#HIVBI: Bisexuality is real. Why aren’t female partners on PrEP?

 

Brian Dodge may very well be the mother of all “sexperts.”

Dodge sits on the board of the Kinsey Institute, and is widely considered an expert on health issues for bisexual men and women. Like Lauren Beach and Faith Cheltenham, he agrees it’s past time for the CDC to collect epidemiological data pertaining to men who have sex with men and women exactly as such; not to lump them together with men who have sex with men, which has been the case since the HIV epidemic began.

“Not only does it not make sense, it’s not reflective of reality,” Dodge said of the current data collection system. “Even within the CDC framework, the acronym MSM was created because in the earliest days of HIV it became immediately clear that large numbers of individuals don’t identify as gay.”

Sadly, only a handful of coins are directed toward research aimed specifically at bisexuals and HIV prevention.

“For long periods people were satisfied with the samples they recruited, from bars, pride parades, etc.,” Dodge said. “The earliest studies of substance abuse and alcohol abuse used samples of men recruited from bars. That’s fundamentally flawed.”

He adds, “In 2016 when they say some populations are hard to reach, we don’t accept that. Either you don’t know where to look for them or you don’t know how to engage them.”

The CDC does have some expanded HIV testing initiatives targeted at African American and Latino men who have sex with men and women. The CDC has said they are cost effective at reducing overall infections, practical to implement at full scale, target high-risk populations and can be combined for specific populations.

But bisexual people span beyond people of color.  Beyond the “Bruthas” and the “Hombres” projects, what’s there?

“There is nothing, “Dodge said, “within a compendium of CDC based interventions.”

Who are we missing?

For starters, sex workers, and college students, both have high rates of MSMW. Their sexual experiences are much different from the culturally inspired sexualities of men of color.

In an era of 50,000 new HIV infections each year in this country, it makes you wonder how many new infections are resulting from people not getting important HIV prevention messages around tools such as PrEP. Lest we forget: HIV never will be eliminated without eliminating new infections, too.

Report: More than 26 percent of men with HIV having sex with women 

In a 2014 paper (Singh, Hu, Wheeler, Hall) published in the American Journal of Public Health, researchers reported that 26.4 percent of 30,096 MSM diagnosed with HIV in 2011 also had sex with women. “A larger percentage of MSMW were Black/African American, at 44.5 percent, compared with men who only have sex with men, at 36 percent. Fewer men who have sex with women were white (26.4 percent) compared to those men who had sex with men only (36.2 percent).

The paper, like so many before it, concluded that “intensified interventions are needed to decrease HIV infections overall for MSMW and reverse the increasing trends among young MSMO.”

Diagnoses of HIV among men who have sex with men and women tend to increase with age, data shows.

Research being released soon will show that more positive attitudes are being shown toward bisexual individuals, Dodge said. Yet some sociologists and bisexual activists surmise that it may be bad business for predominately gay-run LGBT groups to get behind bisexual advocacy too much. For example, with gay men and lesbians now having achieved marriage equality, what will it mean if we begin dispelling notions of monosexism (you either are gay or straight). Does that deflate the argument for allowing gay marriage?

But if we don’t dispel notions of monosexism and discuss the fluid realities of sex, what will be next? Teaching “no sex before marriage” to both gay and straight children, Dodge surmised?

Meanwhile, as bisexual people are forced further to the edges of the margins, many remain closeted about their true sexuality and as a result don’t have healthy, open communication with their sexual partners. Healthy communication is a must-first-step for safer sex and HIV prevention.

“For 2006 to 2010 data from the National Survey for Family Growth, among MSM, 43.9 identified as bisexual,” reported Singh, et al in their 2014 paper. “HIV diagnoses increased among MSMO overall and were relatively stable for MSMW. Studies have shown that among MSMWs, less exclusive homosexual identification is associated with greater sexual risk behavior without disclosure with female partners. While overall decreases in HIV diagnoses have been observed among women during 2008 to 2011 and the magnitude of MSMW transmission is unknown, MSMW constitute a large percentage of persons with HIV and may require tailored prevention interventions.”

Related [imstilljosh] Bisexual HIV Guide: Bisexual men have sex with women, too. So why is the CDC counting them as MSM?