Skip to main content

Advertisement

SpringerLink
Log in

Behaviorally Bisexual Men and their Risk Behaviors with Men and Women

  • Published:
Journal of Urban Health Aims and scope Submit manuscript

Abstract

Gay and bisexual men are often treated as a homogenous group; however, there may be important differences between them. In addition, behaviorally bisexual men are a potential source of HIV infection for heterosexual women. In this study, we compared 97 men who have sex with men only (MSM) to 175 men who have sex with men and women (MSMW). We also compared the 175 MSMW to 772 men who have sex with women only (MSW). Bivariate and multiple logistic regression analyses were performed to assess correlates of MSMW risk behaviors with men and with women as well as whether MSMW, compared with MSW, engaged in more risky behaviors with women. Compared with MSM, MSMW were less likely to be HIV-positive or to engage in unprotected receptive anal intercourse. In contrast, MSMW were more likely than MSW to be HIV-positive and to engage in anal intercourse with their female partners; however, rates of unprotected anal intercourse were similar. The study findings suggest that there may be important differences in HIV risk behaviors and HIV prevalence between MSM and MSMW as well as between MSMW and MSW.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Normand JL, Lambert EY, Vlahov D. Understanding the dynamics of sexual transmission of HIV among drug-using populations: an integration of biological, behavioral, and environmental perspectives. J Urban Health. 2003; 80(4 Suppl 3): iii1–6.

    Google Scholar 

  2. McFarland W, Katz MH, Stoyanoff SR, et al. HIV incidence among young men who have sex with men—seven U.S. cities, 1994–2000 (Reprinted from MMWR, 2001;50:440-444). JAMA. 2001; 286(3): 297–299.

    Google Scholar 

  3. Chu SY, Peterman TA, Doll LS, Buehler JW, Curran JW. AIDS in bisexual men in the United States: epidemiology and transmission to women. Am J Public Health. 1992; 82(2): 220–224.

    Article  PubMed  CAS  Google Scholar 

  4. Ekstrand ML, Coates TJ, Guydish JR, Hauck WW, Collette L, Hulley SB. Are bisexually identified men in San Francisco a common vector for spreading HIV infection to women? Am J Public Health. 1994; 84(6): 915–919.

    Article  PubMed  CAS  Google Scholar 

  5. Hightow LB, Leone PA, Macdonald PD, McCoy SI, Sampson LA, Kaplan AH. Men who have sex with men and women: a unique risk group for HIV transmission on North Carolina college campuses. Sex Transm Dis. 2006; 33(10): 585–593.

    Article  PubMed  Google Scholar 

  6. Montgomery JP, Mokotoff ED, Gentry AC, Blair JM. The extent of bisexual behaviour in HIV-infected men and implications for transmission to their female sex partners. AIDS Care. 2003; 15(6): 829–837.

    Article  PubMed  CAS  Google Scholar 

  7. O’Leary A, Jones KT. Bisexual men and heterosexual women: how big is the bridge? How can we know? Sex Transm Dis. 2006; 33(10): 594–595.

    Article  PubMed  Google Scholar 

  8. Kahn JG, Gurvey J, Pollack LM, Binson D, Catania JA. How many HIV infections cross the bisexual bridge? An estimate from the United States. AIDS. 1997; 11(8): 1031–1037.

    Article  PubMed  CAS  Google Scholar 

  9. Millett G, Malebranche D, Mason B, Spikes P. Focusing “down low”: bisexual black men, HIV risk and heterosexual transmission. J Natl Med Assoc. 2005; 97(7 Suppl): 52S–59S.

    PubMed  Google Scholar 

  10. Doll LS, Beeker C. Male bisexual behavior and HIV risk in the United States: synthesis of research with implications for behavioral interventions. AIDS Educ Prev. 1996; 8(3): 205–225.

    PubMed  CAS  Google Scholar 

  11. Kalichman SC, Roffman RA, Picciano JF, Bolan M. Risk for HIV infection among bisexual men seeking HIV-prevention services and risks posed to their female partners. Health Psychol. 1998; 17(4): 320–327.

