Oh, my goodness! Straight men have sex with other men? Married straight men? Married non-black straight men? Oh, my! Who knew?
...Well, anyone with a functioning brain, actually, but we'll get back to that.
Nearly one in 10 men who say they're straight have sex only with other men, a New York City survey finds. And 70% of those straight-identified men having sex with men are married. In fact, 10% of all married men in this survey report same-sex behavior during the past year.
This means safe-sex messages aimed at straight and gay men are likely missing this important subgroup, suggest Preeti Pathela, DrPH, New York City Department of Health and Mental Hygiene, and colleagues. "To reduce the burden of sexually transmitted diseases and HIV infection among men who have sex with men, it is of utmost importance for [health care] providers to take a sexual history that ascertains the sex of a partner," Pathela and colleagues report. "Asking about a patient's sexual identity will not adequately assess his risk."
In 2003, Pathela's team performed telephone interviews with nearly 4,200 New York City men. They conducted the interviews in English, Spanish, Chinese, and Russian; a translation service helped with interviews in Greek, Korean, Yiddish, Polish, and Haitian Creole. In nearly every study of sexual behavior, the percentage of men who report sex with men is higher than the percentage of men who report being gay. So Pathela and colleagues first asked the men if they were bisexual, gay, or straight. Then they asked about specific sexual behaviors.
Some of the findings:
* Straight-identified men who have sex with men report fewer sex partners than gay men.
* Straight-identified men who have sex with men report fewer STDs in the past year than gay men.
* Straight-identified men who have sex with men are less likely than gay men to report using a condom during their last sexual encounter.
* Straight-identified men who have sex with men are more likely to be foreign born than gay men.
Also, a man who says he is straight but is having sex with other men is more likely to be married than a straight man who has sex with women, according to the survey. Only 54% of the men who say they're straight and have sex with women are married, compared with the 70% marriage rate among the men who say they're straight but have sex with men....
Discordance between Sexual Behavior and Self-Reported Sexual Identity: A Population-Based Survey of New York City Men
Preeti Pathela, DrPH; Anjum Hajat, MPH; Julia Schillinger, MD; Susan Blank, MD; Randall Sell, ScD; and Farzad Mostashari, MD
Annals of Internal Medicine
19 September 2006 | Volume 145 Issue 6 | Pages 416-425
Background: Persons reporting sexual identity that is discordant with their sexual behavior may engage in riskier sexual behaviors than those with concordant identity and behavior. The former group could play an important role in the spread of sexually transmitted diseases.
Objective: To describe discordance between self-described sexual identity and behavior among men who have sex with men and associations between identity–behavior and risk behaviors.
[...] Men who have sex with men account for 45% of incident cases of HIV infection in the United States annually (1). Despite earlier declines in incidence rates of HIV infection among men who have sex with men (2, 3), recent data show increases in high-risk sexual behaviors (4, 5), sexually transmitted diseases (STDs) (6–9), and HIV diagnoses (10) among these men.
Previous research has found discordance between self-reported sexual identity and sexual behavior in men (11–13). Several reports (14–22) have focused on risk behaviors among men who have sex with men and acknowledge having male sexual partners but do not report a gay identity. Compared with gay-identified men who have sex with men, these men were less likely to use condoms during anal intercourse with other men (21) and less likely to have been recently tested for HIV infection (17). Because of secrecy about their sexual identity, these men may be distanced from the gay community, where most activities that focus on HIV prevention in men who have sex with men occur; therefore, they may have an increased risk for acquiring HIV infection and other STDs.
