Bisexual male sexual health needs neglected, study finds

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A U.S. study has found that the sexual health needs of bisexual men are not being adequately met, making them more vulnerable to sexual health risks.

Consequently, bisexual men (also referred to as Men who have Sex with Men and Women) are more likely to be infected with HIV and may be at increased risk for other sexually transmitted infections.

The Centers for Disease Control and Prevention published the study "Beyond the Bisexual Bridge" by William Jeffries in the American Journal of Preventative Medicine.

Although bisexual men and MSMW only comprise a small portion of the U.S. population (only two percent of sexually active males), Jeffries notes that a historical preoccupation with bisexual men and MSMW as transmitters of HIV to women (the "bisexual bridge") has resulted in a limited understanding of the sexual health needs of this demographic.

The study points out that bisexual men and MSMW face numerous factors, often different from gay men, that affect sexual health in relationships: unprotected sex, early sexual debut, forced sexual encounters, increased numbers of sexual partners, substance use, exchange sex, risky behaviors of their male and female partners, and pregnancy-related considerations.

"MSMW's attitudes toward pregnancy influence their sexual health," Jeffries explains in the report. "Qualitative data from black men suggest that desires to prevent pregnancy may prompt some MSMW to consistently use condoms with women. Yet, MSMW may avoid condom use when their female partners use other contraceptives or when female partners perceive condom use as a sign of relationship infidelity. Further, MSMW's desires to produce offspring biologically may prompt sex without a condom with female partners. In this regard, desires for fatherhood may indirectly increase these men's vulnerability to HIV/STIs and transmission of these infections within their sexual networks."

Bisexual men and MSMW can also experience biphobia (or discrimination against bisexuals) from both straight and gay people. The study states that biphobia is actually more prevalent than homophobia.

"Biphobia can manifest in erroneous beliefs that MSMW are gay men who have not disclosed their sexual orientation and, particularly for black men, responsible for HIV transmission to women," Jeffries states. "Experiencing these sentiments can contribute to MSMW's social isolation and psychological distress, which in turn may promote HIV/STI risk through substance use, sexual risk behaviors, and the avoidance of prevention services."

Biphobia may also contribute to a higher number of sexual partners.

"Because biphobia manifests in beliefs that bisexuality is not a legitimate sexual orientation, MSMW may feel inclined to publicly validate their bisexuality through multiple sexual partnerships with men and women," Jeffries states.

MSMW may also face challenges finding a well-defined male bisexual community to participate in or belong to.

Socioeconomic marginalization, culturally specific definitions of masculinity, and sexual identity issues are social and cultural factors that also affect bisexual men and MSMW.

Adolescent MSMW were significantly more likely to experience intimate partner violence and more likely to skip school due to not feeling safe. Adult MSMW are less likely to have a bachelor's degree and more likely to have lower incomes or be homeless.

The study advises that while risk-reduction initiatives can improve sexual health, they themselves alone aren't enough to bisexual/MSMW sexual health needs; the study recommends that social context must be addressed as well. 

Jeffries recommends the following strategies for addressing bisexual male and MSMW health:

• Launch social marketing campaigns that use affirmative images of sexual minority men to counteract the biphobia and homophobia that MSMW experience

• Develop comprehensive sexuality education programs that provide invaluable HIV/STI prevention education to MSMW, including promoting school safety for MSMW

• Encourage social spaces that cultivate a sense of community to provide opportunities for social support and candid discussion of sexual health concerns

• Engage medical and health professionals in sensitivity trainings to lessen any hostility encountered by MSMW when they seek information about sexual health or HIV/STI testing

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