The uncritical use of the term ‘on the down low’ in HIV prevention strategies is likely to undermine efforts to understand the nature of HIV risk among African-American men, write researchers in the January 2009 issue of Social Science & Medicine. The term is used to describe black men who identify as heterosexual but have secretive sex with other men, but the authors believe its use stigmatises and exoticises this behaviour as an issue unique to black men.
In the United States, HIV infection rates are seven times higher among African-American men than they are for white men, and twenty times higher for African-American women than white women. In discussing the issue, the media have frequently focused on the possibility that men ‘on the down low’ have high-risk sex with other men and may also be responsible for HIV transmission to their female partners.
Moreover, some public health and HIV prevention professionals have used the term in order to highlight a subgroup of men whose needs may be overlooked in programmes for gay men.
The authors highlight the origin of the term in African-American communities in the early 1990s. At the time it simply meant a desire for discretion or secrecy, and there was no specific reference to sexual behaviour. However it was later appropriated by African-American men to describe secretive same-sex behaviour, as an alternative to terms such as gay or bisexual which are stigmatised in black communities. Appropriating the term “has functioned to reinforce men’s sense of masculinity and membership in the African-American community,” the authors write.
However authors believe that there are several problems with outsiders such as public health professionals using this terminology:
- It suggests that there is something unique and peculiar about African-American men’s same-sex behaviours that merits special language, whereas similar behaviours are found in men of other ethnicities.
- Discussion often assumes, but does not demonstrate, that men ‘on the down low’ engage in behaviour that is particularly risky for HIV transmission.
- It may also be assumed that these men are inherently gay, but are yet to embrace that identity. This characterises men’s self-understanding as flawed and dishonest.
- The way African-American men use the term is likely to change over time, and not all will agree on its meaning. However outsiders’ use of the term does not reflect this.
- The term is used as a simple label, without understanding the social, cultural and historical factors that drive behaviour.
The authors don’t deny that there are African-American men who have secretive sex with other men, and suggest that qualitative research could further clarify their HIV prevention needs.
However they underline the importance of poverty, racism and social inequality to the HIV epidemic, and note that few HIV prevention interventions address these structural factors. Moreover, targeting interventions to men who fit the ‘down low’ profile “conforms to a narrow, individual-level approach to HIV prevention”.
Saleh LD & Operario D Moving beyond ‘the Down Low’: a critical analysis of terminology guiding HIV prevention efforts for African American men who have secretive sex with men. Social Science & Medicine 68: 390-5, 2009.