Bisexual men are at increased risk for HIV/STI and early pregnancy involvement compared to heterosexual men, and minority stressors (e.g., enacted and internalized stigma) are associated with sexual risk behavior in samples of gay and bisexual men. However, few studies have specifically focused on bisexual men, and little is known about the unique predictors of sexual risk behavior in this population. Further, few studies have focused on positive sexual orientation-related factors such as identity affirmation, which may be protective against sexual risk behavior. As such, the goals of the current study were to examine minority stressors and identity affirmation as predictors of condomless sex among self-identified bisexual men, and whether these associations differed as a function of partner gender. We used four waves of data spanning 24 months from a subset of self-identified bisexual men in a larger cohort of gay and bisexual men ages 16–29 years at enrollment. At each wave, participants reported on up to four partners, allowing us to examine within-person associations. We used mixed effects negative binomial models to examine the associations between our predictors (discrimination, internalized binegativity, and identity affirmation) and condomless sex acts. In addition, we tested whether partner gender moderated each of the associations by including interaction effects in each of the models. Results indicated that higher levels of internalized binegativity and lower levels of identity affirmation were associated with less condomless sex with female partners, but they were not associated with condomless sex with male partners. Discrimination was not associated with condomless sex with male or female partners. These findings suggest that predictors of condom use among self-identified bisexual men differ as a function of partner gender, and they highlight the need to identify strategies to promote sexual health while also supporting positive identity development in this population.
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Amola, O., & Grimmett, M. A. (2015). Sexual identity, mental health, HIV risk behaviors, and internalized homophobia among black men who have sex with men. Journal of Counseling and Development, 93(2), 236–246. https://doi.org/10.1002/j.1556-6676.2015.00199.x.
Balaji, A. B., Bowles, K. E., Hess, K. L., Smith, J. C., & Paz-Bailey, G. (2016). Association between enacted stigma and HIV-related risk behavior among MSM. National HIV Behavioral Surveillance System. https://doi.org/10.1007/s10461-016-1599-z.
Brewster, M. E., & Moradi, B. (2010). Perceived experiences of anti-bisexual prejudice: Instrument development and evaluation. Journal of Counseling Psychology, 57(4), 451–468. https://doi.org/10.1037/a0021116.
Caceres, B. A., Brody, A. A., Halkitis, P. N., Dorsen, C., Yu, G., & Chyun, D. A. (2018). Sexual orientation differences in modifiable risk factors for cardiovascular disease and cardiovascular disease diagnoses in men. LGBT Health, 5, 284–294.
Dodge, B., Jeffries, W. L., & Sandfort, T. G. (2008). Beyond the down low: Sexual risk, protection, and disclosure among at-risk Black men who have sex with both men and women (MSMW). Archives of Sexual Behavior, 37, 683–696.
Dyar, C., Feinstein, B. A., & Davila, J. (2019). Development and validation of a brief version of the Anti-Bisexual Experiences Scale. Archives of Sexual Behavior, 48, 175–189.
Feinstein, B. A., Dodge, B., Korpak, A. K., Newcomb, M. E., & Mustanski, B. (2019a). Improving the health of cisgender men who identify as bisexual: What do they want from interventions? Sexuality Research and Social Policy, 16, 385–391.
Feinstein, B. A., Moran, K. O., Newcomb, M. E., & Mustanski, B. (2019b). Differences in HIV risk behaviors between self-identified gay and bisexual young men who are HIV-negative. Archives of Sexual Behavior, 48, 261–275.
Ferlatte, O., Hottes, T. S., Trussler, T., & Marchand, R. (2014). Evidence of a syndemic among young Canadian gay and bisexual men: uncovering the associations between anti-gay experiences, psychosocial issues, and HIV risk. AIDS and Behavior, 18(7), 1256–1263. https://doi.org/10.1007/s10461-013-0639-1.
Fredriksen-Goldsen, K. I., Kim, H.-J., Bryan, A. E. B., Shiu, C., & Emlet, C. A. (2017). The cascading effects of marginalization and pathways of resilience in attaining good health among LGBT older adults. The Gerontologist, 57, S72–S83.
Friedman, M. R., Stall, R., Plankey, M., Shoptaw, S., Herrick, A. L., Surkan, P. J., et al. (2017). Stability of bisexual behavior and extent of viral bridging behavior among men who have sex with men and women. Archives of Sexual Behavior, 46, 903–912.
Frye, V., Nandi, V., Egan, J., Cerda, M., Greene, E., Van Tieu, H., & Koblin, B. A. (2015). Sexual orientation- and race-based discrimination and sexual HIV risk behavior among urban MSM. AIDS and Behavior, 19(2), 257–269. https://doi.org/10.1007/s10461-014-0937-2.
