Meeting the Sexual Health Needs of Bisexual Men in the Age of Biomedical HIV Prevention: Gaps and Priorities

Abstract

The field of HIV/STI prevention has primarily focused on gay men (or "men who have sex with men" [MSM] as a broad category) with limited attention to bisexual men in particular. Although bisexual men are also at increased risk for HIV and other STI, they are less likely to utilize HIV/STI prevention services than gay men, and very few interventions have been developed to address their unique needs. Further, while biomedical advances are changing the field of HIV prevention, bisexual men are also less likely to use biomedical HIV prevention strategies (e.g., preexposure prophylaxis [PrEP]) than gay men. In an effort to advance research on bisexual men and their sexual health needs, the goals of this commentary are: (1) to review the empirical literature on the prevalence of HIV/STI among bisexual men, the few existing HIV/STI prevention interventions developed for bisexual men, and the use of biomedical HIV prevention among bisexual men; (2) to describe the ways in which the field of HIV/STI prevention has largely overlooked bisexual men as a population in need of targeted services; and (3) to discuss how researchers can better address the sexual health needs of bisexual men in the age of biomedical HIV prevention.

Race and Sexual Identity Differences in PrEP Continuum Outcomes Among Latino Men in a Large Chicago Area Healthcare Network

“…In addition to treating Latino men as a homogenous ethnic group, research on HIV has historically treated MSM as a homogenous group with limited attention to potential differences based on sexual identity, especially between gay and bisexual men [20]. Morever, there is a paucity of research addressing PrEP use among heterosexual men in the U.S. [5].…”

“…While there has been some attention to behaviorally bisexual men (i.e., men who have sex with men and women [MSMW]), the category MSMW is not inclusive of all bisexual men and may include heterosexual men [21]. For example, among sexually active men ages 24-32, only 45% of those who described themselves as bisexual or mostly heterosexual (but somewhat attracted to their own sex) reported having had sex with both male and female partners in their lifetime [20]. Moreover, behavioral categories such as MSM and MSMW have been criticized for ignoring the context in which sexual behavior occurs (e.g., social and cultural norms) and for obscuring important differences based on identity [22,23].…”

“…Moreover, there are currently no evidence-based HIV prevention interventions that are tailored to bisexual men [54] and that existing interventions focus on anal sex with male partners which may alienate bisexual men who have female and non-binary partners [55]. There is also a need for bisexual-affirming messaging in PrEP campaigns to better reach bisexual men who may not see themselves reflected in advertisements that are depicting gay men or same-sex male relationships [20]. While there are possible factors at play among providers, bisexual men may also face a range of unique obstacles to PrEP care such as unique forms of stigma, lower perceived HIV risk, lower perceived need for PrEP or barriers to access.…”

“…In addition to previously mentioned culturally-specific gender norms, intersectional stigma, and internalized identity stigma, Latino Bisexual men experience unique forms of stigma [20] such as experiencing bisexual stigma among heterosexual and gay communities. Stigma in intimate relationships with women may also be at play such that female partners may stigmatize bisexual men's identity which could feasibly contribute to hesitancy to use PrEP, especially if PrEP seen as a medication linked to same-sex attraction.…”

Introduction to the Special Issue: Improving the Health of a Local Bisexual Community through the Creation of a Citywide Task Force

“…Bisexual community activists have a long history of fighting for visibility, respect, and equitable access to healthcare and social services (Burleson, 2005;Holthaus, 2015;Movement Advancement Project, 2016). Despite mounting evidence that bisexual people are disproportionately affected by numerous negative health outcomes (e.g., depression, anxiety, suicidality, HIV and other sexually transmitted infections; Feinstein & Dodge, 2020;Friedman et al, 2014;Ross et al, 2018;Salway et al, 2019), researchers and healthcare providers have been slow to recognize bisexual people's unique needs and concerns. Recently, scholars have called for interventions at multiple levels to reduce the health disparities affecting bisexual people (e.g., individual-level interventions to help them cope with discrimination and population-level interventions to improve societal attitudes toward them; Feinstein et al, 2019).…”