Archives of Sexual Behavior

, Volume 46, Issue 4, pp 903–912 | Cite as

Stability of Bisexual Behavior and Extent of Viral Bridging Behavior Among Men Who Have Sex with Men and Women

  • M. Reuel Friedman
  • Ron Stall
  • Michael Plankey
  • Steve Shoptaw
  • A. L. Herrick
  • Pamela J. Surkan
  • Linda Teplin
  • Anthony J. Silvestre
Original Paper


Bisexual men experience significant health disparities likely related to biphobia. Biphobia presents via several preconceptions, including that bisexuality is transitory, and that bisexual men act as viral bridges between men who have sex with men and heterosexual populations. We analyzed data from a prospective cohort of gay and bisexual men, the Multicenter AIDS Cohort Study, to test these preconceptions. Men reporting both male and female sexual partners (MSMW) between 2002 and 2009 (n = 111) were classified as behaviorally bisexual. We assessed five hypotheses over two domains (transience of bisexual behavior and viral bridging). No evidence was found supporting the transitory nature of bisexuality. Trajectories of bisexual behavior were not transient over time. We found little evidence to support substantial viral bridging behavior. Notably, HIV-positive MSMW reported lower proportions of female partners than HIV-negative MSMW. Our results provide no empirical support for bisexual transience and scant support for viral bridging hypotheses. Our results provide key data showing that male bisexual behavior may be stable over long time periods and that behaviorally bisexual men’s risk to female sexual partners may be lower than expected.


Bisexuality Biphobia HIV/AIDS Sexual orientation 



We are deeply indebted to the anonymous peer reviewers for their comments, which we believe have significantly strengthened this article. Data in this article were collected by the Multicenter AIDS Cohort Study (MACS) with centers at Baltimore (U01-AI35042): The Johns Hopkins University Bloomberg School of Public Health: Joseph B. Margolick (PI), Jay Bream, Todd Brown, Barbara Crain, Adrian Dobs, Richard Elion, Richard Elion, Michelle Estrella, Lisette Johnson-Hill, Sean Leng, Anne Monroe, Cynthia Munro, Michael W. Plankey, Wendy Post, Ned Sacktor, Jennifer Schrack, Chloe Thio; Chicago (U01-AI35039): Feinberg School of Medicine, Northwestern University, and Cook County Bureau of Health Services: Steven M. Wolinsky (PI), John P. Phair, Sheila Badri, Dana Gabuzda, Frank J. Palella, Jr., Sudhir Penugonda, Susheel Reddy, Matthew Stephens, Linda Teplin; Los Angeles (U01-AI35040): University of California, UCLA Schools of Public Health and Medicine: Roger Detels (PI), Otoniel Martínez-Maza (Co-P I), Aaron Aronow, Peter Anton, Robert Bolan, Elizabeth Breen, Anthony Butch, Shehnaz Hussain, Beth Jamieson, Eric N. Miller, John Oishi, Harry Vinters, Dorothy Wiley, Mallory Witt, Otto Yang, Stephen Young, Zuo Feng Zhang; Pittsburgh (U01-AI35041): University of Pittsburgh, Graduate School of Public Health: Charles R. Rinaldo (PI), Lawrence A. Kingsley (Co-PI), James T. Becker, Phalguni Gupta, Kenneth Ho, Susan Koletar, Jeremy J. Martinson, John W. Mellors, Anthony J. Silvestre, Ronald D. Stall; Data Coordinating Center (UM1-AI35043): The Johns Hopkins University Bloomberg School of Public Health: Lisa P. Jacobson (PI), Gypsyamber D’Souza (Co-PI), Alison, Abraham, Keri Althoff, Jennifer Deal, Priya Duggal, Sabina Haberlen, Alvaro Muoz, Derek Ng, Janet Schollenberger, Eric C. Seaberg, Sol Su, Pamela Surkan. Institute of Allergy and Infectious Diseases: Robin E. Huebner; National Cancer Institute: Geraldina Dominguez. The MACS is funded primarily by the National Institute of Allergy and Infectious Diseases (NIAID), with additional co-funding from the National Cancer Institute (NCI), the National Institute on Drug Abuse (NIDA), and the National Institute of Mental Health (NIMH). Targeted supplemental funding for specific projects was also provided by the National Heart, Lung, and Blood Institute (NHLBI), and the National Institute on Deafness and Communication Disorders (NIDCD). MACS data collection is also supported by UL1-TR001079 (JHU ICTR) from the National Center for Advancing Translational Sciences (NCATS) a component of the National Institutes of Health (NIH), and NIH Roadmap for Medical Research. The contents of this publication are solely the responsibility of the authors and do not represent the official views of the National Institutes of Health (NIH), Johns Hopkins ICTR, or NCATS. The MACS website is located at Additional support was provided by the National Institute of Drug Abuse through 1 R01 DA022936, “Long Term Health Effects of Methamphetamine Use in the MACS,” Ronald Stall, Ph.D., PI, 5 P30 MH058107.

