This post is in honor of Bisexual Health Awareness Month.
Bisexual people make up the majority of the LGBTQ population, yet somehow still experience erasure and stereotypes. As a result, bi+ people suffer from worse health disparities than both lesbians and gay people. It’s time for this to change.
According to the Movement Advancement Project’s 2016 report, bi+ people are more likely to smoke cigarettes, drink heavily, and struggle with obesity than both gay or straight people. Studies also show that bi+ people struggle with mental health more than gay and straight people. The reason for this, according to these studies, is biphobia coming from both outside and within the LGBTQ community.
The same goes for sexual health disparities among bi+ people. A 2016 study found that bisexual teenage girls face barriers to sexual healthcare such as “judgmental attitudes and assumptions of patient heterosexuality among healthcare providers, and missed opportunities for HIV and sexually transmitted infections (STI) testing.” Several other studies say that bi+ people are more at risk for contracting HIV or an STI, especially for bisexual people of color. The reason for this is because of intersecting forms of oppression. The more you experience—biphobia, racism, misogyny, classism—the more at risk you are.
What’s worse is that many healthcare professionals are ignorant about bisexuality and specific issues bi+ people face. I talked to two experts in the field to find out how we can do better.
“Interlocking Systems of Discrimination”
Dr. H. “Herukhuti” Sharif Williams is a sexologist, sex educator, playwright, author, and bisexual activist. He says there needs to be a nuanced discussion about bi+ people and sexual health because bisexual people of color are at a higher risk of contracting HIV. “There’s research that suggest that Black, indigenous, and people of color make up a significant amount of the bisexual population,” he told me, “and so people are dealing with the interlocking systems of discrimination, prejudice, and oppression that exist in the society.”
Dr. Herukhuti says that biphobia often stems from racism and white supremacy. “I would argue that one of the reasons why sexual fluidity is a lot less accepted and tolerated in society is because of so many Black, indigenous, and people of color are sexually fluid, as opposed to being just heterosexual or just gay and lesbian,” he told me. “Society is pushing back against ways of being that come out of the cultural communities and cultural context of Black, indigenous and other people of color.”
Studies show that bi+ people are less likely to be open about their sexual orientation than gays and lesbians to their healthcare providers, due to biphobia.
Dr. Lauren B. Beach, a research assistant professor at Northwestern Institute for Sexual and Gender Minority Health and Wellbeing, agrees that intersecting forms of oppression create great sexual health disparities for bi+ people. “Bisexual populations disproportionately are impacted by poverty and violence,” she told me recently over the phone, “and that violence includes sexual assault,” which puts bi+ people at a higher risk of contracting STIs.
“A Perfect Impasse”
Studies show that bi+ people are less likely to be open about their sexual orientation than gays and lesbians—even to their healthcare providers—due to this biphobia. Dr. Herukhuti says that people often assume they know a bisexual person’s orientation based on their gender expression or their current relationship. “That assumption,” he says, “negatively impacts the mental health of the bisexual person.”
Another reason why bi+ people are less likely to disclose their sexuality to their healthcare providers, according to Dr. Beach, is because the providers don’t know how to ask the right questions. Not only do they often not ask about identity, Beech told me, “they may not ask about behavior, or they may not go into what they’re doing with different body parts, which really matters when you’re thinking about STI risk.”
Healthcare providers also often feel like patients should tell them about their sexuality first, while patients think the opposite, so it creates what Dr. Beach calls “a perfect impasse” where nothing progresses. “You really need to build a trusting relationship,” she told me, “and I just think it’s harder to build a trusting relationship when people don’t even understand what bisexuality is.”
“I’d recommend providers look at bi-specific community symbols to figure out how to communicate safety.”
Dr. Herukhuti told me countless bi+ people have shared stories with him about experiencing biphobia in the medical field, from healthcare providers to therapists. “They prolong going to see a provider because they’re trying to gear up for the inevitable biphobia that they will experience, or they’re trying to avoid the biphobia that they experience.”
How Healthcare Providers Can Better Serve Bi+ People
Dr. Beach recommends that healthcare providers make it clear to patients that they’re welcoming to all LGBTQ people, not just gays and lesbians. “You should ideally have a patient portal that asks people their sexual orientation or sex and their gender identity, their pronouns and their name,” she told me. “If you don’t do it before the visit, it should be on a paper form and then the providers should look at the form and actually understand the information.”
Dr. Beach also recommends designing the waiting room in a way that lets bisexual patients know they are welcomed. “You can have rainbows,” she told me, though “I don’t necessarily feel welcomed by a rainbow flag. But I do feel welcomed by a bi or pan flag. I’d recommend providers look at bi-specific community symbols to figure out how to communicate safety.”
The most important thing healthcare providers can do is to educate themselves. “They have to understand that being bisexual is uniquely and distinctively different than being gay and lesbian,” Dr. Herukhuti told me. “They need very specific training and education in dealing with bisexual issues, and recognize that they are carrying biphobic prejudices that they are not aware of.”
Dr. Beach adds that that training should include making healthcare affordable for bi+ people, asking the right questions about sexual history, and recognizing intersectional forms of marginalization many bi+ people experience. “You can address bisexual disparities,” she told me, “but then you can have disparities within disparities by race, by age, and by geography. It’s important to try to fight back against that by making sure all trainings and approaches are intersectional.”