For many years, I did my advocacy in confidential settings like Ryan White Planning Council and HIV prevention community planning groups. My efforts made a difference in the lives of people living with HIV; however, my activism -- through writing and speaking, even when I lived in fear -- has had a greater impact. But while I was out about living with HIV, for many years I was silent about my sexuality. I think that perhaps if I would have stepped out of the shame and stigma about identifying as a bisexual man, my contribution to the fight to end HIV may have been even more significant. For most of my adult life, I have had to deal with the dual stigma of being out about my bisexual identity and living with HIV. But in the past few years, it has been more important for me to unite my efforts by continuing my activism to fight for justice for people living with HIV without leaving my bisexual community behind.
Today is the 20th anniversary of Bisexual Visibility Day (also known as International Celebrate Bisexuality Day), which was founded to highlight biphobia and to help people looking for community to find other bisexuals. The day calls for bisexual communities and the friends and supporters of bisexuals to recognize and celebrate bisexual history, bisexual community and culture, and all the bisexual people in their lives.
First officially observed in 1999 at the International Lesbian and Gay Association conference in Johannesburg, South Africa, Bisexual Visibility Day is the brainchild of three bisexual rights activists: Wendy Curry, Michael Page, and Gigi Raven Wilbur. Wilbur shared with HuffPost in 2013, "Ever since the Stonewall Rebellion, the gay and lesbian community has grown in strength and visibility. The bisexual community also has grown in strength but in many ways we are still invisible. I too have been conditioned by society to automatically label a couple walking hand in hand as either straight or gay, depending upon the perceived gender of each person."
The importance of Bisexual Visibility Day is in part to also highlight the often invisible history of bisexual activism and the contributions of bisexuals to LGBTQ history. Bisexual people have stood shoulder to shoulder with gay men and lesbians in every major movement in contemporary U.S. queer history, including non-discrimination efforts, HIV activism, the Stonewall riots, and even marriage equality. I believe recognizing the historical work of bisexual activists and movements is essential to the struggle and survival of the bisexual community's experience. The visibility allows other closeted bisexuals to find and gain awareness and a sense of security.
According to a report by the Movement Advancement Project, over half of all people on the LGBTQ spectrum identify as bisexual. The demographic trends hold true across multiple intersections of identity and experience. A large percentage of bisexual people are also transgender and people of color. However, structural biphobia has negative health effects on bisexual people, and health care providers must understand the relationship between biphobia, the low level of bisexual health research funding, and the existence of bisexual health disparities to avoid replicating these negative effects in their practice. The lack of scientific research funding and the experiences of bisexual communities speak to the urgent need to combat biphobia and scale up bisexual health research funding.
Movement Advancement Project also reports that only 28% of bisexual people are out to the most important people in their lives, compared to more than 70% of gay men and lesbians. That's in part because they don't have faith that their experience will be seen as legitimate. That erasure leads to dangerous medical outcomes. Studies show that 39% of bisexual men and 33% of bisexual women don't disclose their sexuality to health care providers, compared to 13% of gay men and 10% of lesbians.
With regard to physical health, bisexual people (and people who have sexual or romantic attraction to or contact with people of more than one gender) have a higher prevalence of a range of health conditions including cardiovascular disease, smoking, substance use, some cancers, and sexually transmitted infections.
The biphobia and lower percentage of bisexuals who are out also have negative health outcomes as related to HIV prevention, treatment, and care. Studies of the efficacy of HIV prevention, treatment, and care are primarily focused on men who have sex with men (MSM). While this behavior-based category has helped move HIV prevention and treatment away from a sole focus on gay-identified men, the real result of the "MSM" category means the prevention and treatment methods developed are not tailored specifically to all of the communities they are supposed to cover. The data collected does not provide information about the specific disparities faced by each subpopulation.
To support better health outcomes for bisexual communities, the federal Department of Health and Human Services (HHS), as well as local and state departments of health, should provide guidance to grantees on prioritizing culturally competent research and programs specific to bisexual people and the treatment, prevention, and care of HIV.
Lastly, HHS and local and state departments of health should provide guidance to grantees on the differences between men who have sex with men, men who have sex with men and women, men who identify as bisexual, and transgender women, as well as appropriate methods of differentiating approaches to those populations in research and program development.
Raising the visibility of bisexual communities can go a long way in supporting better health outcomes for bisexual communities. So it is important that I, and other bisexuals, speak out. But it is also important that government agencies tasked with understanding the health needs of people in the country spend the resources needed to tailor research and programs for bisexuals, too.