Compliance with Ethical Standards

Conflict of interest

The Multicenter AIDS Cohort Study is funded by the National Institutes of Health (see Acknowledgments section for full grants information). The authors declare that they have no conflicts of interest.

Ethical Statement

The manuscript has not been submitted to more than one journal for simultaneous consideration. Small portions of this appeared previously in substantially different form in the lead author’s doctoral dissertation: Friedman et al. (2014b). HIV among men who have sex with men and women (MSMW): prevalence estimates, acquisition and transmission risks, and implications for interventions (Doctoral dissertation, University of Pittsburgh). This article significantly expands upon this previous work. We have taken care not to split up these data into several parts to increase submission quantity. No data have been fabricated or manipulated to support conclusions. No data, text, or theories by others are presented as if they were the author’s own, and all source data have been properly cited. Consent to submit has been received explicitly from all co-authors, as well as from the responsible authorities—tacitly or explicitly—at the institute/organization where the work has been carried out, before the work was submitted. All authors whose names appear on the submission have contributed sufficiently to the scientific work and therefore share collective responsibility and accountability for the results.

Informed Consent

Informed consent was obtained from all individual participants included in the study. The Institutional Review Boards at each respective Multicenter AIDS Cohort Study partner institution (University of Pittsburgh, Johns Hopkins University, University of California-Los Angeles, and Northwestern University) approved of the behavioral measures assessed and reported on herein.


