Search

Sexual minority youth are at increased risk of substance use compared to their heterosexual peers, and bisexual youth appear to be at greatest risk. However, little is known about their motivations for and against using substances, how they make decisions, and what consequences they experience. We used qualitative data from a study of 54 cisgender and transgender male youth (ages 14–17 years) who reported attractions to more than one gender or regardless of gender (i.e., bisexual, pansexual, or queer; collectively referred to as bi+) to explore these aspects of substance use. Participants completed a survey and an interview, and interviews were thematically analyzed. Qualitative analyses revealed that participants described diverse motivations for using substances (e.g., to cope with stress, to experiment, to have fun) and for not using them (e.g., concern about consequences, not having access). The most common sources of stress were mental health problems, school, and family. They did not describe sexual orientation-related stress as a motivation for their use, but they acknowledged that it could influence others' use. Participants also described thinking about when, where, and with whom they were going to use prior to doing so (e.g., only using in safe places and with people who they trusted). Finally, they described a range of consequences they experienced (e.g., getting sick, getting in trouble), and a subset of transgender participants described experiencing dependence symptoms. These findings suggest that substance use prevention and harm reduction interventions for bi+ male youth should address diverse motivations for use, including general stressors, which are often overlooked compared to minority-specific stressors. Further, interventions should approach youth as capable of making decisions. Findings also highlight the particular need to address substance use among transgender youth. [ABSTRACT FROM AUTHOR]

The principles of community-based participatory research were applied to an exploratory sexual health study that examined 'cruising for sex' among men on a college campus. In the context of a study seeking a broad interpretation of the health implications of cruising, and when faced with methodological challenges, the researchers found these principles to provide invaluable guidance. A review of the research process is offered and the manner in which the principles of community-based participatory research were operationalized for this study is described. KEY WORDS: sexual health; community-based participatory research; public sex; cruising.

The field of HIV/STI prevention has primarily focused on gay men (or "men who have sex with men" [MSM] as a broad category) with limited attention to bisexual men in particular. Although bisexual men are also at increased risk for HIV and other STI, they are less likely to utilize HIV/STI prevention services than gay men, and very few interventions have been developed to address their unique needs. Further, while biomedical advances are changing the field of HIV prevention, bisexual men are also less likely to use biomedical HIV prevention strategies (e.g., pre-exposure prophylaxis [PrEP]) than gay men. In an effort to advance research on bisexual men and their sexual health needs, the goals of this commentary are: (1) to review the empirical literature on the prevalence of HIV/STI among bisexual men, the few existing HIV/STI prevention interventions developed for bisexual men, and the use of biomedical HIV prevention among bisexual men; (2) to describe the ways in which the field of HIV/STI prevention has largely overlooked bisexual men as a population in need of targeted services; and (3) to discuss how researchers can better address the sexual health needs of bisexual men in the age of biomedical HIV prevention. [ABSTRACT FROM AUTHOR]

Sexual orientation is a multi-dimensional concept, at a minimum comprised of sexual identity, sexual attraction, and sexual behavior. Our study aimed to assess relationships among self-identified sexual identity, sexual attraction, and sexual behaviors in a probability sample of adults in the U.S. and to identify associated factors with diverse patterns. We collected data from adults in the 2015 National Survey of Sexual Health and Behavior, an Internet-based nationally representative probability survey of the general U.S. population. Concordance between sexual identity versus sexual attraction and sexual behaviors was assessed using percent agreement. We identified correlates of discordance using logistic regression. Concordance between sexual identity versus sexual attraction and past-year sexual behaviors was 94% and 96%, respectively, though our sample was predominately composed of heterosexual individuals. Women and sexual minority individuals reported greater discordance across sexuality-related measures than men and heterosexual individuals. Younger adults (aged 18-24 years) were more likely to report sexual behaviors discordant with sexual identity compared with older adults (including those ages 25-34 years). Higher levels of educational attainment were significantly associated with less discordance of reported recent sexual activity and sexual identity. Measures of sexual identity, attraction, and behaviors are not interchangeable. Future research should consider multiple sexuality-related measures in order to capture the complexity and variability of sexualities. [ABSTRACT FROM AUTHOR]