    Article  PubMed  CAS  Google Scholar 

  12. Lichtenstein B. Secret encounters: black men, bisexuality, and AIDS in Alabama. Med Anthropol Q. 2000; 14(3): 374–393.

    Article  PubMed  CAS  Google Scholar 

  13. McKirnan DJ, Stokes JP, Doll L, Burzette RG. Bisexually active men: social characteristics and sexual behavior. J Sex Res. 1995; 32(1): 65–76.

    Article  Google Scholar 

  14. Myers HF, Javanbakht M, Martinez M, Obediah S. Psychosocial predictors of risky sexual behaviors in African American men: implications for prevention. AIDS Educ Prev. 2003; 15(1 Suppl A): 66–79.

    Article  PubMed  Google Scholar 

  15. Stokes JP, McKirnan DJ, Doll L, Burzette RG. Female partners of bisexual men: what they don’t know might hurt them. Psychology of Women Quarterly. 1996; 20(2): 267–284.

    Article  Google Scholar 

  16. Shehan DA, LaLota M, Johnson DF, et al. HIV/STD risks in young men who have sex with men who do not disclose their sexual orientation—six U.S. cities, 1994–2000. (Reprinted from MMWR. 2003;52:81–86,). JAMA. 2003; 289(8): 975–977.

  17. Padian N, Marquis L, Francis DP, et al. Male-to-female transmission of human immunodeficiency virus. JAMA. 1987; 258(6): 788–790.

    Article  PubMed  CAS  Google Scholar 

  18. Powers KA, Poole C, Pettifor AE, Cohen MS. Rethinking the heterosexual infectivity of HIV-1: a systematic review and meta-analysis. Lancet Infect Dis. 2008; 8(9): 553–563.

    Article  PubMed  Google Scholar 

  19. Harawa NT, Williams JK, Ramamurthi HC, Bingham TA. Perceptions towards condom use, sexual activity, and HIV disclosure among HIV-positive African American men who have sex with men: implications for heterosexual transmission. J Urban Health. 2006; 83(4): 682–694.

    Article  PubMed  Google Scholar 

  20. Stall R, Paul JP, Greenwood G, et al. Alcohol use, drug use and alcohol-related problems among men who have sex with men: The Urban Men’s Health Study. Addiction. 2001; 96(11): 1589–1601.

    Article  PubMed  CAS  Google Scholar 

  21. Woody GE, VanEtten-Lee ML, McKirnan D, et al. Substance use among men who have sex with men: comparison with a national household survey. JAIDS. 2001; 27(1): 86–90.

    PubMed  CAS  Google Scholar 

  22. Beckett M, Burnam A, Collins RL, Kanouse DE, Beckman R. Substance use and high-risk sex among people with HIV: a comparison across exposure groups. AIDS Behav. 2003; 7(2): 209–219.

    Article  PubMed  Google Scholar 

  23. Woody GE, Donnell D, Seage GR, et al. Non-injection substance use correlates with risky sex among men having sex with men: data from HIVNET. Drug Alcohol Depend. 1999; 53(3): 197–205.

    Article  PubMed  CAS  Google Scholar 

  24. Frosch D, Shoptaw S, Huber A, Rawson RA. Sexual HIV risk among gay and bisexual male methamphetamine abusers. J Subst Abuse Treat. 1996; 13(6): 483–486.

    Article  PubMed  CAS  Google Scholar 

  25. Dolezal C, Carballo-Diéguez A, Nieves-Rosa L, Díaz F. Substance use and sexual risk behavior: understanding their association among four ethnic groups of Latino men who have sex with men. J Subst Abuse. 2000; 11(4): 323–336.

    Article  PubMed  CAS  Google Scholar 

  26. Baseman J, Ross M, Williams M. Sale of sex for drugs and drugs for sex: an economic context of sexual risk behavior for STDs. Sex Transm Dis. 1999; 26(8): 444–449.