  1. Agronick, G., O’Donnell, L., Stueve, A., Doval, A. S., Duran, R., & Vargo, S. (2004). Sexual behaviors and risks among bisexually- and gay-identified young Latino men. AIDS and Behavior, 8(2), 185–197. doi: 10.1023/B:AIBE.0000030249.11679.d0.CrossRefPubMedGoogle Scholar
  2. Bauer, G. R., & Brennan, D. J. (2013). The problem with ‘behavioral bisexuality’: Assessing sexual orientation in survey research. Journal of Bisexuality, 13(2), 148–165.CrossRefGoogle Scholar
  3. Binson, D., Michaels, S., Stall, R., Coates, T. J., Gagnon, J. H., & Catania, J. A. (1995). Prevalence and social distribution of men who have sex with men: United States and its urban centers. Journal of Sex Research, 32(3), 245–254.CrossRefGoogle Scholar
  4. Cunningham, S., Olthoff, G., Burnett, P., Rompalo, A., & Ellen, J. (2006). Evidence of heterosexual bridging among syphilis-positive men who have sex with men. Sexually Transmitted Infections, 82(6), 444–445.CrossRefPubMedPubMedCentralGoogle Scholar
  5. Diamond, L. M. (2008). Female bisexuality from adolescence to adulthood: Results from a 10-year longitudinal study. Developmental Psychology, 44(1), 5–14.CrossRefPubMedGoogle Scholar
  6. Dodge, B., & Sandfort, T. G., (2007). A review of mental health research on bisexual individuals when compared to homosexual and heterosexual individuals. In B. Firestein (Ed.), Becoming visible: Counseling bisexuals across the lifespan (pp. 28–51). Columbia University Press.Google Scholar
  7. Dodge, B., Schnarrs, P. W., Reece, M., Martinez, O., Goncalves, G., Malebranche, D., … Fortenberry, J. D. (2013). Sexual behaviors and experiences among behaviorally bisexual men in the midwestern United States. Archives of Sexual Behavior, 42(2), 247–256.CrossRefPubMedGoogle Scholar
  8. Dudley, J., Jin, S., Hoover, D., Metz, S., Thackeray, R., & Chmiel, J. (1995). The Multicenter AIDS Cohort Study: Retention after 9½ years. American Journal of Epidemiology, 142(3), 323–330.CrossRefPubMedGoogle Scholar
  9. Dyer, T. P., Shoptaw, S., Guadamuz, T. E., Plankey, M., Kao, U., Ostrow, D., … Stall, R. (2012). Application of syndemic theory to Black men who have sex with men in the Multicenter AIDS Cohort Study. Journal of Urban Health, 89(4), 697–708.CrossRefPubMedPubMedCentralGoogle Scholar
  10. Flores, S. A., Bakeman, R., Millett, G. A., & Peterson, J. L. (2009). HIV risk among bisexually and homosexually active racially diverse young men. Sexually Transmitted Diseases, 36(5), 325–329. doi: 10.1097/OLQ.0b013e3181924201.CrossRefPubMedGoogle Scholar
  11. Friedman, M. R., Dodge, B., Schick, V., Herbenick, D., Hubach, R. D., Bowling, J., … Reece, M. (2014a). From bias to bisexual health disparities: Attitudes toward bisexual men and women in the United States. LGBT Health, 1(4), 309–318.CrossRefPubMedPubMedCentralGoogle Scholar
  12. Friedman, M. R., Kurtz, S. P., Buttram, M. E., Wei, C., Silvestre, A. J., & Stall, R. (2014b). HIV risk among substance-using men who have sex with men and women (MSMW): Findings from South Florida. AIDS and Behavior, 18(1), 111–119.CrossRefPubMedPubMedCentralGoogle Scholar
  13. Friedman, M. R., Stall, R., Silvestre, A. J., Mustanski, B., Shoptaw, S., Surkan, P. J., … Plankey, M. W. (2014c). Stuck in the middle: Longitudinal HIV-related health disparities among men who have sex with men and women. Journal of Acquired Immune Deficiency Syndromes, 66(2), 213–220.PubMedPubMedCentralGoogle Scholar
  14. Friedman, M. R., Wei, C., Klem, M. L., Silvestre, A. J., Markovic, N., & Stall, R. (2014d). HIV infection and sexual risk among men who have sex with men and women (MSMW): A systematic review and meta-analysis. PLoS ONE, 9(1), e87139.CrossRefPubMedPubMedCentralGoogle Scholar
  15. Friedman, M. S., Marshal, M. P., Guadamuz, T. E., Wei, C., Wong, C. F., Saewyc, E., & Stall, R. (2011). A meta-analysis of disparities in childhood sexual abuse, parental physical abuse, and peer victimization among sexual minority and sexual nonminority individuals. American Journal of Public Health, 101(8), 1481–1494.CrossRefPubMedPubMedCentralGoogle Scholar
