By Alex Vaughn

Young black men who have sex with men (MSM) get infected with HIV nearly five times more often than MSM from other races, even though they don’t have more unprotected sex.

The discrepancy has long mystified  public health experts, but a new study by investigators at Johns Hopkins and elsewhere now offers a possible explanation for it.

The study found that young black  MSM – a group that includes openly gay and bisexual men, as well as those who have sex with men but do not identify themselves as gay or bisexual – select  partners and judge these partners’ HIV  status in a specific way. The results are based on interviews with 35 black men ages 18 to 24 who have sex with men in New York City, Upstate Ney York and Atlanta. The most notable findings include an overwhelming preference for masculine partners, accepting masculine partners as dominant in the sex act and leaving to them decisions about condom use,  perceiving masculine men as low risk for HIV and feminine men as high risk.

“There may be no difference in HIV prevalence between masculine-looking and feminine-looking men, but because black MSM perceive masculine men as lower risk, their sexual encounters with such men may make HIV infection more likely,” said investigator Jonathan Ellen, M.D., a pediatrician and teen health expert at Johns Hopkins Children’s Center.

In other words, even though young black MSM have unprotected sex just as often as others, they may be having unprotected sex in riskier ways with partners whose HIV status they often miscalculate, the researchers explain.

The findings offer new insight into how black MSM judge risk based on perceptions of masculinity and can help inform public health campaigns to reduce new HIV infections in this disproportionately affected group. The findings, the researchers say, can also guide safe-sex conversations between primary care physicians and patients.

Lead author, Dr. Errol L. Fields, a  pediatric resident at Children’s Hospital Boston and Boston Medical Center, says young black males who have sex with men have twice the number of new HIV infections as young Hispanic and white men who have male partners. Young black males who have sex with males are five times more likely to be HIV-infected than white males of similar ages, Fields says.

“We interviewed young black men to hear the stories behind these statistics,” Fields said in a statement. “Most of the men interviewed said they preferred to partner with men they perceived as masculine and they allowed partners who were more masculine to control what sexual activity they engaged in and whether they used condoms,” Fields says.

“We found that their beliefs about masculinity may affect their ability to protect themselves against HIV,” Fields says. “For example, many believed that men who acted more feminine were at greater risk for HIV than men who acted more masculine.”
Jonathan Ellen, M.D., a pediatrician and teen health expert at Johns Hopkins Children’s Center presented the findings of their study at the 2011 Pediatric Academic Societies Annual Meeting in Denver.

In 2006, male-to-male sexual contact was associated with an estimated 63% of new HIV infections among black males. Data from CDC’s National HIV Behavioral System show that, in 2008, 59% of HIV-infected black men who have sex with men (MSM) did not know they were infected compared with 26% of white MSM.

Young black MSM need to be encouraged to be tested, to know their HIV status and to be educated that masculinity/femininity doesn’t equate with HIV status.