Ha, H., Risser, J. M. H., Ross, M. W., Huynh, N. T., & Nguyen, H. T. M. (2015). Homosexuality-related stigma and sexual risk behaviors among men who have sex with men in Hanoi, Vietnam. Archives of Sexual Behavior, 44(2), 349–356. https://doi.org/10.1007/s10508-014-0450-8.
Hogan, B., Melville, J. R., Philips II, G. L., Janulis, P., Contractor, N., Mustanski, B. S., & Birkett, M. (2016). Evaluating the paper-to-screen translation of participant-aided sociograms with high-risk participants. Paper presented at the Proceedings of the 2016 CHI Conference on Human Factors in Computing Systems.
Israel, T., Choi, A. Y., Goodman, J. A., Matsuno, E., Lin, Y.-J., Kary, K. G., & Merrill, C. R. S. (2019). Reducing internalized binegativity: Development and efficacy of an online intervention. Psychology of Sexual Orientation and Gender Diversity, 6, 149–159.
Jeffries, W. L. T. (2010). HIV testing among bisexual men in the United States. AIDS Education and Prevention, 22, 356–370.
Leluţiu-Weinberger, C., Rendina, H. J., Mirandola, M., Gios, L., Folch, C., Rafila, A., & Pachankis, J. E. (2019). The role of gay-related stigma in HIV-risk behavior among sexual minority men in Europe. AIDS and Behavior, 23, 684–694. https://doi.org/10.1007/s10461-018-2306-z.
Lindley, L., & Walsemann, K. (2015). Sexual orientation and risk of pregnancy among New York City high-school students. American Journal of Public Health, 105, 1379–1386. https://doi.org/10.2105/ajph.2015.302553.
Magnusson, A., Skaug, H., Nielsen, A., Berg, C., Kristensen, K., Maechler, M., … Brooks, M. (2016). glmmTMB: Generalized linear mixed models using template model builder. Retrieved from https://github.com/glmmTMB/.
Malebranche, D. J., Arriola, K. J., Jenkins, T. R., Dauria, E., & Patel, S. N. (2010). Exploring the “bisexual bridge”: A qualitative study of risk behavior and disclosure of same-sex behavior among black bisexual men. American Journal of Public Health, 100, 159–164.
Meanley, S., Egan, J. E., & Bauermeister, J. A. (2018). Policing heteronormativity and sexual risk-taking among young adult men who have sex with men in the Detroit metro area. AIDS and Behavior, 22, 3991–4000. https://doi.org/10.1007/s10461-018-2257-4.
Mizuno, Y., Borkowf, C., Millett, G. A., Bingham, T., Ayala, G., & Stueve, A. (2012). Homophobia and racism experienced by Latino men who have sex with men in the United States: correlates of exposure and associations with HIV risk behaviors. AIDS and Behavior, 16(3), 724–735. https://doi.org/10.1007/s10461-011-9967-1.
Mustanski, B. (2007). The influence of state and trait affect on HIV risk behaviors: A daily diary study of MSM. Health Psychology, 26, 618–626.
Mustanski, B. (2011). Ethical and regulatory issues with conducting sexuality research with LGBT adolescents: A call to action for a scientifically informed approach. Archives of Sexual Behavior, 40(4), 673–686. https://doi.org/10.1007/s10508-011-9745-1.
Mustanski, B., Newcomb, M. E., & Clerkin, E. M. (2011). Relationship characteristics and sexual risk-taking in young men who have sex with men. Health Psychology, 30, 597–605.
Mustanski, B., Starks, T., & Newcomb, M. E. (2014). Methods for the design and analysis of relationship and partner effects on sexual health. Archives of Sexual Behavior, 43(1), 21–33. https://doi.org/10.1007/s10508-013-0215-9.
Nakamura, N., & Zea, M. C. (2010). Experiences of homonegativity and sexual risk behaviour in a sample of Latino gay and bisexual men. Culture, Health and Sexuality, 12(1), 73–85. https://doi.org/10.1080/13691050903089961.
Newcomb, M. E., Moran, K., Feinstein, B. A., & Mustanski, B. (2018). Pre-exposure prophylaxis (PrEP) use and condomless anal sex: Evidence of risk compensation in a cohort of young men who have sex with men. Journal of Acquired Immune Deficiency Syndromes, 77, 358–364.
Newcomb, M. E., & Mustanski, B. (2011). Moderators of the relationship between internalized homophobia and risky sexual behavior in men who have sex with men: a meta-analysis. Archives of Sexual Behavior, 40(1), 189–199. https://doi.org/10.1007/s10508-009-9573-8.