  16. Goodenow, C., Netherland, J., & Szalacha, L. (2002). AIDS-related risk among adolescent males who have sex with males, females, or both: Evidence from a statewide survey. American Journal of Public Health, 92(2), 203–210.CrossRefPubMedPubMedCentralGoogle Scholar
  17. Herrick, A. L., Lim, S. H., Plankey, M. W., Chmiel, J. S., Guadamuz, T. T., Kao, U., … Stall, R. (2013). Adversity and syndemic production among men participating in the Multicenter AIDS Cohort Study: A life-course approach. American Journal of Public Health, 103(1), 79–85.CrossRefPubMedPubMedCentralGoogle Scholar
  18. Jeffries, W. L., IV. (2011). The number of recent sex partners among bisexual men in the United States. Perspectives on Sexual and Reproductive Health, 43(3), 151–157. doi: 10.1363/4315111.CrossRefPubMedGoogle Scholar
  19. Jeffries, W. L., & Dodge, B. (2007). Male bisexuality and condom use at last sexual encounter: Results from a national survey. Journal of Sex Research, 44(3), 278–289. doi: 10.1080/00224490701443973.CrossRefPubMedGoogle Scholar
  20. Kaslow, R. A., Ostrow, D. G., Detels, R., Phair, J. P., Polk, B. F., & Rinaldo, C. R. (1987). The Multicenter AIDS Cohort Study: Rationale, organization, and selected characteristics of the participants. American Journal of Epidemiology, 126(2), 310–318.CrossRefPubMedGoogle Scholar
  21. Knight, K. R., Shade, S. B., Purcell, D. W., Rose, C. D., Metsch, L. R., Latka, M. H., … Gomez, C. A. (2007). Sexual transmission risk behavior reported among behaviorally bisexual HIV-positive injection drug-using men. Journal of Acquired Immune Deficiency Syndromes, 46(Suppl. 2), S80–S87. doi: 10.1097/QAI.0b013e3181576828.CrossRefPubMedGoogle Scholar
  22. Latkin, C., Yang, C., Tobin, K., Penniman, T., Patterson, J., & Spikes, P. (2011). Differences in the social networks of African American men who have sex with men only and those who have sex with men and women. American Journal of Public Health, 101(10), e18–e23. doi: 10.2105/ajph.2011.300281.CrossRefPubMedPubMedCentralGoogle Scholar
  23. Levin, E. M., Koopman, J. S., Aral, S. O., Holmes, K. K., & Foxman, B. (2009). Characteristics of men who have sex with men and women and women who have sex with women and men: Results from the 2003 Seattle Sex Survey. Sexually Transmitted Diseases, 36(9), 541–546. doi: 10.1097/OLQ.0b013e3181a819db.CrossRefPubMedGoogle Scholar
  24. Malebranche, D. J. (2008). Bisexually active Black men in the United States and HIV: Acknowledging more than the “Down Low.” Archives of Sexual Behavior, 37(5), 810–816. doi: 10.1007/s10508-008-9364-7.CrossRefPubMedGoogle Scholar
  25. Marshal, M. P., Dietz, L. J., Friedman, M. S., Stall, R., Smith, H. A., McGinley, J., … Brent, D. A. (2011). Suicidality and depression disparities between sexual minority and heterosexual youth: A meta-analytic review. Journal of Adolescent Health, 49(2), 115–123.CrossRefPubMedPubMedCentralGoogle Scholar
  26. Martinez-Donate, A. P., Zellner, J. A., Sanudo, F., Fernandez-Cerdeno, A., Hovell, M. F., Sipan, C. L., … Carrillo, H. (2010). Hombres Sanos: Evaluation of a social marketing campaign for heterosexually identified Latino men who have sex with men and women. American Journal of Public Health, 100(12), 2532–2540. doi: 10.2105/ajph.2009.179648.CrossRefPubMedPubMedCentralGoogle Scholar
  27. Millett, G., Malebranche, D., Mason, B., & Spikes, P. (2005). Focusing “down low”: Bisexual black men, HIV risk and heterosexual transmission. Journal of the National Medical Association, 97(7 Suppl.), 52S–59S.PubMedPubMedCentralGoogle Scholar
  28. Montgomery, J., Mokotoff, E., Gentry, A., & Blair, J. (2003). The extent of bisexual behaviour in HIV-infected men and implications for transmission to their female sex partners. AIDS Care, 15(6), 829–837. doi: 10.1080/09540120310001618676.CrossRefPubMedGoogle Scholar
  29. Morrison, T. G., Harrington, R., & McDermott, D. T. (2010). Bi now, gay later: Implicit and explicit binegativity among Irish university students. Journal of Bisexuality, 10(3), 211–232.CrossRefGoogle Scholar
