Focusing "DownLow":Bisexual Black Men, HIVRisk andHeterosexual Transmission

Introduction: Black menwhohavesexwith men(MSM) and womenbutwhodonotidentify asgayordisclose their bisexual activities tomainfemale partners, also knownas men"onthedown-low," havebeencited asthemain reasonfor theincrease inHIVinfections inblack women. Methods: Three online databases (PsychInfo, MEDLINE and AIDSLINE) weresearched forscientific articles related to menonthedown-low. Atotal of24articles andtwoconferenceabstracts wereselected for review. Results: Datafrom existing studies ofMSMreveal lowagreementbetween professed sexual identity andcorresponding sexual behavior amongblack andother MSM;showthat black MSMaremorelikely than MSMofother racial orethnic groups tobebisexually active oridentified; and, compared with white MSM,areless likely todisclose their bisexual or homosexual activities toothers. However, black MSMwho donotdisclose their homosexual orbisexual activities engage inalower prevalence ofHIVrisks than black MSM whododisclose; andblack menwhoarecurrently bisexuallyactive account for avery small proportion oftheoverall population ofblack men(2%). Conclusion: Thehigh prevalence ofHIVintheblack community andthegreater likelihood ofbisexuality among black menplace heterosexual black womenatrisk for HIV infection. However, thecontribution ofhigh-risk heterosexual black mentothersing HIVcaseload amongblack women hasbeenlargely ignored. Future research must evaluate the relative contributions ofbisexual menandexclusively heterosexual black mentoHIVcases amongblack women.