Homophobia could be causing black men who have sex with men (MSM) to engage in more risky behavior for HIV, according to a new study published in the journal AIDS and Behaviour.

“We found that experiencing homophobia was independently associated with sexual risk behavior that can result in both transmitting and acquiring HIV infection,” says lead study author William Jeffries, an epidemiologist at the Center for Disease Control’s Division of HIV Prevention.

The new research considered the HIV status of 1,140 sexually active MSM in New York City and Philadelphia between 2005 and 2006. It looked at the association between men experiencing homophobia within the last year and unprotected anal sex.

For men who were HIV-positive, experiencing homophobia was significantly linked to having unprotected anal sex — which placed their partners at increased risk of getting HIV. There were similar, though less strong, associations between homophobia and HIV-negative men having unprotected sex.

Recent reports show that 28 percent of black U.S. MSM are HIV-positive, compared to 18 percent of Latino and 16 percent of white MSM. At an individual level, risky sexual behavior alone does not explain these differences. On the contrary, black MSM engaged in less drug use and risky sexual behaviors than MSM from other racial groups.

“Black gay men generally don’t engage in greater risk behavior than white gay men,” says A. Cornelius Baker, senior communications director and project manager at Centre on AIDS and Community Health. “They have fewer sexual partners, they are more likely to use a condom in their sexual encounters than white gay men, but yet they have higher rates of HIV. We also know the same for black women.”

For men who identified as gay in the study, there were no associations between homophobia and recently having unprotected anal sex.

HIV is most often spread between MSM who are in relationships. Having unprotected sex within relationships can signify intimacy for both partners and was also more likely to happen between committed partners in this study.

“Men do not use condoms for a variety of reasons,” Baker explains, “including lack of sexual intimacy and reduced sensitivity, stigma against condoms, low perception of risk, and beliefs that wearing a condom indicates unfaithfulness.”

Homophobia had been linked to less condom use and more risky sexual behavior for MSM. For black MSM, homophobia comes typically from people in their social circles from whom they might anticipate support.

Fifty seven percent of black MSM had internalized homophobia, having negative feelings about themselves and believing that homosexuality is ‘always wrong,’ according to one report.

“Internalized homophobia may be reflective of the larger communities’ views on homosexuality,” explains Jeffries.

Both external and internalized homophobia could lead black MSM avoiding HIV-related interventions — including condom use — thereby putting themselves at risk of getting and transmitting HIV.

HIV on the “down low?”

Suggestions have been made that high rates of HIV-AIDS in U.S. black communities are driven by gay black men spreading the virus on the “down low.”

“Down-low” HIV spread seems to be driven more by homophobia and a demonization of gay men as vectors of disease in the black community than real evidence, Baker says.

The majority of HIV infections among African-Americans are spread by gay men to gay men and by heterosexual men to heterosexual women, he adds. Evidence to support the “down low” spread of HIV is weak.

Explaining that only two percent of black U.S. men are bisexually active, Jeffries suggests that other factors are likely to play a more substantial role in shaping HIV transmission to black women — he notes, in particular, the risk from black heterosexual men who have multiple female partners.

While societal factors may play a role in driving the HIV epidemic, both agree that all sexually active adults must take individual responsibility to protect against HIV by insisting on condom use, talking with partners about sexual behavior and crucially getting testing regularly.

Black men in the U.S. — including heterosexual men and MSM — are particularly unlikely to know their HIV status, and should test regularly.

Stigma of homosexuality

Challenging the stigma associated with homosexuality could help reduce the impact of HIV on gay men and MSM, Baker says.

“Stigma is about power, it’s about bigotry, it’s about hatred, it’s about marginalization,” reflects Baker, himself an HIV-positive gay man. “The only thing that can be used against it is to stand up against it.”

More discussion about and societal support for homosexuality may lessen the stigma. And importantly, legislation and social policies could promote the acceptance of homosexuality and reduce homophobia. Obama’s recent statement of support for gay marriage could go a long way to challenge homophobia. Black Americans may be ready to support these challenges, according to Baker.

“I believe that the president’s statement and leadership will reduce homophobia in black communities,” he concludes. “Much of the progress on gay civil rights has been due to the courage of black political leaders.”