PLEASURE

Pleasure Has No Passport, No Identity Card Can We Separate Sexual Practices from Identity?

Pleasure Has No Passport, No Identity Card Can We Separate Sexual Practices from Identity?

Introduction

Men who have sex with men and women (MSMW) represent an important target population for understanding the spread of HIV because of the inherent bridging aspect of their sexual behavior. Despite their potentially central role in the HIV epidemic,1 , 2 much of what is known about MSMW is anecdotal, coming from the popular media, and has been discussed as the “down low” phenomenon among black men.-6 The considerable research on male same-sex behavior typically focuses on men who have sex with men only (MSM) and does not treat MSMW as a distinct subpopulation (Hightow, 2006, 585-593).

A survey of about 10,000 men who have sex with men conducted in 2003-2005 by the Centers for Disease Control and Prevention in 17 US metropolitan areas found that 14% also reported having sex with women in the previous 12 months. While this study did not report on racial/ethnic differences in male bisexuality, a review of 26 studies by Millet and colleagues5 concluded that among MSM in the USA, bisexual behavior is more prevalent among blacks than whites and Latinos (Hightow, 2006, 585-593). For example, a 12-state study of HIV-positive MSM found that 34% of blacks, 26% of Hispanics, and 13% of whites reported having sex with women (Malebranche, 2008, 810-816).

Although widely speculated, evidence to support the notion that the sexual practices of MSMW account for much of the HIV prevalence among heterosexual women is lacking. For example, Adimora and Fullilove report that only about 5% of men report ever engaging in sex with another man, and less than 1% of sexually active men report bisexual behavior in the past year. Of black men, it is estimated that 2% are bisexually active (Deren, 2004, 1067-1074). Further, limited HIV prevalence data exist for the MSMW subpopulation, and data about bisexual men as a transmission source for women are inconclusive (Malebranche, 2008, 810-816). Nonetheless, Adimora and Fullilove10 compellingly argue that MSMW may have a “substantial impact on population transmission” that goes well beyond the actual number of women they directly infect with HIV. As evidence, they cite a study by Hightow and colleagues2 of HIV seropositive college students on North Carolina campuses that found MSMW bridged six separate sexual networks into one interconnected component spanning 26 schools (Deren, 2004, 1067-1074). Thus, while the sheer numbers and proportions of bisexually active males may be low, their positioning between otherwise disconnected populations and geographies makes them an important target for HIV prevention (Chu, 1992, 220-224).

How and to whom MSMW are networked have important implications for understanding HIV transmission. Recent epidemiological evidence suggests that a risk partner's characteristics may be as or more important than behaviors with that partner. , 12 In this paper, a series of “who” and “with whom” questions are addressed regarding MSMW—who they constitute, with whom they identify, and with whom they have sex and use ...