Despite comprising the largest proportion of the "lesbian, gay, and bisexual" population, research focusing on the unique health concerns and needs of bisexual individuals is relatively scarce. While health disparities are increasingly well documented among lesbian, gay, bisexual, and transgender individuals relative to their heterosexual and cisgender counterparts, gaps remain in our basic understanding of how health status, behaviors, and outcomes vary within these groups, especially bisexual individuals. The lack of specified research on bisexual health is even more curious given that, when separated from both heterosexual and gay/lesbian individuals, bisexual individuals consistently report higher rates of a wide range of negative health outcomes, including mood and anxiety disorders, substance use, suicidality, as well as disparities related to healthcare access and utilization. Indeed, in scientific research, mass media, and in public health interventions, bisexual individuals remain relatively invisible. This Special Section represents an effort to shed light on a new generation of quantitative, qualitative, and mixed methods research studies that examine health-related concerns, outcomes, and intervention opportunities specifically among diverse samples of bisexual individuals from a variety of social and cultural contexts. The research herein focuses on intersections of multiple identities, the development of new measures, the use of large national data sets, and diverse groups of self-identified bisexual men (who tend to be least visible in health research). Findings from these studies will significantly advance our knowledge of factors associated with health disparities, as well as health and well-being more generally, among bisexual individuals and will help to inform directions for future health promotion research and intervention efforts. [ABSTRACT FROM AUTHOR]

Research examining the sexual identities, behaviors, and experiences of bisexual men outside of Western contexts (including in India) is limited. Individuals who self-identify as bisexual due to their orientation toward partners of more than one gender face distinct psychosocial challenges relative to exclusively heterosexual, gay/lesbian, or other individuals. We conducted four focus group discussions (n = 22) and in-depth interviews (n = 50) with self-identified bisexual men (age 18 years and older) who were recruited from the metropolitan area of Mumbai, India, between June and August 2013. We triangulated and analyzed focus group and interview data using standard qualitative research techniques. Findings from our study suggest that multiple factors influence the sexual experiences of self-identified bisexual men in Mumbai, including contexts of sexual interactions, sexual positioning, and the gender of sexual partners. Participants described cultural meaning systems and psychosocial dynamics that regulate bisexual identity development, disclosure, and sexual decision making with male, female, and other partners. Secrecy, discretion, and sexual pleasure also influenced sexual behaviors and relationships. Although Western sexual identity categories are not necessarily equivalent in the Indian context, it is interesting and important to note that a number of individuals in India continue to use the identity label of "bisexual." Before developing interventions to meet unique sexual health needs of bisexual men, it is crucial to understand how these men perceive themselves, reconcile the ordinary aspects of their lives with their sexuality, and structure their relationships with partners. [ABSTRACT FROM AUTHOR]

Bisexual parents have been notably absent from prior research on parenting, despite comprising the largest proportion of parents among "lesbian, gay, and bisexual" (LGB) individuals. Indeed, recent national probability data indicate that young bisexual women are more likely than their heterosexual counterparts to report having at least one child. Intentions to have children, patterns of family planning and contraception use, and related issues have important implications for health and healthcare-related decisions and priorities among bisexual parents. We conducted in-depth interviews with a sample of 33 bisexual parents from across the U.S. who reported having at least one child (genetic, adopted, step or foster child, guardian, and/or warden of the state). In cases of intentional pregnancies, participants considered relationship and financial stability, job security and their ideal family size. Unintentional pregnancies, as well as pregnancy terminations, were often reframed as positive experiences. After deciding not to have more children, participants reported using contraceptive methods, including sterilization or long-acting reversible contraceptive methods (e.g., intrauterine devices). Instances of deception, in which partners deceived participants with false beliefs regarding their contraceptive use, were recalled negatively for the relatively small number of participants who reported such experiences. Overall, our findings point to a diversity in the intentions and ways bisexual individuals become parents, similar to parents of other sexual identities. Acknowledgements of the diverse experiences and concerns faced by bisexual parents may be beneficial in improving efforts related to providing appropriate and relevant health- and healthcare-related services. [ABSTRACT FROM AUTHOR]