  30. Morse, E. V., Simon, P. M., Osofsky, H. J., Balson, P. M., & Gaumer, H. R. (1991). The male street prostitute: A vector for transmission of HIV infection into the heterosexual world. Social Science and Medicine, 32(5), 535–539.CrossRefPubMedGoogle Scholar
  31. Mulick, P. S., & Wright, L. W. (2002). Examining the existence of biphobia in the heterosexual and homosexual populations. Journal of Bisexuality, 2(4), 45–64.CrossRefGoogle Scholar
  32. Mulick, P. S., & Wright, L. W. (2011). The biphobia scale a decade later: Reflections and additions. Journal of Bisexuality, 11(4), 453–457.CrossRefGoogle Scholar
  33. Munoz-Laboy, M., & Dodge, B. (2007). Bisexual Latino men and HIV and sexually transmitted infections risk: An exploratory analysis. American Journal of Public Health, 97(6), 1102–1106. doi: 10.2105/ajph.2005.078345.CrossRefPubMedPubMedCentralGoogle Scholar
  34. Mustanski, B., Andrews, R., Herrick, A., Stall, R., & Schnarrs, P. W. (2014). A syndemic of psychosocial health disparities and associations with risk for attempting suicide among young sexual minority men. American Journal of Public Health, 104(2), 287–294.CrossRefPubMedPubMedCentralGoogle Scholar
  35. Nakamura, N., Semple, S. J., Strathdee, S. A., & Patterson, T. L. (2011). HIV risk profiles among HIV-positive, methamphetamine-using men who have sex with both men and women. Archives of Sexual Behavior, 40(4), 793–801. doi: 10.1007/s10508-010-9713-1.CrossRefPubMedPubMedCentralGoogle Scholar
  36. Ochs, R. (1996). Biphobia: It goes more than two ways. In B. A. Firestein (Ed.), Bisexuality: The psychology and politics of an invisible minority (pp. 217–239). Thousand Oaks, CA: Sage Publications.Google Scholar
  37. O’Leary, A., & Jones, K. T. (2006). Bisexual men and heterosexual women: How big is the bridge? How can we know? Sexually Transmitted Diseases, 33(10), 594–595. doi: 10.1097/01.olq.0000225280.44538.f6.CrossRefPubMedGoogle Scholar
  38. Operario, D., Smith, C. D., Arnold, E., & Kegeles, S. (2010). The Bruthas Project: Evaluation of community-based HIV prevention intervention for African American men who have sex with men and women. AIDS Education and Prevention, 22(1), 37–48. doi: 10.1521/aeap.2010.22.1.37.CrossRefPubMedGoogle Scholar
  39. Pathela, P., & Schillinger, J. A. (2010). Sexual behaviors and sexual violence: Adolescents with opposite-, same-, or both-sex partners. Pediatrics, 126(5), 879–886. doi: 10.1542/peds.2010-0396.CrossRefPubMedGoogle Scholar
  40. Prabhu, R., Owen, C. L., Folger, K., & McFarland, W. (2004). The bisexual bridge revisited: Sexual risk behavior among men who have sex with men and women, San Francisco, 1998–2003. AIDS, 18(11), 1604–1606.CrossRefPubMedGoogle Scholar
  41. Quinn, T. C., Wawer, M. J., Sewankambo, N., Serwadda, D., Li, C., Wabwire-Mangen, F., … Gray, R. H. (2000). Viral load and heterosexual transmission of human immunodeficiency virus type 1. New England Journal of Medicine, 342(13), 921–929.CrossRefPubMedGoogle Scholar
  42. Robin, L., Brener, N. D., Donahue, S. F., Hack, T., Hale, K., & Goodenow, C. (2002). Associations between health risk behaviors and opposite-, same-, and both-sex sexual partners in representative samples of Vermont and Massachusetts high school students. Archives of Pediatrics and Adolescent Medicine, 156(4), 349.CrossRefPubMedGoogle Scholar
  43. Saewyc, E. M., Homma, Y., Skay, C. L., Bearinger, L. H., Resnick, M. D., & Reis, E. (2009). Protective factors in the lives of bisexual adolescents in North America. American Journal of Public Health, 99(1), 110–117.CrossRefPubMedPubMedCentralGoogle Scholar
  44. Saleh, L. D., & Operario, D. (2009). Moving beyond “the Down Low”: A critical analysis of terminology guiding HIV prevention efforts for African American men who have secretive sex with men. Social Science and Medicine, 68(2), 390–395.CrossRefPubMedGoogle Scholar
