Bisexual Women Often Overlooked in HIV Education and Safer Sex Efforts
September 24, 2014
Who do you think of when you hear the word "bisexual"? A glance through articles referencing bisexual people published this year on TheBody.com shows a focus on bisexual men. But did you know that most people who identify as bisexual are women? Clearly we need to take a closer look at bisexual women and HIV.
What does it mean to identify as bisexual? The consensus in the bisexual community leans toward this definition: Bisexuals are people attracted to more than one gender, although not necessarily at the same time, to the same extent, or in the same way.
Among people who identify as either gay, lesbian or bisexual, 50% of that group identifies as bisexual. And of that 50%, two-thirds are women. So if we're going to talk about HIV in the LGBT community, and we leave out bisexual women, we're not having a full conversation.
This week is Bisexual Awareness Week, so let's have that conversation! Identity matters, and identity can intersect with health and well-being, especially when it comes to HIV. The bisexual population has a unique health profile, and its own set of health inequities, risks and resiliencies.
Dona Lackey, 41, is a medical massage therapist. She's also bisexual and HIV positive. She says, "I have not found much, if any, information about HIV-positive women and bisexuality."
Dona's experience is not unique. Not much information about bisexual women's health is available, period, let alone when it comes to HIV. What we do know is bisexual women have higher rates of some behaviors that can elevate HIV risk -- like substance use -- as well as higher rates of mental health challenges including depression, anxiety, self-harming behaviors and suicidal ideation. Bisexual people, in general, are less likely to be out to their doctors. And the research on bisexual people and safer sex practices is a mixed-bag of findings.
When it comes to safer sex with female partners, Dona says, "When women ask how to have safer sex with me, I refer them to safer sex practices for lesbians."
Unfortunately, lesbian safer sex education materials are not always inclusive of bisexual women. In a way, that makes sense: Lesbian and bisexual identities are different. However, many bisexual women and lesbians share community space and share resources. Like bisexual women, many lesbians have sexual relationships with men, and many women who initially identify as lesbian later come out as bisexual. Bisexual women are already part of the lesbian community, and these materials should be inclusive.
Because bisexuals are less out to health care providers, we must encourage bisexuals to come out and educate the medical profession on being bi-friendly and knowledgeable about bisexual health.
Fortunate to be in a situation where she can be out to her doctor, Dona has invited past partners to join her at doctor's appointments to ask questions. "My doctor is awesome and happy to teach about safer sex practices," she explained.
But addressing the needs of bisexual women with HIV is not just about being inclusive, being out or being supportive to bisexual patients and clients. Education needs to happen between women and their partners and potential partners. Dona shared her experiences with two potential partners:
I do not allow intimacy until I disclose. I tell the story and let them decide if they want to be involved with me. I met [a woman and] told her my status. She told me that she was not comfortable with dating me, as she just got out of a relationship with a woman who had cancer and could not face the fear of falling for me and losing me. I am not sick, never have been, and never plan on it! But, I respect her choice and moved on.
[On a date with a man] I told my story. He said, "You won't mind if I don't contact you for a few days, will you?" I said, "Not at all, take all the time you need and when you have questions, I will be happy to answer them." Then he said, "So, if we have sex, do we use condoms?" I smiled and said "Yes! I know what I have, but I don't know what you have, and I am not interested in adding anything else to my body!" [He] was shocked! Like I insulted him. Or rather, he [hadn't thought] about it that way.
I turn down more people than I actually date. Turning them down makes them mad. They expect me to want them just because they accept me. I am not that needy.
Whether you identify as bisexual or as an ally to the bisexual community, you have an opportunity to support bisexual women with HIV by creating space for Dona and women like her. In fact, by doing so, the entire LGBT community becomes that much more healthy and whole.
Amy Andre is a co-author of Bisexual Health: An Introduction and Model Practices for HIV/STI Prevention Programming and a member of the Fenway Institute's new consortium on bisexual health.
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