Sexual health behaviors among bisexual men in the United States

Throughout the last few decades, the scientific community's interest in bisexual men has substantially increased. Much of the attention to them has been because of their relevance to epidemics of human immunodeficiency virus and other sexually transmitted infections (HIV/STIs). Despite the elevated HIV/STI risks found in some studies, the vast majority of sexual health studies focus on homosexual men, with few distinguishing bisexual men from their gay/homosexual counterparts. Such has resulted in little being known regarding bisexual men's distinct sexual health behavior patterns. This study is unique in its use of sexual behavior, identity, attraction measures to compare sexual health behaviors among bisexual, homosexual, and heterosexual men. Data came from the 2002 National Survey of Family Growth, which has a nationally-representative sample of 3,875 sexually-active men in the United States. I measured sexual health based upon condom use, HIV testing, and the number of recent sex partners. Bivariate and multivariate analyses compared bisexual, heterosexual, and homosexual men on all study measures. The most meaningful differences were observed along sexual behavior. Relative to heterosexual and homosexual men, bisexual men had significantly higher levels of condom use. However, bisexual men had much lower levels of HIV testing than homosexual men and far more sex partners than both heterosexual and homosexual men. Bisexual men also appear to be at elevated risk levels due to their high likelihoods of drug use and sex work. Interestingly, the effect of bisexual behavior upon condom use and HIV testing was different for men who identified as bisexual or not. By and large, identity and attraction measures only produced bisexual-heterosexual differences, which tended to disappear in multivariate analyses. These findings suggest that behaviorally bisexual men are at high risk for HIV infection. I discuss the need for better data and interventions to improve the sexual health behaviors of bisexual men in the United States.