Bisexual men and women face numerous health issues that need to be identified and addressed as a distinct subset of health issues for the broader LBGT community. This is of growing importance as an increasing percentage of young people identify themselves as sexually attracted to more than one gender. In a study of urban Pittsburgh teenaged girls (ages 16-19) who identified as LGBT, the majority (141 of 173) identified themselves as bisexual. (Marshal, 2013 – Am J Pub H) A recent survey of young British adults aged 18-24 found that 43% consider themselves as somewhere between exclusively heterosexual and exclusively gay or lesbian. (YouGov.UK, 2015) A survey of U.S.teens aged 13-20 found that about 35% identified themselves as somewhat bisexual. (J. Walter Thompson Innovation Group, 2016)
At the same time, studies indicate that the wellbeing of bisexuals is, in many ways, worse than that of heterosexuals or exclusive homosexuals. From studies cited in a 2010 Center for Disease Control (CDC) fact sheet through studies published in 2018, bisexuals in the U.S. emerge with a distinct set of health risks. To shed light on some of the reasons for these findings, consider a study that examined sexual orientation bias among 300 midwestern U.S. college students. The study concluded that biphobia is distinct from homophobia, and that the bias against bisexual men and women is stronger than the bias in all other sub-population characteristics, including other sexual orientations, religion, race, and political leaning, with men expressing more negative attitudes toward bisexuals than women. (Friedman, 2014)
Fear of Disclosure and Lack of Social Support
Considering the widespread biphobia, it’s not surprising that bisexuals are reluctant to disclose their sexual orientation to family, friends, or health professionals. The San Francisco Human Rights Commission published a comprehensive report about the “invisibility” of bisexuals, noting that while bisexuals make up an increasing majority of the LGBT community, they are often subjected to a double dose of exclusion and discrimination from both heterosexuals and within the LGBT community, leading to social isolation and stress, both of which increase health risks. While gay men and lesbians have developed social support networks in the face of homophobia, the same has not been as true for bisexuals facing biphobia.
Trauma and Mental health
Surveys indicate a high level of traumatic experience among bisexuals, including sexual abuse as children and adults, and high levels of partner violence. Numerous studies document the negative impact that trauma, biphobia and social isolation have on the mental health of bisexual people. A publication of the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA) cited evidence that bisexual women and men have the lowest level of emotional wellbeing and highest levels of depression and anxiety, as compared with heterosexuals, lesbians, and gay men, with more self-harm such as eating disorders, suicidal ideation and suicide attempts than any other sexual orientation. Bisexuals and lesbians who have “come out” are more likely than heterosexual women to show suicidal ideation, and if they are not out, they are more likely to attempt suicide. But bisexuals and lesbians will contact professionals for emotional help more often if their primary care physician knows their sexual orientation.
Heavy Smoking and Drinking
The toxic stew of trauma, isolation, anxiety and depression are correlated with high rates of heavy smoking and drinking among bisexuals. An analysis of 10 years of California data concluded that bisexuals are at particular risk for smoking prevalence, heavy smoking behavior, and exposure to secondhand smoke. (Max, 2016) A study of smoking risk in high school students found a significantly greater smoking risk among younger bisexuals, bisexual girls and Asian-American and Pacific Islander bisexuals. (Corliss, 2014) Heavy drinking among bisexual men and women also emerges in study after study that breaks out data on bisexuals.
Poverty, Lack of Health Insurance and Difficulties Obtaining Health Care
Older and more recent studies conclude that bisexuals report higher rates of poverty than lesbian and gay male individuals, at rates far higher than heterosexuals. (Matthews, 2018) Another study concluded that bisexual women in the U.S. were less likely to have health insurance, and more likely to have difficulty obtaining medical care.
All the factors above are likely contributors to poor overall health quality and specific physical health disparities found among bisexuals. A range of studies in the U.S. have found higher rates of breast, ovarian and endometrial cancers in bisexual women, and higher rates of high cholesterol, high blood pressure, asthma, disability, and low weight in bisexual adult men and women. Numerous studies have also found lower rates of some preventive disease screening, with the likely result that disease has progressed further in bisexuals when it is finally discovered. An analysis of Washington state data on adults 50 and older found a higher rate of diabetes and a lower rate of HIV testing in bisexual men as compared to gay men. (Frederiksen-Goldsen, 2013)
Risky Sexual Behaviors
Lower rates of preventive screening is especially problematic because studies find bisexuals more likely to engage in high-risk sexual behaviors, including unprotected sex, sex work, a higher number of sexual partners, and frequent use of emergency contraception and pregnancy termination. As expected, these behaviors also result in higher rates of HIV, cancer-causing HPV, and numerous other sexually transmitted infections in bisexual men and women.
Recommendations For the Future
The studies referenced here offered a wide range of recommendations for improving the health of bisexuals, including greater awareness and sensitivity on the part of medical and mental health care providers about the unique disparities among this population. Bisexuality needs to be accepted as a unique sexual orientation, so that efforts to reduce stigma may lead to a greater willingness to disclose bisexual orientation to health professionals and others. Greater acceptance may help to reduce depression, anxiety and substance abuse and improve health outcomes overall.
Awareness and education efforts to end bias should be particularly targeted toward heterosexual men, gay men, lesbians, and racial minorities. Medical and mental health care professionals need to provide an accepting environment for bisexuals, particularly for adolescents who are exploring sexual identity and behavior. There is a need to target bisexuals with prevention and cessation programs for smoking and substance abuse; one study recommends that youth be involved in the planning and implementation of such programs. Other suggestions include identifying and studying the coping strategies of happier bisexuals and increasing social support networks for bisexual men and women of all ages.
While the research literature on bisexuality has improved, it is important for further studies to sort populations by sexual orientation that specifies bisexuals as distinct from gay men and lesbians, as well as by the gender of sexual partners, and to research those who choose a category such as “other.” Expanding the timeframe for studies is also recommended, since attitudes toward bisexuality are changing, and the experience of older bisexuals is likely to differ from that of younger people. Finally, we recommend more research on the social determinants of health, such as income, housing, and education affect the health status of bisexual men and women.