{"id":1006,"date":"2014-07-28T15:07:20","date_gmt":"2014-07-28T15:07:20","guid":{"rendered":"https:\/\/blogs.bmj.com\/sti\/?p=1006"},"modified":"2014-07-22T11:00:49","modified_gmt":"2014-07-22T11:00:49","slug":"should-bisexuals-be-considered-a-population-with-specific-sexual-health-needs","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/sti\/2014\/07\/28\/should-bisexuals-be-considered-a-population-with-specific-sexual-health-needs\/","title":{"rendered":"Should bisexuals be considered a population with specific sexual health needs?"},"content":{"rendered":"<p>Across\u00a0many cultural contexts, men who have sex with both men and women (MSMW) have levels of STIs\/HIV comparable to those we find in men who have sex only with men (MSM); but MSMW have often proved particularly hard for health services to access.\u00a0 <a href=\"http:\/\/std.sagepub.com\/content\/20\/2\/87.abstract\">Mercer &amp; Cassell<\/a> (M&amp;C) (UK) and <a href=\"http:\/\/sti.bmj.com\/content\/86\/4\/323.full.pdf+html?sid=42d7d3d4-a4ad-4e3f-b240-3e810c80ae9a\">STIs\/Beyrer &amp; Baral<\/a> (B&amp;B) (South Africa) refer to poor rates of HIV testing as compared to MSM (RR 0.31 and 0.62 respectively). Both studies stress the need to find ways of targeting safe-sex messages for MSMW who do not identify as gay.<\/p>\n<p>In an intriguingly entitled reivew of the literature on MSMW sexual health in the US 2008-2013 (\u201cBeyond the bisexual bridge\u201d)\u00a0 <a href=\"http:\/\/www.ajpmonline.org\/article\/S0749-3797(14)00186-X\/abstract\">Jeffries<\/a>\u00a0 corroborates this general picture of high STI risk and poor accessibility. \u00a0But he seeks to get beyond what he considers an obsession on the part of researchers with the role of MSMW as a \u201cbridging\u201d population with women.\u00a0 He claims this \u201ccharacterization\u201d is not justified by the research &#8211; at least where the US is concerned (<a href=\"http:\/\/ajph.aphapublications.org\/doi\/abs\/10.2105\/AJPH.82.2.220\">Chu &amp; Curran<\/a>; <a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/18160368\">Satcher &amp; Dean<\/a>; <a href=\"http:\/\/journals.lww.com\/aidsonline\/Abstract\/1997\/08000\/How_many_HIV_infections_cross_the_bisexual.12.aspx\">Kahn &amp; Catania<\/a>).\u00a0 He also\u00a0views\u00a0it as ultimately detrimental to the sexual health of MSMW, which needs to be founded on the \u201crecognition of MSMW\u2019s unique sexual and social experiences\u201d.<\/p>\n<p>The article reviews both the sexual health, and socio-cultural challenges to MSMW\u2019s health.\u00a0 Sexual health challenges include: levels of STIs other than HIV <strong>equalling and exceeding<\/strong> MSM levels, alongside levels of HIV <strong>lower than<\/strong> MSM, yet higher than MSW (as in the UK (see M&amp;C)); also enormously higher levels of injection drug use, sex in exchange for money or drugs, and drug and alcohol use during sex than in MSM; also sex within <strong>female<\/strong> networks (as well as male) that imperil sexual health, with a high proportion of female partners having injected drugs, being under influence of drugs during sex, and having concurrent partners.\u00a0 Socio-cultural challenges include biphobia in society at large, and fairly extreme socio-economic marginalization, as indicated by lack of education, poverty, homelessness and incarceration.<\/p>\n<p>Some corroboration of the role that Jeffries attributes to settled identities in moderating at risk behaviour is provided by the success of a number of ongoing initiatives aimed at black or Latino MSMW.\u00a0 These\u00a0all appear to\u00a0address MSMW\u2019s masculinity concerns and heterosexual identities in a non-judgmental and culturally sensitive manner.\u00a0 Men of African American Legacy Empowering Self (MAALES) has been evaluated in a RCT discussed in an earlier blog (<a href=\"https:\/\/blogs.bmj.com\/sti\/2013\/10\/30\/are-bisexuals-well-served-by-hiv-interventions-that-assume-gay-identity\/\">STI\/blog\/Are bisexuals well served by interventions that assume gay identity?<\/a>).\u00a0 Jeffries also mentions: Hombres Sanos; the Bruthas Project; the Enhanced Sexual health Intervention for Men (ES-HIM).<\/p>\n<p>A\u00a0puzzle remains in the lower susceptibility of MSMW, as against MSM, to HIV &#8211; alongside equivalent or higher susceptibility to other\u00a0STIs .\u00a0 Jeffries discusses this, but offers no explanation.\u00a0 Could the less than expected levels of HIV in MSMW be the result of an association between MSM identity and sexual networks that carry particular risk of HIV transmission?<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Across\u00a0many cultural contexts, men who have sex with both men and women (MSMW) have levels of STIs\/HIV comparable to those we find in men who have sex only with men (MSM); but MSMW have often proved particularly hard for health services to access.\u00a0 Mercer &amp; Cassell (M&amp;C) (UK) and STIs\/Beyrer &amp; Baral (B&amp;B) (South Africa) [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/sti\/2014\/07\/28\/should-bisexuals-be-considered-a-population-with-specific-sexual-health-needs\/\">Read More&#8230;<\/a><\/p>\n","protected":false},"author":152,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[2043,2797,2796,1613],"tags":[],"class_list":["post-1006","post","type-post","status-publish","format-standard","hentry","category-behaviour","category-bisexual","category-homosexual","category-sexual-health-services"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.4 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Should bisexuals be considered a population with specific sexual health needs? 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