    Article  PubMed  CAS  Google Scholar 

  27. Latkin CA, Hua W, Forman VL. The relationship between social network characteristics and exchanging sex for drugs or money among drug users in Baltimore, MD, USA. Int J STD AIDS. 2003; 14(11): 770–775.

    Article  PubMed  CAS  Google Scholar 

  28. Weiser SD, Dilworth SE, Neilands TB, Cohen J, Bangsberg DR, Riley ED. Gender-specific correlates of sex trade among homeless and marginally housed individuals in San Francisco. J Urban Health. 2006; 83(4): 736–740.

    Article  PubMed  Google Scholar 

  29. Rietmeijer CA, Wolitski RJ, Fishbein M, Corby NH, Cohn DL. Sex hustling, injection drug use, and non-gay identification by men who have sex with men: associations with high-risk sexual behaviors and condom use. Sex Transm Dis. 1998; 25(7): 353–360.

    Article  PubMed  CAS  Google Scholar 

  30. Kuyper LM, Lampinen TM, Li K, et al. Factors associated with sex trade involvement among male participants in a prospective study of injection drug users. Sex Transm Infec. 2004; 80(6): 531–535.

    Article  CAS  Google Scholar 

  31. Kral AH, Lorvick J, Ciccarone D, et al. HIV prevalence and risk behaviors among men who have sex with men and inject drugs in San Francisco. J Urban Health. 2005; 82(1 Suppl 1): i43–i50.

    PubMed  Google Scholar 

  32. Newman PA, Rhodes F, Weiss RE. Correlates of sex trading among drug-using men who have sex with men. Am J Public Health. 2004; 94(11): 1998–2003.

    Article  PubMed  Google Scholar 

  33. El-Bassel N, Schillng RF, Gilbert L, Faruque S, Irwin KL, Edlin BR. Sex trading and psychological distress in a street-based sample of low-income urban men. J Psychoactive Drugs. 2000; 32(3): 259–267.

    PubMed  CAS  Google Scholar 

  34. Weber AE, Craib KJ, Chan K, et al. Sex trade involvement and rates of human immunodeficiency virus positivity among young gay and bisexual men. Int J Epidemiol. 2001; 30(6): 1449–1454; discussion: 1455–1446.

    Google Scholar 

  35. Centers for Disease Control and Prevention. Methamphetamine use and HIV risk behaviors among heterosexual men—preliminary results from five northern California counties, December 2001–November 2003. MMWR. 2006; 55(10): 273–277.

    Google Scholar 

  36. Zule WA, Costenbader EC, Meyer WJ Jr, Wechsberg WM. Methamphetamine use and risky sexual behaviors during heterosexual encounters. Sex Transm Dis. 2007; 34(9): 689–694.

    Article  PubMed  CAS  Google Scholar 

  37. Zule WA, Desmond DP. An ethnographic comparison of HIV risk behaviors among heroin and methamphetamine injectors. Am J Drug Alcohol Abuse. 1999; 25(1): 1–23.

    Article  PubMed  CAS  Google Scholar 

  38. Siegel K, Schrimshaw EW, Lekas HM, Parsons JT. Sexual behaviors of non-gay identified non-disclosing men who have sex with men and women. Arch Sex Behav. 2008; 37(5): 720–735.

    Article  PubMed  Google Scholar 

  39. Adimora AA, Schoenbach VJ, Martinson FE, et al. Heterosexually transmitted HIV infection among African Americans in North Carolina. J Acquir Immune Defic Syndr. 2006; 41(5): 616–623.

    Article  PubMed  Google Scholar 

  40. Durant T, McDavid K, Hu X, Sullivan P, Janssen R, Fenton K. Racial/Ethnic disparities in diagnoses of HIV/AIDS—33 states, 2001–2005 (Reprinted from MMWR. 2006;56:189–193). JAMA. 2007; 297(15): 1647–1649.

    Google Scholar 

  41. Heckathorn DD. Respondent-driven sampling: a new approach to the study of hidden populations. Social Problems. 1997; 44(2): 174–199.

