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1 February 2006

Focusing "Down Low":
Sexual Behavior and Identity Issues
in Clinical Medicine and Public Health

David J. Malebranche, M.D., M.P.H., General Medicine, Emory University

Men on the "Down Low" (DL) are described as Black men who identify as heterosexual and live overtly heterosexual lives but secretly have sex with other men. These men may be responsible for high HIV prevalence now among Black women. What do we know about DL men vs. myths and assumptions about this population? How can clinicians and public health professionals best address DL sexual behavior and identity issues and HIV prevention?

Read Focusing “Down Low”: Bisexual Black Men, HIV Risk
and Heterosexual Transmission


David J. Malebranche is a board certified Internal Medicine physician with additional training in Preventive Medicine and Public Health. He is currently an assistant professor at the Division of General Medicine at Emory University's School  of Medicine. Dr.  Malebranche supervises health care providers-in-training at the Urgent Care Center at Grady Hospital in downtown Atlanta, and also sees his own panel of patients at the Ponce Infectious Disease Center, a local  AIDS clinic in Atlanta. 
            Dr. Malebranche’s research explores the racial, gender, age, and cultural factors that influence black men’s health, particularly with regard to HIV/AIDS prevention and treatment.   He recently completed a visiting professorship for the Center for AIDS Prevention Studies at the University of California, San Francisco, where  he was involved in the HIV Prevention Research in Minority Communities Program. There, he examined how notions of masculinity among black men who have sex with men influence sexual behavior decision-making and risk for HIV. In 2003, he was awarded a 3 year cooperative agreement with the Centers for Disease Control and Prevention to study the influence or racial, sexual and masculine identities on the HIV risk assessment, testing practices and sexual behaviors of black men who have sex with men.
            Dr. Malebranche has made it his personal mission to change what we think we know about how HIV/AIDS is contracted and how it affects the African American community. As a black doctor who comes in contact with AIDS patients on a regular basis, Malebranche is on the frontline of the war on HIV/AIDS; however, he said trying to disseminate information that is current and practical is often an uphill battle given the stigma still attached to HIV.
            Dr. Malebranche is waging his own personal battle to dispel the “myth behind brothers on the ‘downlow’ or ‘the “DL.’” This topic has become an increasingly popular one with books and publications like E. Lynn Harris’s Not a Day Goes By, The New York Times’s investigative piece on the subject, and the much-anticipated release of J.L. King’s On the Down Low: A Journey Into the Lives of Straight Black Men Who Sleep with Men. He shares that the media has misled us into believing it’s more pervasive than it really is, “I am so tired of hearing about this I feel I am the direct antithesis of J.L. King and I travel to churches, colleges, everywhere I can to counterpoint the misinformation out there.”
            Dr. Malebranche is a much sought after speaker and writer. His work has been published in medical journals such as Patient Care, The American Journal of Public Health, Health Affairs and The Journal of the National Medical Association. He’s also written for Arise Magazine, Code, HIV Plus and The Village Voice.

Co-presented with the medical student Committee
on Confronting Health Inequalities