The LGBT Health & Development Program

Research Blog—Bisexual (In)Visibility in Sexual Health Research

Posted on March 11th, 2016 by IMPACT in Featured, Research Blog. No Comments

Written by Paul Salamanca, IMPACT Undergraduate Research Assistant.

Bisexual pride flag

Peter Salanki, “The bisexual pride flag,” June 28, 2009.

The HIV/AIDS epidemic in the United States brought with it many changes, including the beginning of a surge in health research about LGBT populations. With these roots in HIV/AIDS, researchers have historically viewed LGBT populations through a lens that focuses on sexually transmitted infections (STIs) [1]. Because of this focus, researchers have often constructed population categories based on sexual behavior rather than sexual identity [2]. While they may seem benign, these categorizations have consequences for research about health disparities and for the people who fall, neatly or otherwise, into these categories.

For bisexual-identified individuals, these assigned categories for research can be especially problematic. Sexual health researchers often group bisexual men with gay men in the category of “men who have sex with men (MSM).” Bisexual women are also often grouped with lesbian women in the category of “women who have sex with women (WSW)” [2,3]. While this sorting might be “useful” for data analysis, such a grouping methodology misses out on many parts of the bisexual experience that are relevant for health research [2]. Moreover, these categories perpetuate the invisibility of bisexuality. Although bisexuals may fall into MSM and WSW categories in terms of behavior, these categories conceal the fact that bisexuals are attracted to and may engage in sex with more than one sex or gender [4].

A focus on MSM and WSW categories implies that behavior, and not identity, matters for sexual health. These categories may also hinder research on interactions between behavior and identity, interactions that have been shown to affect health [2,5]. In a national study that looked at the link between sexual behavior and sexual orientation, it was found that STI risks were elevated among heterosexual and bisexual WSW compared with lesbian WSW. Similar health disparities were found between gay and bisexual MSM [5]. These important findings would have been forfeited in analyses that focused only on sexual behavior without accounting for sexual identity.

Additionally, categories such as MSM and WSW ignore the complex social networks and communities of the people who fall into those groups [2]. These categorizations can hide nuances in the ways that MSM and WSW relate to other MSM and WSW. For example, one study of a sexually diverse population in New York City found that bisexual MSM and WSW felt less connectivity to the LGBT community [6]. Thus, bisexual MSM and WSW may face different social factors relevant to sexual health than those faced by gay MSM and lesbian WSW. The use of methodologies that don’t fully capture the bisexual experience can overlook potential health disparities and contribute to bisexual invisibility.

To be clear, categories that emphasize sexual behavior are not without their merits, including their technical and analytic utility. But, their usefulness shouldn’t be their sole justification. Health researchers and professionals must be mindful of whom these categories truly represent; what aspects of sexual minority identities these groupings emphasize, blur, or ignore; and the broader consequences of these categorizations for the individuals that they implicate.

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[1] Boehmer, U. (2002). Twenty years of public health research: Inclusion of lesbian, gay, bisexual, and transgender populations. American Journal of Public Health, 92(7), 1125-1130.

[2] Young, R. M., Meyer, I. H. (2005). The trouble with “MSM” and “WSW”: Erasure of the sexual-minority person in public health discourse. American Journal of Public Health, 95(7), 1144-1149.

[3] Bostwick, W., & Hequembourg, A. L. (2013). Minding the noise: Conducting health research among bisexual populations and beyond. Journal of Homosexuality, 60(4), 655-661. doi:10.1080/00918369.2013.760370

[4] Human Rights Commission of San Francisco LGBT Advisory Committee, & Ulrich, L. (2012). Bisexual invisibility: Impacts and recommendations: San Francisco Human Rights Commission, LGBT Advisory Committee.

[5] Everett, B. G. (2013). Sexual orientation disparities in sexually transmitted infections: Examining the intersection between sexual identity and sexual behavior. Archives of Sexual Behavior, 42(2), 225-236. doi:10.1007/s10508-012-9902-1

[6] Frost, D. M., & Meyer, I. H. (2012). Measuring community connectedness among diverse sexual minority populations. Journal of Sex Research, 49(1), 36-49. doi:10.1080/00224499.2011.565427




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