    Article  Google Scholar 

  42. Heckathorn DD, Semaan S, Broadhead R, Hughes JJ. Extensions of respondent-driven sampling: a new approach to the study of injection drug users aged 18–25. AIDS Behav. 2002; 6(1): 55–67.

    Article  Google Scholar 

  43. Iguchi MY, Ober AJ, Berry SH, et al. Simultaneous recruitment of drug users and men who have sex with men in the United States and Russia using respondent driven sampling: Sampling methods and implications. J Urban Health. 2009.

  44. Metzger DS, Koblin B, Turner C, et al. Randomized controlled trial of audio computer-assisted self-interviewing: utility and acceptability in longitudinal studies. HIVNET Vaccine Preparedness Study Protocol Team. Am J Epidemiol. 2000; 152(2): 99–106.

    Article  PubMed  CAS  Google Scholar 

  45. Simoes AA, Bastos FI, Moreira RI, Lynch KG, Metzger DS. Acceptability of audio computer-assisted self-interview (ACASI) among substance abusers seeking treatment in Rio de Janeiro, Brazil. Drug Alcohol Depend. 2006; 82(Suppl 1): S103–S107.

    Article  PubMed  Google Scholar 

  46. Simoes AA, Bastos FI, Moreira RI, Lynch KG, Metzger DS. A randomized trial of audio computer and in-person interviewing to assess HIV risk among drug and alcohol users in Rio De Janeiro, Brazil. J Subst Abuse Treat. 2006; 30(3): 237–243.

    Article  PubMed  Google Scholar 

  47. Cepeda MS, Boston R, Farrar JT, Strom BL. Comparison of logistic regression versus propensity score when the number of events is low and there are multiple confounders. Am J Epidemiol. 2003; 158(3): 280–287.

    Article  PubMed  Google Scholar 

  48. D’Agostino RB. Propensity score methods for bias reduction in the comparison of a treatment to a non-randomized control group. Statistic in Medicine. 1998; 17(19): 2265–2281.

    Article  Google Scholar 

  49. Rosenbaum PR, Rubin DB. Reducing bias in observational studies using subclassification on the propensity score. J Am Stat Assoc. 1984; 79(387): 516–524.

    Article  Google Scholar 

  50. Sandfort TGM, Dodge B. “And then there was the Down Low”: introduction to Black and Latino male bisexualities. Arch Sex Behav. 2008; 37(5): 675–682.

    Article  PubMed  Google Scholar 

  51. Tillerson K. Explaining racial disparities in HIV/AIDS incidence among women in the U.S.: a systematic review. Statistics in Medicine. 2008; 27(20): 4132–4143.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

This research is supported by grant no. U01da017373 from the National Institute on Drug Abuse (NIDA). The interpretations and conclusions do not necessarily represent the position of NIDA or the U.S. Department of health and human services.

Author information

Authors and Affiliations

  1. Substance Abuse Treatment Evaluation and Invention Research Program, RTI International, Research Triangle Park, NC, USA

    William A. Zule, Wendee M. Wechsberg & Curtis M. Coomes

  2. Statistics and Epidemiology division, RTI International, Research Triangle Park, NC, USA

    Georgiy V. Bobashev

  3. Family Health International, Durham, NC, USA

    Elizabeth C. Costenbader

  4. RTI International, 3040 Cornwallis Drive, Research Triangle Park, NC, 27709-2194, USA

    William A. Zule

Authors
  1. William A. Zule
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Georgiy V. Bobashev
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Wendee M. Wechsberg
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Elizabeth C. Costenbader
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Curtis M. Coomes
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to William A. Zule.

Additional information

RTI International is a trade name of Research Triangle Institute.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Zule, W.A., Bobashev, G.V., Wechsberg, W.M. et al. Behaviorally Bisexual Men and their Risk Behaviors with Men and Women. J Urban Health 86 (Suppl 1), 48–62 (2009). https://doi.org/10.1007/s11524-009-9366-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11524-009-9366-3

Keywords

Search

Navigation