Limelight On "Down Low" Lifestyle May Hinder HIV Prevention

Main Category: HIV / AIDS
Also Included In: Sexual Health / STDs;  Public Health
Article Date: 25 Feb 2007 - 0:00 PDT

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Sensational depictions of the so-called "down low" or "DL" lifestyle may unwittingly influence health research and hamper HIV prevention efforts in the African-American community.

Researchers from Columbia University, the University of North Carolina and Duke University sent that caution to colleagues and the popular media in a commentary published in the March issue of the Annals of Epidemiology.

In recent years, a string of widely reported news stories have spotlighted men who openly maintain heterosexual relationships while also secretly having sex with men. The stories typically depict African-American men, and many accounts describe HIV-positive men who spread the infection to their female partners with indifference.

Lead commentary author Chandra Ford, Ph.D., said these stories often imply that the DL phenomenon has fueled the HIV epidemic among black women in the United States.

Ford and colleagues challenge these portrayals and admonish researchers and others to exercise caution when conducting research that could stigmatize black sexuality.

"The lifestyle referenced by the term the DL is neither new nor limited to blacks and sufficient data linking it to HIV/AIDS currently are lacking," the authors write.

Ford said media portrayals of black sexuality have historically been problematic, and she added that epidemiologists, like everyone in society, can be influenced by hyperbolic headlines. "There are sometimes occasions when research assumptions are based not on the results of empirical knowledge but on what researchers see and hear in the media," she said.

"HIV/AIDS is a major public health issue for African Americans and we need all segments of our communities working together to fight it," said Ford, a Kellogg Health Scholar based at Columbia University Medical Center's Mailman School of Public Health.

Popular news accounts rarely discuss ways to meet the HIV/AIDS and mental health needs of men on the DL, she said. "Vilifying the DL will not help men to be better partners in these HIV-prevention efforts," she added.

Ford is concerned that the focus on the DL phenomenon will divert researchers from investigating environmental and society-level factors that contribute to HIV in the African American community. "Inadequate access to health care, high rates of incarceration among black men and other factors deserve more attention than any DL phenomenon does," she said.

"In years to come we may find that the down low does contribute significantly to the HIV/AIDS disparities; that is fine," Ford said. "But it's very important to me that we do not skip over a critical self-examination of our assumptions when we take up these questions of black sexual behavior, particularly behavior that is perceived as deviant or immoral, as the DL lifestyle is often described."

Lisa Hightow-Weidman, M.D., an infectious disease specialist with the University of North Carolina School of Medicine, has read Ford's commentary but was not involved in the research.

"To say that these black men who have sex with men are [deliberately] hiding their sexuality from black women in order to spread HIV is a real disservice and it just spreads stigma and homophobia," Hightow-Weidman said.

"I think this perception of the down low persists in the media because it's sexy," she said. "It's exciting to the media to scapegoat a particular group, and certainly black men for years have been scapegoated as vectors of disease. It's easier to ignore, take the blame off society, poverty and structural factors if you have a scapegoat," Hightow-Weidman said.

"It's also a disservice to black women," she said.

Ford agrees. "Many of the women that I've spoken with about this are paralyzed," she said. "These stories have created an environment of fear that is disempowering."

"Instead, it's important to empower black women, white women all women to protect themselves," Hightow-Weidman said.

Ford CL, et al. Black sexuality, social construction, and research targeting 'the down low' ('the DL'). Ann Epidemiol 17(3), 2007.

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