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Blaming 'Down Low' for HIV spread on the way out?

Last year, J.L. King's On the Down Low spent 12 weeks on the New York Times' best-seller list. The book chronicled the author's experience as an African-American man whose public life was as a heterosexual but who pursued a gay lifestyle in secret.

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Besides raising public awareness on what had largely been a taboo subject, King also implied that there was a direct link between men on the "DL" and the high HIV infection rate in women. (According to the Centers for Disease Control and Prevention, black women are 19 times more likely to contract HIV than white women.)

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But a study just released by CDC and Emory researchers suggests that "down low" men may be being unfairly scapegoated for the spread of HIV to black women.

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Dr. David J. Malebranche, who specializes in studying HIV risk in black men, ideally would have liked to study "down low" men directly. But finding them was next to impossible since, by definition, they don't want to be found. Instead, Malebranche looked at more than 24 previous HIV studies. By analyzing other researchers' data, Malebranche and his colleagues were able to question the common assumption that secretive behavior — a fundamental component of the "down low" lifestyle — results in risky sex. For instance, Malebranche's analysis showed that "down low" men were less likely to engage in unsafe sex than openly gay men.

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"The reality is that coming out of the closet may not mean safer sex," he says. "But people don't want to say that out loud."

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Malebranche is quick to point out that his findings rely on studies of "down low" men who were recruited at gay bars and clinics, places where true "down low" men may not visit.

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Still, Malebranche's study is among the first to examine the implications of the lifestyle that King's book brought to the public eye. As to why HIV infection rates are so high in African-American women, Malebranche's study says that the contribution of high-risk heterosexual black men to the spread of HIV has "largely been ignored."

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Malebranche says he hopes that public health officials will focus on promoting sexual responsibility and educating the black community to practice safer sex.




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