Abstract
Men who have sex with men (MSM) are typically studied as though they were a homogeneous population. This has resulted in a lack of knowledge about the sexual health and behavior of bisexual men as distinct from gay men. In this study, patterns of sexual behavior and rates of HIV testing were compared between 854 gay-identifying and 164 bisexual-identifying men who participated in an Australian nationwide online survey. Approximately half of both groups engaged in unprotected anal intercourse (UAI) at their most recent sexual encounter, but bisexual-identifying men were more likely to have had sex with a partner who was either serodiscordant or with whom their seroconcordance was unknown. Despite these patterns, only 62% of bisexual-identifying men had ever been tested for HIV compared to 84% of gay-identifying men. Multivariate logistic regression focused on rates of UAI and HIV testing among bisexual-identifying men. Patterns were similar across all age groups and educational backgrounds. However, bisexual-identifying men were less likely to engage in UAI with a casual partner and were more likely to have been tested for HIV if they had multiple partners or had disclosed their sexual orientation to their social networks. In all, these data reveal important differences between gay- and bisexual-identifying men, particularly with regard to HIV testing, and highlight a need for HIV prevention strategies to focus more strategically on finding ways of promoting safer sex and HIV testing among all MSM.
Similar content being viewed by others
References
Smith AMA, Rissel CE, Richters J, Grulich AE, de Visser RO. Sex in Australia: sexual identity, sexual attraction and sexual experience among a representative sample of adults. Aust NZ J Public Health. 2003;27(2):138–45.
Mercer CH, Hart GJ, Johnson AM, Cassell JA. Behaviourally bisexual men as a bridge population for HIV and sexually transmitted infections? Evidence from a national probability survey. Int J STD AIDS. 2009;20(2):87–94.
Wells JE, McGee MA, Beautrais AL. Multiple aspects of sexual orientation: prevalence and sociodemographic correlates in a New Zealand national survey. Arch Sex Behav. 2011;40(1):155–68.
McLean K. Inside, outside, nowhere: bisexual men and women in the gay and lesbian community. J Bisex. 2008;8(1–2):63–80.
Jin FY, Prestage G, Law MG, Kippax S, Van de Ven P, Rawsthorne P, et al. Predictors of recent HIV testing in homosexual men in Australia. HIV Med. 2002;3(4):271–6.
Morris SR, Little SJ. MSM: resurgent epidemics. Curr Opin HIV AIDS. 2011;6(4):326–32.
Pollock JA, Halkitis PN. Environmental factors in relation to unprotected sexual behavior among gay, bisexual, and other MSM. AIDS Educ Prev. 2009;21(4):340–55.
Prestage G, Ferris J, Grierson J, Thorpe R, Zablotska I, Imrie J, et al. Homosexual men in Australia: population, distribution and HIV prevalence. Sex Health. 2008;5(2):97–102.
Prestage G, Jin F, Zablotska IB, Imrie J, Grulich AE, Pitts M. Trends in HIV testing among homosexual and bisexual men in eastern Australian states. Sex Health. 2008;5(2):119–23.
Wolitski RJ, Fenton KA. Sexual health, HIV, and sexually transmitted infections among gay, bisexual, and other men who have sex with men in the United States. AIDS Behav. 2011;15(Suppl 1):S9–17.
Elford J, Hart G. If HIV prevention works, why are rates of high-risk sexual behavior increasing among MSM? AIDS Educ Prev. 2003;15(4):294–308.
Elford J. Changing patterns of sexual behaviour in the era of highly active antiretroviral therapy. Curr Opin Infect Dis. 2006;19(1):26–32.
Heckman TG, Kelly JA, Sikkema KJ, Roffman RR, Solomon LJ, Winett RA, et al. Differences in HIV risk characteristics between bisexual and exclusively gay men. AIDS Educ Prev. 1995;7(6):504–12.
Zule WA, Bobashev GV, Wechsberg WM, Costenbader EC, Coomes CM. Behaviorally bisexual men and their risk behaviors with men and women. J Urban Health. 2009;86(Suppl 1):48–62.
Lever J, Kanouse DE, Rogers WH, Carson S, et al. Behavior patterns and sexual identity of bisexual males. J Sex Res. 1992;29(2):141–67.