Paul, R., Smith, N. G., Mohr, J. J., & Ross, L. E. (2014). Measuring dimensions of bisexual identity: Initial development of the bisexual identity inventory. Psychology of Sexual Orientation and Gender Diversity, 1, 452–460.
Puckett, J. A., Newcomb, M. E., Garofalo, R., & Mustanski, B. (2017). Examining the conditions under which internalized homophobia is associated with substance use and condomless sex in young MSM: The moderating role of impulsivity. Annals of Behavioral Medicine, 51(4), 567–577. https://doi.org/10.1007/s12160-017-9878-0.
R Core Team. (2017). R: A language and environment for statistical computing. Retrieved from https://www.R-project.org/.
Rosario, M., Schrimshaw, E. W., & Hunter, J. (2006). A model of sexual risk behaviors among young gay and bisexual men: Longitudinal associations of mental health, substance abuse, sexual abuse, and the coming-out process. AIDS Education and Prevention, 18(5), 444–460.
Ross, M. W., Berg, R. C., Schmidt, A. J., Hospers, H. J., Breveglieri, M., Furegato, M., & Weatherburn, P. (2013). Internalised homonegativity predicts HIV-associated risk behavior in European men who have sex with men in a 38-country cross-sectional study: Some public health implications of homophobia. British Medical Journal Open, 3(2), e001928. https://doi.org/10.1136/bmjopen-2012-001928.
Saewyc, E. M., Poon, C. S., Homma, Y., & Skay, C. L. (2008). Stigma management? The links between enacted stigma and teen pregnancy trends among gay, lesbian, and bisexual students in British Columbia. Canadian Journal of Human Sexuality, 17(3), 123–139.
Sarno, E. L., Mohr, J. J., & Rosenberger, J. G. (2017). Affect and condom use among men who have sex with men: A daily study. AIDS and Behavior, 21, 1429–1443.
Stokes, J. P., McKirnan, D., & Burzette, R. (1993). Sexual behavior, condom use, disclosure of sexuality, and stability of sexual orientation in bisexual men. Journal of Sex Research, 30, 203–213.
Swann, G., Newcomb, M. E., & Mustanski, B. (2018). Validation of the HIV risk assessment of sexual partnerships (H-RASP): Comparison to a two month prospective diary study. Archives of Sexual Behavior, 47(1), 121–131. https://doi.org/10.1007/s10508-017-1033-2.
Toomey, R. B., Anhalt, K., & Shramko, M. (2016). An examination of the validity and reliability of a measure of sexual orientation identity exploration, resolution, and affirmation. Self and Identity, 15, 488–504.
Torres, H. L., Delonga, K., Lee, S., Gladstone, K. A., Barrad, A., Huckaby, S., & Gore-Felton, C. (2013). Sociocontextual factors: Moving beyond individual determinants of sexual risk behavior among gay and bisexual adolescent males. Journal of LGBT Youth, 10(3), 173–185. https://doi.org/10.1080/19361653.2013.799000.
Watson, R. J., Allen, A., Pollitt, A. M., & Eaton, L. A. (2019). Risk and protective factors for sexual health outcomes among black bisexual men in the U.S.: Internalized heterosexism, sexual orientation disclosure, and religiosity. Archives of Sexual Behavior, 48, 243–253. https://doi.org/10.1007/s10508-018-1216-5.
White, D., & Stephenson, R. (2014). Identity formation, outness, and sexual risk among gay and bisexual men. American Journal of Men’s Health, 8(2), 98–109. https://doi.org/10.1177/1557988313489133.
This research was supported by a grant from the National Institute on Drug Abuse (U01DA036939; PI: Mustanski). Brian Feinstein’s time was supported by a grant from the National Institute on Drug Abuse (K08DA045575; PI: Feinstein). Elissa Sarno’s time was supported by a grant from the National Institute on Alcohol Abuse and Alcoholism (F32AA028194; PI: Sarno). The content is solely the responsibility of the authors and does not necessarily represent the official views of the funding agencies.
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All authors declare that they have no conflict of interest.
This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Institutional Review Board at Northwestern University.
Informed consent was obtained from all individual participants included in the study.
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Feinstein, B.A., Swann, G., Sarno, E.L. et al. Minority Stressors and Identity Affirmation as Predictors of Condomless Sex Among Self-Identified Bisexual Men: The Role of Partner Gender. Arch Sex Behav 50, 1057–1065 (2021). https://doi.org/10.1007/s10508-020-01775-y
- Condom use
- Internalized binegativity
- Identity affirmation
- Minority stress
- Sexual orientation