Dear Corrections Colleagues,

Infectious diseases are opportunistic. To establish a niche they exploit opportunities to survive, if not thrive. Human behaviors are the fertile soil in which HIV has been able to establish itself and spread within our species. Poverty, war, mobility, gender power imbalance, the commercialization of sex, disparities in wealth and health care, the prevalence of other sexually transmitted diseases, bad government and ignorance are some of the human forces that have fueled the HIV epidemic and confound efforts to contain its reach.

In our country, the virus has found African-American men and women. Entire careers have been dedicated to understanding why and how the epidemic shifted toward this population but during the past several years, as rates of HIV infection have increased sharply among African-American women, the public spotlight has been focused on their male partners, usually African-American men. In particular, black men who have sex with men (MSM) who also have sex with women have been cast in the role of Typhoid Mary and have been accused of being responsible for the transmission of HIV within African-American communities. A very public, and often contentious, discussion regarding such men, described as being secretive about their bisexuality to their female partners (i.e. living on the 'down low'), and their role in the spread of HIV to women has become a staple of the day time talk shows and the subject of popular books. However, there has been relatively little in the social science or medical literature to indicate just how many African-American women are actually becoming infected with HIV from down low men.

In this issue of IDCR, Lisa Hightow, a clinical scientist who first detected an outbreak of HIV among MSM college students in the U.S. South that was subsequently described in the CDC's Morbidity and Mortality Reports, and Justin Smith, the director of a project Dr. Hightow founded to provide outreach and counseling to young MSM of color, enumerate and refute the myths they encounter regarding the down low. As a clinician who staffs a department of corrections HIV clinic, Dr. Hightow is familiar with the concerns regard sex between men and incarceration as overlapping forces abetting HIV transmission within African-American communities. To supplement her article, we have included in our Spotlight a discussion of how incarceration itself may produce conditions that foster acquisition of HIV by African-American women. This piece is written with the assistance of my colleagues Drs. Adaora Adimora and Becky White (formerly Stephenson) - experts on this topic.

Together, these articles are intended to be informative and thought provoking - in this, I am certain, they will succeed. Your provoked thoughts can be emailed to me at wohl@med.unc.edu for potential re-print in our Letters to the Editor section of our website.

Sincerely,

David A. Wohl, MD
Associate Professor of Medicine
University of North Carolina
AIDS Clinical Research Unit

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