Over the Down Low

During their five-month whirlwind romance, 19-year-old Marvelyn Brown’s lover wined and dined her. “It was everything I wanted,” she recalls. “I couldn’t believe that someone as sophisticated and fine was so attentive to me.” Brown’s older man was prominent in her Nashville community. She was so swept off her feet that she “thought it was a privilege that he wanted to have sex with me.”

But one day, he didn’t have any condoms. Brown, now 21, admits she could have insisted that he wear one, but she feared it might make him think she wasn’t committed to him—and that he might even end the relationship.

Two months after their first sexual encounter, Brown landed unconscious in the hospital with a 106 degree fever and pneumonia. “I was expecting the doctor to tell me that I was pregnant,” she says. Instead, she learned she had HIV.

THE “SPOOK BEHIND THE DOOR”
Brown knew little about her man’s sexual history. Like many women, she believed she was safe—that only gay or effeminate men had HIV. “I just thought you could look and tell,” she says. Later, she discovered that her partner, who looked healthy, had known he had HIV all along.

“I think many women, myself included, have believed that men who outwardly portray a masculine image would be the last men who would engage in sex with other men,” says Lisa (not her real name), a 41-year-old Chicago resident who says she was infected by a professional athlete—and believes he was having sex with men and other women.

Lisa and Brown have joined a fast-growing group. In 2001, among black women 25 to 34, AIDS was the leading cause of death. Black women’s HIV rate is 19 times that of white women. In addition, while 16% of black women are infected through IV drug use, according to the Centers for Disease Control and Prevention (CDC), 81% are infected by men.

It’s no wonder the “down low”— men who front like they’re straight and have sex with women yet get busy with guys on the sly—has become a money-making industry. Several books on the subject have become New York Times bestsellers; three movie projects are rumored to be in development and media giants as varied as Oprah, hip-hop shock jock Wendy Williams and novelist Terry McMillan have all given the phenomenon play with their massive audiences. “It’s sexy, exotic and dangerous,” says University of Michigan social-work professor Larry Gant, PhD.

But a growing cadre of public-health experts, many of them black, worry that the phenomenon has been overhyped. The community—and black women in particular—are looking for the “spook behind the door,” as one expert calls it (“They even have down-low detective websites,” says Keith Boykin, author of Beyond the Down Low) rather than grappling with more difficult solutions. These include educating men about the importance of condom use; empowering women to negotiate it and refuse sex without it and reducing stigma around disclosure of IV drug use as well as sexual orientation and HIV status.

DISSECTING THE DOWN LOW
Recently, a group of Atlanta-based public-health researchers—including Gregorio Millett, MPH, David Malebranche, MD, MPH, Byron Mason, BS and Pilgrim Spikes, PhD, MSW—tried to tackle the burning questions about black men on the down low (DL): How prevalent is the phenomenon? Is it specific to blacks? Are men “on the low” the dominant cause of black women’s astronomical HIV rates?

They pored through two dozen surveys and analyses of the sexual behavior of men of different races, conducted from 1980 to 2004, and found that significant percentages of black men who have sex with men (MSMs) say they’re heterosexual. In one Los Angeles study, one in six straight-identifying, HIV negative black men and one in three of their HIV positive, straight-identifying brethren admitted that they’d had anal sex with a man.

However, it isn’t black guys who have the greatest discrepancy between talking straight and walking straight. In three studies, 18% to 34% of straight Latino men and 18% to 46.5% of their white counterparts fessed up to having had anal or oral sex with another man. Another study found that consistency between identifying and acting straight was actually highest among Asian men (78.4%) and lowest among white men (34.7%), with brothers falling in between, at 43%.

Still, black guys who have sex with other guys are definitely less likely to admit it than other men—and more likely to be having sex with women. A Virginia study of more than 500 men found that white men were significantly more likely than blacks to disclose their bisexual or gay identity to family (62% versus 46%) and heterosexual friends (59% versus 35%).

But do guys on the down low put women at risk for HIV? The data is inconclusive. One 2003 CDC survey of HIV risk-taking among more than 5,000 young MSMs in six cities over five years found that 32% of black MSMs were HIV positive. It also found that among black MSMs, “nondisclosers” were more likely to have a main female partner and to practice unprotected sex with women than openly bisexual or gay men. However, they were less likely to have had unprotected anal sex with men, to have had five or more male partners or to be HIV positive.

