The Hidden Epidemic

Last Editorial Review: 1/30/2005

Bi Men Under the Radar

By Daniel DeNoon
WebMD Feature

July 9, 2001 -- America has a new AIDS demon, but it's understanding, not exorcism, that's needed.

They are men on the down-low, or DL -- bisexual black men whose sexuality is kept secret. And it can be a deadly secret. The latest CDC figures show that the AIDS virus infects nearly a third of young, urban, black men who have sex with other men. But it's not that they can't get the safe-sex message. The safe-sex message is not getting to them.

That's the view of Jamal Bey, manger of the Black Brothers Esteem project of the San Francisco AIDS Foundation, which offers support and education to gay and bisexual black men.

"Down low means under the radar screen; it means not on the surface -- so the fact that you have to go down low to find some kind of connection that you can't find in your day-to-day life speaks for itself," Bey tells WebMD. "The debate about men on the DL is creating even more of a wedge of homophobia between these men and their community."

A Vicious Cycle

Homophobia is the fear that underlies discrimination against homosexual men and women. How could homophobia be to blame for the way a man chooses to lead his sex life? Actually, it's at the heart of the issue, says Georgia State University psychologist John Peterson, PhD.

"African-American men can engage in same-sex behavior as long as they remain closeted," says Peterson, who has conducted extensive studies on the AIDS-related attitudes and behaviors of gay and bisexual black Americans.

"These men feel they must remain a part of the African American community but face stigma if they come out. So they continue to feel negatively about themselves regarding this part of their life. This constant anti-gay sentiment -- without any alternative to live out their lives in another community -- creates enormous self-denigration and poor self-esteem. This is very different from what white men experience," he says.

Community support is vital to an African-American man's sense of identity, Peterson says. But gay and bisexual black men are caught on the horns of a dilemma -- they risk losing that vital community support if they reveal their sexual identity. Peterson stresses that there is no more homophobia among black Americans than among white Americans, but his studies show that black men suffer far more from this loss of community than do their white counterparts.

"So these men really have these very poor feelings about themselves because their community will not accept that part of them," he says. "This leads to the likelihood that if they need support around HIV they will not receive it from the very community they want to remain a part of. That leads to the likelihood they will not receive a proper HIV message. It leads them to feel further denigrated and alienated from the community and leaves it more likely that they will engage in high-risk behavior."


Best-selling novelist E. Lynn Harris writes about the problems faced by black men whose sex lives are not exclusively heterosexual.

"I do think they have been made targets, and I think that is really sad because people don't understand the difficulties of being both black and bisexual," Harris tells WebMD. "Especially in our own [African-American] community, you don't want to be ostracized from your own family. It has made it hard for these men to be true to themselves and to be true to the people with whom they become involved."

Often these men cannot admit their true sexual identity even to themselves. This makes safe sex extremely difficult to accept.

"For some men, putting on a condom is entering into a thought process -- 'I am actually having sex with another man; I am conscious of what I am doing,'" Bey says. "My theory is that the problem for men who might use a condom with a man and not with a woman is about acknowledgement of who they are."

The problem often stems from the very place where men might otherwise turn for support -- their church.

"I would tend to agree that the African-American church promotes homophobia," Harris says. "There is a semiannual gay or bisexual 'damnation sermon' in most churches. That crumbles the soul of people, and it is very disastrous. [They should] preach love and respect for individuals' right to be who they are."

Recognizing this problem, the nonprofit organization Balm in Gilead works not only to end discrimination against homosexual men and women, but to put black churches at the forefront of AIDS prevention and care. Pernessa C. Seele, Balm in Gilead founder and CEO, says this change is well under way.

"I strongly believe that all black churches are not homophobic -- all African-Americans are not homophobic," Seele tells WebMD. "In my work with black churches over the course of 12 years, I have seen more and more churches get involved in HIV prevention from an inclusive point of view. I am seeing them move through the process. I saw my preacher the day he began to talk about the inclusion of gay people in our church. He was saying, 'We have gay members in our church and in our families, and if we are going to get over HIV we have to get over our homophobia.' That is the kind of movement that is happening all over our country today."

But the church is only part of the solution, she says.

"All of us, the entire African-American community at large, have a role to play in breaking down the barriers of homophobia," Seele says. "The black gay community has just as much a role to play as the church does."

Success Means Tackling Myths

"I would like to have the issue seen as how do you get people into HIV testing? How do you do an education campaign for DL men?" says Bey. "We want to talk to people about risk and testing and self-esteem issues. We don't want to point fingers. It is just a vicious cycle when people point to this segment of brothers and say the reason why HIV transmission rates are so high in our community is that black men are secret about their sex. Some of this is true -- but let's put it in context."

Peterson's academic research echoes Bey's street-wise perspective.

"Programs and media campaigns are largely going to have to focus on the myths about sexual orientation," Peterson says. "They must help the general public understand that ... people are engaging in sexual behaviors that they have no more choice about than heterosexuals in the general population have about their sexual behavior. When you begin to help people understand these things you help them change their attitudes about sexual behavior that differs from their own."

Bey's work focuses on rebuilding self-esteem -- and training each person to be a leader.

"We encourage men to learn how to advocate for themselves, to be leaders in their own lives," he says. "If you can build those skill sets, it is diffusion: Each one teach one. If you work with individuals, whether gay or senior or youth, they go out and communicate these messages."

Seele sees the issue in the historical context of black consciousness.

"The black gay community is a subset of an oppressed community," she says. "One of the things that changed the African-American community was when James Brown came out and said, 'I'm black and I'm proud.' I believe that black gay men must stand up and say, 'Yes, I'm black and gay and proud. It comes down to accepting yourself."

Peterson also stresses the link between self-esteem and responsible behavior.

"My message to bisexual men is that one sexual behavior, be it bisexual or homosexual or heterosexual, is just as natural as the other," he says. "There is nothing to feel guilty about or shameful about because you have a particular sexual attraction or tendency. What you need to do is find a way to receive the support you need to live your sexual life in a way that is healthy. That means engaging in whatever sexual activity you find fulfilling -- but safely, so you pose a risk neither to yourself nor to your partner."

Not Just a 'Gay' Message

"Clearly we need many more interventions to prevent HIV and studies among African-American and Latino men who have sex with men -- both those who identify as gay and not," says Peterson. "We have very few of these programs. We need a substantial increase in resources and research. The types of programs we need are those that encourage HIV testing and counseling, and programs that address the kind of resources men need to reduce risk of HIV transmission. We need programs for the already infected that provide adequate treatment services, and for those not infected we need risk reduction tailored to their needs."

The focus of these programs must go beyond AIDS prevention.

"We will have to address more than HIV because of the plethora of needs of men who are going to be unemployed and who are from high poverty groups," Peterson says. "We need not just HIV counseling but programs that deal with the whole person. ... We need programs that deal with general health, unemployment, and poverty, because these are the issues that confront African-American men."

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