Researchers posit that negative attitudes, prejudice, and discrimination (i.e., binegativity) from heterosexual and gay/lesbian individuals may contribute to health disparities among bisexual individuals relative to heterosexual and gay/lesbian individuals. Recent studies have focused on gay, lesbian, and heterosexual people's (e.g., "others") attitudes toward bisexual people. No studies have investigated how bisexual individuals perceive others' attitudes toward bisexual people, which are generally known as "meta-perceptions." As part of the 2015 National Survey of Sexual Health and Behavior, we collected data from a nationally representative probability sample of 2999 adults, including from a subsample of 33 men and 61 women self-identified as bisexual. The Bisexualities: Indiana Attitudes Scale-bisexual (BIAS-b), a modified 5-item scale assessing bisexual people's perceptions of others' attitudes toward bisexual individuals, was included and was followed by an open-ended text box question. Quantitative scale data were analyzed using descriptive and gamma regression methods. Two coders thematically analyzed the open-ended text box data. The internal consistency of the BIAS-b was high (Cronbach's α = 0.85). An exploratory factor analysis supported a one-factor solution. Participants responded to statements regarding others' attitudes toward them as bisexual people, including the domains of confusion, HIV/STD risk, incapability of monogamy, promiscuity, and instability ("just a phase"). Participants' text box descriptions largely aligned with these five domains, with the exception of HIV/STD risk. Additionally, some participants reported others' positive perceptions of them as bisexual individuals. In sum, we observed a range of meta-perceptions, primarily neutral to negative, but also including some relatively positive. These results show the need for interventions to promote acceptance of bisexual individuals among heterosexual and gay/lesbian individuals. [ABSTRACT FROM AUTHOR]

Collecting information on sexual identity is critical to ensuring the visibility of minority populations who face stigmatization and discrimination related to sexual identities. However, it is challenging to capture the nuances of sexual identity with traditional survey research methods. Using a mixed-methods approach, we gathered data on the sexual identities of 80 behaviorally bisexual women in the Midwestern United States through an online survey. When provided different types of measures (e.g., open ended and fixed response) and different contexts in which to identify (e.g., private and public), participants varied in how they reported their sexual identities. Qualitative analysis of participant narratives around identity change finds partitioning and ranking of attraction is a key component in understanding behaviorally bisexual women's identities. We further identify a division regarding the desired outcomes of identity development processes. Given the multiple ways in which participants identified depending upon the type of measure and the context specified, and the variation in identification over time, results support reconsidering the capability of typical measures and methods used in survey research to capture sexual identity information. Additionally, findings highlight the utility of including multiple, context-specific measures of sexual identities in future research. [ABSTRACT FROM AUTHOR]

The HIV epidemic continues to be a major public health concern, affecting communities with varying prevention and treatment needs. In the U.S., Latino men who have sex with men (MSM) bear a disproportionate burden of HIV incidence. While recent studies have highlighted the relevance of relationship factors for HIV transmission among MSM generally, the unique needs and experiences of Latino MSM have received relatively little attention. Consequently, associations between relationship factors and HIV risk among Latino MSM remain unknown. This mixed-method study examined relationship status and dynamics and potential HIV-related risk behaviors among Latino MSM. Quantitative analyses with 240 Latino MSM investigated associations between relationship status and engagement in condomless anal intercourse (CAI). Focus groups with 20 Latino male couples and 10 health service providers explored the impact of relationship dynamics on sexual behaviors, as well as opportunities to intervene on HIV risk. The majority of participants were predominantly Spanish speaking, most screened positive for high-risk alcohol consumption in the past month, more than half engaged in CAI in the past 3 months, and a majority reported multiple sexual partners in this period. Among participants in same-sex relationships (n = 175), approximately half reported multiple partners in the previous 3 months and more than two-thirds reported CAI in this time period. Being in a same-sex relationship was positively associated with high-risk alcohol consumption and being age 30 or older and negatively associated with having multiple partners. Moreover, being in a same-sex relationship significantly increased the likelihood that participants would report engaging in CAI. Qualitative analyses identified themes related to relationship dynamics and sexual behavior, as well as opportunities to intervene on HIV risk. Despite the challenges encountered by Latino male couples, most participants expressed commitment to and support for their partners. As such, prevention efforts involving Latino male couples must address relationship dynamics and the role they play in sexual health, including safer sex practices. [ABSTRACT FROM AUTHOR]

