We need to do a better job talking to straight black men about HIV

Gay men and heterosexual women are often urged to take sexual safety into their own hands, but very little is being done for black, heterosexual men—and it’s a problem.

In fact, black men represented 68 percent of all heterosexually acquired HIV cases amongst men in 2011, despite making up only 12 percent of the U.S. male population. According to a recent CDC report, which uses figures from 2010, African-Americans in general (male, female, gay, straight) accounted for 44 percent of all new HIV cases, 38 percent of which were attributed to heterosexual sex.

Not only that, black men were 2.7 times more likely than black women to contract HIV and 6.6 times more likely to contract HIV than white men.

A new study published in the journal Health Psychology set out to discover why there’s an over-representation of straight black males contracting HIV and how to better promote safe sex—and debunk the misconception that straight black men with HIV may secretly be gay.

The study

For the study, researchers from The George Washington University conducted in-depth interviews (lasting 90 minutes) and focus groups with 56 black, heterosexual men from the Philadelphia area, aged 18 to 44, many of which came from low socioeconomic backgrounds

The purpose of the interviews was to find out how these men viewed safe sex (namely condom and other contraceptive use) and how their viewpoints influenced their actions.

The researchers found several prevailing ideas shared by the men, which in turn highlighted the shortcomings of safe sex education within this community.

1. Women are untrustworthy: Rather than viewing condoms as a way to prevent STDs / HIV, the men largely viewed condoms as way to tell whether or not a woman wanted to trap them. Specifically, if a woman wanted to use a condom, that meant she wasn’t trying to trick her partner into pregnancy—and was thus deemed safe.

At the same, if the woman provided the condom herself, then her status reverted back to unsafe. The logic? A woman could poke a hole in the condom or otherwise tamper with it.

“That’s dangerous there . . . usin’ their [a woman’s] condom,” said one male in the focus group. Followed by another shouting, “Entrapment!”

2. Safe sex is the woman’s responsibility: Still, many men saw women as the condom gatekeepers. It was a woman’s job to push for condom use and the man’s job to try and sneak it in without it.

“I have had some women who have insisted upon it [wearing a condom], but all the time I’m thinking of a way to get it off, you know?” said Ricky, a 40-year-old in the group.

The men also viewed women as the carriers, or vectors, of STDs, placing blame on them for the spread. As one male pointed out:

“They don’t care! And that could stop a lotta the issues!”

The issues he’s referring to are STDs and unwanted pregnancy, not taking into account that men, too, hold the power to push for condom use.

3. Not using condoms can be a sign of intimacy and trust—not risky behavior: Many of the men held the belief that not using a condom meant you were with a partner you trusted—and that it could signify taking a relationship to the next level.

While explaining this, one man inadvertently highlighted the risk that comes with ditching condoms by also mentioning his “side partner.” First he talked about his main partner, saying:

“I might know how she take care of her body, right? She might take something that’s guaranteed for her not to get pregnant or something like that.”

Then added:

“But your side partner, you don’t know nothing about, so you gonna strap up [use a condom].”

Another focus group member then interjected,

“Well, it’s because of AIDS. You know what I mean?”

4. Finally, condoms are used for safe sex: The men interviewed were somewhat aware that condoms were used to prevent disease, despite that notion rarely factoring into their decisions about condom use.

“I always heard about, you know, people get AIDS you know, people getting burnt [contracting a STI]. People getting all types of disease, so I’m like, well I ain’t trying to be one of them, so you know what I mean? It’s always just put on a condom.”

On the surface there appears to be a disconnect: The men are aware that they should be wearing condoms, but they aren’t concerned enough to wear them all the time.

But as Lisa Bowleg, a professor at The George Washington University and lead author on the study, told Fusion in an email: “The link between knowledge and behavior is not as solid as we think (ask anyone trying to lose weight by not going to the gym).”

And with this population, the knowledge and awareness itself is still lacking. “There are so few messages about their risk (versus say that of gay black men) anyway, that one could argue there is no disconnect; they are simply in concordance with what public health messages are signaling.”

Which is why more of an effort must be made to bring awareness to the situation.

So what can be done?

The best place to start is with safe-sex education, which means changing the way we as a society (public health officials, parents, teachers, mentors) talk about safe sex and targeting at-risk groups. Right now, black men are largely neglected in this sphere.

“Much of the onus remains on women to prevent HIV and STI transmission. Men are surprisingly absent from most of these discourses,” said Bowleg.

For example, she mentioned that campaigns like Take Charge, Take the Test, and Testing Makes Us Stronger encourage black women—but not black men—to get tested for disease and infection. (The latter also encourages gay black men to get tested, but not straight men.)

Bowleg said both parents (when the men are young) and media campaigns can help bring straight black men into the fold by driving home the risks of unsafe sex in specific contexts.

“Public health messages need to keep up a steady drumbeat of education about the importance of condom use,” she said. “It’s too easy to become lax about condom use and all of the reasons why you don’t need to use condoms.”

Finally, let’s debunk misconceptions about black men with HIV

Another important step? Debunking the prevailing myth that straight black men who contract HIV may be secretly gay, and therefore the problem doesn’t apply to “real” straight men.

“There is this notion that any HIV-related talk about HIV in black men must mean that they are also having sex with men,” said Bowleg, when asked why more people aren’t talking about the issue.

Historically, HIV in black men has largely been categorized as a gay issue, something straight men don’t have to worry about—but that’s clearly not the case.

“The Centers for Disease Control and Prevention and research have debunked the notion of the bisexual bridge and the ‘down low’ as the primary route of heterosexually transmitted HIV in black communities, but this view persists, alas,” Bowleg said.

When it comes down to it, preventing the spread of HIV is something we all need to worry about. Black, white, Asian, Latino, gay, straight—trying to save lives is a human issue.

Correction: This article previously stated that black men represented 68 percent of all heterosexually acquired HIV cases in 2011. It has been updated to reflect they represented 68 percent of all heterosexually acquired HIV cases amongst men.

Taryn Hillin is Fusion’s love and sex writer, with a large focus on the science of relationships. She also loves dogs, Bourbon barrel-aged beers and popcorn — not necessarily in that order.