Not all men who have sex with men identify as gay. Previous reports have indicated that men who do not identify as gay, but who have sex with men, may have higher rates of unprotected sex and lower rates of screening for human immunodeficiency virus (HIV) infection.

Between March and August of 2003, the New York City Department of Health and Mental Hygiene surveyed New York City residents 18 years and older using random digit–dialing of residential phone numbers. Interviews were conducted in multiple languages. Sexual identity questions were asked in the demographic section of the survey. In a separate section, respondents were asked questions about sexual behavior in the past year and their history of testing for HIV infection and condom use. Bisexual men were excluded from analysis.

The results show that 91.3 percent of respondents identified as straight or heterosexual, and 3.7 percent identified as gay. Of the men who answered the questions, 70.6 percent reported having had sex only with women and 9.3 percent reported having had sex only with men. Of straight-identified men, 9.4 percent reported having had sex with one or more men and no women in the previous 12 months. Forty-three percent of these men reported being foreign-born, compared with 15 percent of gay-identified men.

Of the men who had sex with men, 72.8 percent identified as straight. These men were 40 percent less likely to have had recent HIV testing than gay-identified men. They also were one half as likely to have used a condom during their last sexual encounter and one half as likely to have reported risky behavior. However, 7 percent of straight-identified men who had sex with men reported having a history of a sexually transmitted disease compared with 20 percent of gay-identified men. Only 4 percent of heterosexual men reported a history of sexually transmitted disease. In this study, 10 percent of married men reported having sex with men.

The authors conclude that the discrepancy between sexual identity and behavior may be wider than has been reported previously. When taking a sexual history, it is important to identify the sex of the sexual partners to offer appropriate screening, education, and prevention services.