[...] Among men, 91.3% reported straight or heterosexual identity, 3.7% reported gay identity, 1.2% reported bisexual identity, 1.7% responded "not sure or don't know," and 2.1% declined to answer the question. Of men who answered the questions regarding the number and sex of their sex partners, 70.6% reported having sex with only women, 9.3% reported having sex with only men, 0.8% reported having sex with men and women, and 19.3% reported no sexual activity during the past year. The final sample for which identity–behavior groups were constructed consisted of men reporting sexual partners in the previous year who also reported a straight, gay, or bisexual sexual identity; this included approximately 69% of 4193 surveyed men. Demographic characteristics of the 2898 men who were included and the 1295 men who were excluded were largely similar; however, the men who were not included were more likely to be older (>65 years of age) and to report a divorced, separated, or widowed marital status.
[...] Approximately 70% of straight-identified men who have sex with men reported being married, which was substantially more than any other identity–behavior group: 54% of straight-identified men who have sex with women and only 0.2% of gay-identified men who have sex with men reported being married. Gay-identified men who have sex with men were more likely than the men in the other groups to report a higher educational level, a higher annual income, and residence in Manhattan.
Table 3 shows the differences in behaviors and health status among straight-identified men who have sex with women, gay-identified men who have sex with men, and straight-identified men who have sex with men. Straight-identified men who have sex with women and straight-identified men who have sex with men reported having fewer sexual partners than gay-identified men who have sex with men; 15% of straight-identified men who have sex with women, 2% of straight-identified men who have sex with men, and 33% of gay-identified men who have sex with men reported having 3 or more partners in the previous year. Almost 96% of straight-identified men who have sex with men reported having only 1 sex partner in the past year....
I confess, one of my feelings about this study and its results was a certain sense of relief. At last, what should have been perfectly obvious to anyone with a brain is being said explicitly: the whole "down low" phenomenon is not limited to black men. And this non-news is now getting pushed out in a way that people may notice. (After all, I think there are comparatively few black men who speak Greek, Korean, Yiddish, Polish, Chinese or Russian, or who would need an interview conducted in that language.) To put it at its most optimistic, maybe this will increase rational dialogue between people about sex and sexual behaviors. To put it at its most cynical, now women of all races can join in the neurotic discourse that black women have been having about this issue the past few years.
The truly ridiculous behavior that seems to be the same across ethnic groups is that married straight men having sex with other men, despite having a life that they seem to want to keep and protect, are less likely to use condoms or other methods of protection. This goes part and parcel with the idea that preparing for gay sex means that you're actually wanting and having gay sex. There's also the additional issue that, if you're not using condoms with your wife and she finds them, it's prima facie evidence of infidelity. Getting condoms wouldn't be any more or less difficult for these men that for anyone else; keeping them hidden from your family -- and to some degree, yourself -- on the other hand is a notably more difficult proposition. I would also imagine that a lot of this sex is spur-of-the-moment, not thought out (because if you thought it out, you'd duck into a drugstore, buy a single condom, and discard the evidence afterward, and because, again, most of these men can't allow themselves to think it out) which in and of itself would make it more difficult to prepare. The interesting thing, looking at the study's findings on STDs and condom use in these groups, is how very lucky the straight-identified men get on the STD wheel of fortune. To be sure, the bulk of them seem to have comparatively few sexual partners, so it's easier to get lucky; fewer sexual partners means less exposure during the careless sex they're having.
(It would be fascinating if they could get together the people to determine their marriage arrangements. I would be willing to bet that a few of the men -- a very few, to be sure -- had actual open marriages, as opposed to the more typical "It's open because I'm fooling around, so what more do you need to know?" type of open marriage. I would also be willing to bet that those men were more conscientious about using protection, because they didn't have to hide what they were doing from themselves or their partners. But that's just a guess.)
Regardless, I'm not sure how you reach these people with any sort of ad or public education campaign. What do you say, precisely? "Hey, you over there! Yeah, you, that guy thinking about cheating on his wife with that hot man you see. Remember to use a condom! Protect yourself and your wife from your marriage-betraying asshole self!" Because, even without the invective at the end, that would work so well, wouldn't it?
Purely a fascinating side note: interesting well that Kinsey figure of 10% of men reporting same-sex encounters holds up, isn't it?Posted by iain at September 19, 2006 11:25 AM