More research is definitely needed. But “it’s impossible to know how many black women are infected by black men who have sex with men,” says Millett, who along with his coresearchers published the findings in the July 2005 issue of the Journal of the National Medical Association. And Dr. Malebranche, who takes the body of data with a grain of salt (“Black men on the DL aren’t talking to researchers,” he says) feels the research “doesn’t support the theory that DL men are a bridge for HIV to the general black community.” Columbia University public-health professor and HIV expert Robert Fullilove, EdD, adds that the down-low “goes back to the dawn of time,” and there’s no evidence that it’s growing.

THE OTHER DEMONS
The Atlanta researchers cite several HIV risk factors that have been completely absent from the down-low debate. The rate of condom use by straight black couples is low, even when one of the partners is HIV positive. According to the CDC, only 32% of black women of reproductive age report using condoms the last time they had sex.

Black heterosexuals also report having more sex partners and more involvement in multiple and nonmonogamous sexual relationships than other races. In addition, blacks report more trading of sex for drugs or money and a greater likelihood of having ever had a sexually transmitted infection.

But the real “elephant in the room” and much more difficult to study is the role that prison plays. HIV rates in the slammer are 3.5 times that outside the walls, and 17% of black men (as opposed to 2.6% of white men) have been imprisoned. “Prisons are huge reservoirs of folks who are most at risk of having HIV by virtue of their [high rates of] drug use,” says Dr. Fullilove. “The circulation of folks going from prisons to the community and then back has got to be a driving factor.”

It’s widely acknowledged that sex, IV drug use and tattooing with dirty needles take place behind bars. But almost all prisons prohibit condom use, and few facilities encourage prisoners to test for HIV—either while they’re in prison or when they get out. Dr. Fullilove has also heard accounts of prison hospital wards reusing syringes.
 
THE TAKE-HOME
Experts say sisters can’t protect themselves by scapegoating others, whether on the down low, on lockdown or down with “other people’s property.” It may sound like a broken record, but Gary Bell, executive director of Philadelphia’s Blacks Educating Blacks about Sexual Health Issues (BEBASHI), advises sisters to “take their power back by insisting on condom use and HIV testing.” In the safer-sex workshops that he conducts, he says women struggle to stand firm on protection. Many men will respond, ‘I’m not gay,’ or ‘I had an HIV test six months ago,’ Bell says.

In a community where “good men” are at a premium, some women roll the dice and decide, “whatever he wants, I will do it,” even if it endangers them, Dr. Fullilove says.

Marvelyn Brown, now a spokesperson for Hope’s Voice, a national HIV prevention organization, and a peer educator for Nashville CARES, tells women to watch their own backs. “It’s about you,” she says. “You have to have enough respect for yourself to protect yourself and your life.”
Lisa’s advice isn’t at all warm and fuzzy. “My advice to women is to trust no one. As sad as that sounds, it’s advice they need to take to heart.”

Real Men Wear Condoms
Guys, you’re not just at risk for hiv. without condoms, you can also get...

Syphilis
Symptoms: Painless sores followed by a rash, headaches, fatigue, fever, sore throat, loss of appetite and swollen glands.
Best Case: Stick it with afew penicillin injections and you’re clear.
Worst Case: Nasty third-stage syphilis can cause blindness, paralysis, cardiovascular and central nervous system damage and death.

Herpes
Symptoms: Tiny itchy and painful sores, fever, swollen glands, painful urination, muscle aches and fatigue.
Best Case: Suppressive antiviral therapy and medication can speed healing and keep outbreaks under control.
Worst Case: There’s no cure. Outbreaks will recur at the site of infection and can spread.

Chlamydia & Gonorrhea
Symptoms: Pain while peeing, white drip and burning sensations around the tip of the penis. But most guys have no symptoms.
Best Case: A visit to the doc and some antibiotics will cure the infection.
Worst Case: Can lead to pain and swelling in the scrotum and a narrowing of the urethra.

Genital Warts (HPV)
Symptoms: Speedbumps on or around your penis.
Best Case: Treatment with liquid nitrogen, laser removal, surgery or chemical removal.
Worst Case: Left untreated, HPV can lead to abnormal cell formation and, in the vagina or rectum of your partner, cancer. 

Additional reporting by Hilary Beard and Angelo Ragaza.