likelihood of transmission during sexual activity.
In the past, many scientists had hypothesized that African American men on the down low were responsible for the disproportionately high number of sexually transmitted HIV cases in African American women, but this has never been supported by research. Although such men almost certainly do contribute to the epidemic, there is no currently reason to believe they do so more than men who engage in high-risk heterosexual sex with multiple partners or IV drug users.
What Is the Solution?
The only way to eliminate the problem of people having sex behind their partners' backs is to change society so that open and honest communication about sex is the norm. However, there is a simpler solution: Be more tolerant. Allow people to be who they are, whether they are gay, straight, or bisexual. Allow them to choose to embrace the people they desire. Allow them the chance to tell the truth to the people they love. Making homosexuality acceptable would probably eliminate most people's need, or desire, to be on the down low.
If tolerance is too hard, there is another way to deal with the increase in disease risk. Embrace safer sex as the norm, even in committed relationships. Many young couples see getting rid of condoms as a goal and a way to show their commitment to each other. In certain communities where safer sex is normally highly valued, having someone with whom you can engage in unprotected sex is actually known as being "fluid bonded," and those relationships are put on a pedestal. "Maybe one day, we'll get there," couples think. What if, instead, more people just accepted that condoms, dental dams, and the like were going to be part of their sex lives until, and unless, they decided to have children?
Although absolute honesty is certainly preferable for everyone's emotional well-being, a little healthy paranoia can actually be good for your health.
Ford et al. (2007) " Black Sexuality, Social Construction, and Research Targeting ‘The Down Low’ (\The DL’)." Ann Epidemiol 17:209–216.
Miller et al. (2005) "Sexual Diversity Among Black Men Who Have Sex with Men in an Inner-City Community." J Urban Health 82(1 suppl 1):i26-i34
Millett et al. (2006) "Greater Risk for HIV Infection of Black Men Who Have Sex With Men: A Critical Literature Review." Am J Public Health. 96:1007–1019
Montgomery et al. (2003) "The extent of bisexual behaviour in HIV infected men and implications for transmission to their female sex partners." AIDS Care 15(6): 829-837