Assumption of 'down-low' lifestyle can distort HIV/AIDS research

A commentary published in the March issue of Annals of Epidemiology questions whether black men pursuing a "down-low" lifestyle -- when black men secretly have sex with both male and female partners -- are causing an increase in HIV cases among black women, Reuters Health reports.

The lifestyle came to light after the media began to report on books written by such men, according to the commentary's lead author, Chandra Ford of Columbia University.

"Part of what has happened as a result of that initial burst of stories ... is that those stories often tied the down low to high rates of HIV infection among African-American women, which was not supported by epidemiological data," Ford said.

According to the commentary, men of all races and ethnic groups secretly have sex with both women and other men.

In addition, larger numbers of HIV cases occur among black men and women than other races, though they report fewer riskier behaviors.

Ford said that increased attention on the lifestyle could cause men who secretly have sex with other men to further disguise their lifestyle and also become less likely to seek medical treatment.

In addition, the high profile on the lifestyle also shifts the discussion away from measures to prevent HIV, such as routine testing, Ford said.

She suggested that researchers examine other approaches to explain the higher numbers of HIV cases among blacks (Harding, Reuters Health, 2/28).

An abstract of the commentary is available online.