Stokes JP, Vanable P, McKirnan DJ. Comparing gay and bisexual men on sexual behavior, condom use, and psychosocial variables related to HIV/AIDS. Arch Sex Behav. 1997;26(4):383–97.
Messiah A, Mouret-Fourme E. Sociodemographic characteristics and sexual behavior of bisexual men in France: implications for HIV prevention. The French National Survey on Sexual Behavior Group. Am J Public Health. 1995;85(11):1543–6.
Holt M, Rawstorne P, Wilkinson J, Worth H, Bittman M, Kippax S. HIV testing, gay community involvement and internet USE: social and behavioural correlates of HIV testing among Australian men who have sex with men. AIDS Behav. 2012;16(1):13–22.
Holt M, Rawstorne P, Worth H, Bittman M, Wilkinson J, Kippax S. Predictors of HIV disclosure among untested, HIV-negative and HIV-positive Australian men who had anal intercourse with their most recent casual male sex partner. AIDS Behav. 2011;15(6):1128–39.
Jeffries WL IV, Dodge B. Male bisexuality and condom use at last sexual encounter: results from a national survey. J Sex Res. 2007;44(3):278–89.
Jeffries WL IV. HIV testing among bisexual men in the United States. AIDS Educ Prev. 2010;22(4):356–70.
Gorbach PM, Murphy R, Weiss RE, Hucks-Ortiz C, Shoptaw S. Bridging sexual boundaries: men who have sex with men and women in a street-based sample in Los Angeles. J Urban Health. 2009;86(Suppl 1):63–76.
Zellner JA, Martinez-Donate AP, Sanudo F, Fernandez-Cerdeno A, Sipan CL, Hovell MF, et al. The interaction of sexual identity with sexual behavior and its influence on HIV risk among latino men: results of a community survey in northern San Diego County, California. Am J Public Health. 2009;99(1):125–32.
Jeffries WL IV. HIV testing among bisexual men in the United States. AIDS Educ Prev. 2010;22(4):356–70.
Pathela P, Hajat A, Schillinger J, Blank S, Sell R, Mostashari F. Discordance between sexual behavior and self-reported sexual identity: a population-based survey of New York City men. Ann Intern Med. 2006;145(6):416–25.
Grulich AE, de Visser RO, Smith A, Rissel CE, Richters J. Sexually transmissible infection and blood-borne virus history in a representative sample of adults. Aust NZ J Public Health. 2003;27(2):234–41.
Balsam KF, Mohr JJ. Adaptation to sexual orientation stigma: a comparison of bisexual and lesbian/gay adults. J Couns Psychol. 2007;54(3):306–19.
Eliason M. Bi-negativity: the stigma facing bisexual men. J Bisex. 2001;1(2–3):137–54.
Zablotska IB, Grulich AE, De Wit J, Prestage G. Casual sexual encounters among gay men: familiarity, trust and unprotected anal intercourse. AIDS Behav. 2011;15(3):607–12.
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):1031–7.
Malebranche DJ, Arriola KJ, Jenkins TR, Dauria E, Patel SN. Exploring the “bisexual bridge”: a qualitative study of risk behavior and disclosure of same-sex behavior among black bisexual men. Am J Public Health. 2010;100(1):159–64.
Siegel K, Schrimshaw EW, Lekas H-M, Parsons JT. Sexual behaviors of non-gay identified non-disclosing men who have sex with men and women. Arch Sex Behav. 2008;37(5):720–35.
Prabhu R, Owen CL, Folger K, McFarland W. The bisexual bridge revisited: sexual risk behavior among men who have sex with men and women, San Francisco, 1998–2003. AIDS. 2004;18(11):1604–6.
Acknowledgments
We wish to thank Geoffrey Smith at the Australian Research Centre in Sex, Health and Society for his assistance with data collection.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Lyons, A., Pitts, M., Grierson, J. et al. Sexual Behavior and HIV Testing Among Bisexual Men: A Nationwide Comparison of Australian Bisexual-Identifying and Gay-Identifying Men. AIDS Behav 16, 1934–1943 (2012). https://doi.org/10.1007/s10461-012-0148-7
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10461-012-0148-7