Previous social and behavioral research on identity among bisexual men, when not subsumed within the category of men who have sex with men (MSM), has primarily focused on samples of self-identified bisexual men. Little is known about sexual self-identification among men who are behaviorally bisexual, regardless of sexual identity. Using qualitative data from 77 in-depth interviews with a diverse sample of behaviorally bisexual men (i.e., men who have had sex with at least one woman and at least one man in the past six months) from a large city in the Midwestern United States, we analyzed responses from a domain focusing on sexual self-identity and related issues. Overall, participants' sexual self-identification was exceptionally diverse. Three primary themes emerged: (1) a resistance to, or rejection of, using sexual self-identity labels; (2) concurrent use of multiple identity categories and the strategic deployment of multiple sexual identity labels; and (3) a variety of trajectories to current sexual self-identification. Based on our findings, we offer insights into the unique lived experiences of behaviorally bisexual men, as well as broader considerations for the study of men's sexuality. We also explore identity-related information useful for the design of HIV/STI prevention and other sexual health programs directed toward behaviorally bisexual men, which will ideally be variable and flexible in accordance with the wide range of diversity found in this population. [ABSTRACT FROM AUTHOR]

Although frequently cited as being at high risk for HIV/STI transmission, little is known about behaviorally bisexual men's patterns and experiences of condom use and nonuse with male and female sexual partners. Using a variety of recruitment techniques informed by a Community Advisory Committee, a total of 77 behaviorally bisexual men were recruited from Indianapolis, Indiana to participate in semi-structured interviews focused on sexual health. Qualitative data were collected containing detailed information on their patterns and experiences of condom use and nonuse with both male and female partners. Participants described numerous commonly reported barriers for consistent condom use, as well as distinct bisexual-specific barriers. The majority reported consistent condom use with male and female casual partners, but many who did not use condoms described doing so in the context of ongoing relationships. In addition, participants provided reasons for condom use and nonuse that varied based on the gender of the partner and the type of relationship with the partner. Future interventions focused on increasing condom use among behaviorally bisexual men should take into account the unique complexities of gender and relationship configurations in this distinct population. [ABSTRACT FROM AUTHOR]

Research examining the sexual behaviors and experiences of behaviorally bisexual men is limited. Most studies focus primarily on highlighting sexual risk behaviors among groups of 'men who have sex with men (MSM)' or 'gay and bisexual men,' which may not be appropriate in terms of behaviorally bisexual men's sexual repertoires with both men and women. This study aimed to assess a broad range of sexual behaviors and associated experiences among bisexual men living in the midwestern United States. An interviewer-administered questionnaire containing items from the National Survey of Sexual Health and Behavior assessed lifetime and recent (i.e., past 6 months and last event) sexual behaviors and experiences with both male and female partners among a diverse sample of 75 behaviorally bisexual men. Responses were quantified and analyzed using descriptive and multivariate statistics. A wide range of sexual behaviors with partners of both genders was found. Vaginal intercourse and oral sex with both men and women were the most commonly reported behaviors. Subjective reports of pleasure, arousal, and sexual function during sexual activity were similar with both male and female sexual partners. Many participants reported using condoms during insertive sexual behaviors with male and female partners, but less during oral sex. Unprotected receptive anal sex was less commonly reported. Overall, participants reported a variety of sexual behaviors and experiences; however, unlike other populations, they shared these with partners of both genders. Results have implications for interventions targeting the sexual behaviors and associated issues among behaviorally bisexual men. [ABSTRACT FROM AUTHOR]

Little is known about men's potential motivations and barriers associated with specific sexually transmitted infections (STI) testing methods. In this study, we examined experiences of self-sampling for ano-rectal STI among men who have sex with men (MSM) in a midwestern community in the U.S. A total of 75 MSM were recruited from community venues throughout Indianapolis, Indiana. Participants completed semi-structured interviews, were asked to obtain ano-rectal self-sample in a private restroom, and were asked open-ended questions about their experiences with ano-rectal self-sampling for STI. Participants included 35 White, 27 Black, and 13 Latino MSM who ranged in age from 18 to 57 years. Regardless of sexual practices, most participants who obtained an ano-rectal self-sample (68/75) reported that the sampling procedure was relatively painless and physically easy. However, regardless of previous receptive anal sex, participants also expressed concerns about the nature of the test (i.e., inserting something into their rectum), which required increased levels of privacy and cleanliness compared to collection of urine samples. Self-sampling proved to be a feasible and acceptable method of collecting ano-rectal STI specimens among MSM. Increased testing for ano-rectal STI among MSM may require addressing the location of sampling and testing sites, existing negative perceptions of ano-rectal self-sampling, and the measures in place to promote privacy and cleanliness. [ABSTRACT FROM AUTHOR]