The first large-scale investigation comparing self-identified sexual orientation with sexual behavior, released by the New York City Department of Health last fall, reported that 10% of New York City men who identify as “straight” have had sex only with men in the past year. Media accounts used this to focus on the often sensationalized phenomenon of black men secretly sleeping with other men, dubbed the “down low,” instead of, as study authors had intended, the importance of targeting HIV prevention beyond merely men who call themselves gay. But while talk of the down low focuses on the black community, 38% of the study’s straight-identifying men who have sex with men (MSMs) were white, 23% were black and 29% were Hispanic. Preeti Pathela, DrPH, the study’s lead author, says, “When we think of down low, we think of men who don’t admit to having male sex partners. These men admit to it. What the study does show is that whether you are a health care provider or a sexual partner, it is important to ask about behavior.”

These MSMs were 40% less likely to have been tested for HIV and less likely to use a condom than men who identified as gay (though they did list fewer sex partners). “We’ve known that there are many MSMs who don’t identify as such for a long time,” says David Malebranche, MD, MPH, professor of medicine at Emory University. “I do give the authors credit for concluding that instead of getting bogged down in identity, we should focus on the fact that many of the men were having unprotected sex.” The majority of the men are married and foreign-born, and many current prevention messages targeted toward gay men and posted in places gay men frequent may never reach them. Donald R. Powell of Gay Men of African Descent (GMAD) says, “These men won’t step foot in GMAD, so we need to go where they are. We changed our outreach materials to say GMAD [and not spell out gay men]. Sexuality is and should be fluid.”