  45. Sandfort, T. G., & Dodge, B. (2008). “… And then there was the down low”: Introduction to Black and Latino male bisexualities. Archives of Sexual Behavior, 37(5), 675–682.CrossRefPubMedPubMedCentralGoogle Scholar
  46. Savin-Williams, R. C., & Ream, G. L. (2007). Prevalence and stability of sexual orientation components during adolescence and young adulthood. Archives of Sexual Behavior, 36(3), 385–394.CrossRefPubMedGoogle Scholar
  47. Shoptaw, S., Weiss, R. E., Munjas, B., Hucks-Ortiz, C., Young, S. D., Larkins, S., … Gorbach, P. M. (2009). Homonegativity, substance use, sexual risk behaviors, and HIV status in poor and ethnic men who have sex with men in Los Angeles. Journal of Urban Health, 86(Suppl. 1), 77–92. doi: 10.1007/s11524-009-9372-5.CrossRefPubMedPubMedCentralGoogle Scholar
  48. Silvestre, A. J., Hylton, J. B., Johnson, L. M., Houston, C., Witt, M., Jacobson, L., & Ostrow, D. (2006). Recruiting minority men who have sex with men for HIV research: Results from a 4-city campaign. American Journal of Public Health, 96(6), 1020–1027.CrossRefPubMedPubMedCentralGoogle Scholar
  49. Singh, S., Hu, X., Wheeler, W., & Hall, H. I. (2014). HIV diagnoses among men who have sex with men and women—United States and 6 dependent areas, 2008–2011. American Journal of Public Health, 104(9), 1700–1706.CrossRefPubMedPubMedCentralGoogle Scholar
  50. Spikes, P. S., Purcell, D. W., Williams, K. M., Chen, Y., Ding, H., & Sullivan, P. S. (2009). Sexual risk behaviors among HIV-positive black men who have sex with women, with men, or with men and women: Implications for intervention development. American Journal of Public Health, 99(6), 1072–1078. doi: 10.2105/ajph.2008.144030.CrossRefPubMedPubMedCentralGoogle Scholar
  51. Stokes, J. P., McKirnan, D. J., & Burzette, R. G. (1993). Sexual behavior, condom use, disclosure of sexuality, and stability of sexual orientation in bisexual men. Journal of Sex Research, 30(3), 203–213.CrossRefGoogle Scholar
  52. Torian, L. V., Makki, H. A., Menzies, I. B., Murrill, C. S., & Weisfuse, I. B. (2002). HIV infection in men who have sex with men, New York City Department of Health sexually transmitted disease clinics, 1990-1999: A decade of serosurveillance finds that racial disparities and associations between HIV and gonorrhea persist. Sexually Transmitted Diseases, 29(2), 73–78.CrossRefPubMedGoogle Scholar
  53. Udry, J. R., & Chantala, K. (2002). Risk assessment of adolescents with same-sex relationships. Journal of Adolescent Health, 31(1), 84–92.CrossRefPubMedGoogle Scholar
  54. Weinberg, M. S., Williams, C. J., & Pryor, D. W. (2001). Bisexuals at midlife commitment, salience, and identity. Journal of Contemporary Ethnography, 30(2), 180–208.CrossRefGoogle Scholar
  55. Wheeler, D. P., Lauby, J. L., Liu, K.-L., Van Sluytman, L. G., & Murrill, C. (2008). A comparative analysis of sexual risk characteristics of Black men who have sex with men or with men and women. Archives of Sexual Behavior, 37(5), 697–707. doi: 10.1007/s10508-008-9372-7.CrossRefPubMedGoogle Scholar
  56. Yost, M. R., & Thomas, G. D. (2012). Gender and binegativity: Men’s and women’s attitudes toward male and female bisexuals. Archives of Sexual Behavior, 41(3), 691–702.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  1. 1.Department of Infectious Diseases and Microbiology, Graduate School of Public HealthUniversity of PittsburghPittsburghUSA
  2. 2.Center for LGBT Health Research, Graduate School of Public HealthUniversity of PittsburghPittsburghUSA
  3. 3.Department of Behavioral and Community Health Sciences, Graduate School of Public HealthUniversity of PittsburghPittsburghUSA
  4. 4.Department of MedicineGeorgetown University Medical CenterWashingtonUSA
  5. 5.Department of Family Medicine, David Geffen School of MedicineUniversity of California-Los AngelesLos AngelesUSA
  6. 6.PittsburghUSA
  7. 7.Department of International Health, Bloomberg School of Public HealthJohns Hopkins UniversityBaltimoreUSA
  8. 8.Department of Medical Social SciencesNorthwestern UniversityEvanstonUSA

Personalised recommendations