The previous blog entry discussed the first article in a special section of the recent issue of the Archives of Sexual Behavior. The journal presents a number of articles devoted to the issues and complexities involved in Black male bisexuality and its connection with risk. As was noted previously, very little scientific research exists regarding the topic.
One article in this series by Darrell Wheeler and his colleagues compared Black men who have sex with both men and women (MSMW) to Black men who have sex only with men (MSM). The authors did not categorize the men in the study in terms of whether they identify as gay or bisexual, but rather only in terms of the types of sexual behaviors in which they engage. This is because of the complexity of the way in which people apply sexual identity labels to themselves; individuals may engage in behavior that is inconsistent with the label they ascribe to themselves without the behavior affecting the way they view themselves. Specifically, in this case, men may engage in sexual behavior with other men, but view themselves as largely or completely heterosexual. Furthermore, the authors were concerned about the occurrence of risky sexual behavior, such as unprotected penile-anal and penile-vaginal intercourse; this of course is sexual behavior in which a condom is not used, which dramatically increases the risk of infection by a sexually transmitted disease. Consequently, they instead identified men in terms of the sex of their partners and also asked them about the frequency of engaging in anal or vaginal sex when not using a condom.
The study involved a very large number of participants, 1154 men from New York City and Philadelphia; 822 of the men actually met the criteria for inclusion in the study. Of these, 226 were men who have sex with women and men, while 596 were men who have sex with men. They were recruited through a procedure called respondent-driven sampling, a strategy to overcome the challenge of locating men who engage in sexual behavior with other men (contrary to stereotypes, it is not possible to accurately identify such men based on easily observable characteristics). In the respondent driven procedure, an initial set of men who engaged in sex with other men was located through community organizations; these men were paid $15 for each eligible individual they recruited for the study, up to a maximum of three individuals. Those who participated were then paid to recruit up to three other men to participate. The process continued until the researchers obtained the targeted number of participants.
The results of the study were that men who have sex with men (MSM) were more likely to be at risk for HIV infection, to be HIV-positive based on tests conducted for this study, but to be unaware that they had been infected compared to men who have sex with both women and men (MSMW). The men who have sex with men were more likely to report that they had engaged in unprotected sex in which their partner inserted his penis in their anus (unprotected receptive anal intercourse). No difference was found between the two groups in inserting one’s penis in a partner’s anus (insertive anal intercourse). The findings for receptive and insertive anal intercourse have been found in other studies that have not focused exclusively on Black men. The authors propose that MSMW and MSM are equally willing to accept the risk associated with insertive anal intercourse because it involves less risk, but that the greater risk associated with receptive anal intercourse causes MSMW to be less willing to be receptive during anal intercourse.
Important differences were found between the two groups in terms of their economic well-being, with MSMW having lower income, less education, and more likely to be unemployed than MSM. MSMW were also more likely to have engaged in recent exchange sex, having anal sex with a casual partner for money, drugs, a place to stay, or to get other resources they needed. They were also more likely to report recent substance use, being arrested two or more times in their lives, and supporting more than one person with their income. This suggests that men who have sex with both women and men may tend to engage in anal intercourse for economic reasons, because they need money to support themselves and others or to obtain drugs or alcohol. In fact, the strongest factor related to engaging in either receptive or insertive anal intercourse common to both MSMW and MSM was engaging in exchange sex.
The next most influential factor related to engaging unprotected anal intercourse for both groups of men was having a gay identity, that is explicitly labeling themselves as being gay or homosexual. Gay identified men were more likely to engage in unprotected receptive anal sex, as the authors state “the riskiest behavior associated with HIV infection” (p. 705). Sexual orientation identity did not relate to the tendency to engage in unprotected insertive anal intercourse, again possibly because it is relatively less risky than receptive sex.
As it turned out, the majority of men reported sexual orientation identities that matched the types of sexual behavior in which they engaged. That is, most men in the group labeled MSMW identified as bisexual and most men in the MSM group identified as gay. Nonetheless, substantial proportions of men in the MSMW group identified as heterosexual (24%) and substantial proportions of MSM identified as bisexual (25%). These results strengthen the generally accepted conclusion among scientists that sexual orientation identity is not extremely accurate in understanding the types of sexual behavior in which individuals may engage.
Wheeler, D. P., Lauby, J. L., Liu, K., Van Sluytman, L. G., & Murrill, C. (2008). A comparative analysis of sexual risk characteristics of Black men who have sex with men or with men and women. Archives of Sexual Behavior, 37, 697-707.
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