Behaviourally Bisexual Men: Identifying needs for HIV prevention (Thursday, February 3rd, 2011)

This report was commissioned from Sigma Research in 1994 by the UK government's Health Education Authority (HEA), then in charge of official HIV prevention work. I strongly suspect it was in order to demonstrate that, as the head of the work with gay and bisexual men* loved to say, bisexual men are "a minority of a minority of a minority".

He confidently expected that researchers wouldn't find many, despite what the HEA's 'bisexual development group' kept saying, thus demonstrating that bisexual men weren't worth doing anything for.

Everyone – except the bisexual development group, and who cared about them? – would be happy.

But it Didn't Quite Turn Out Like That.

The researchers started out by assuming that if they insisted subjects had been sexual with both men and women in the past year, hardly anyone would qualify. They set the limit at five years and started advertising in the contact ads sections of the mainstream press, inviting men to call a freephone number.

They were swamped with calls and had to reduce the number of ads placed. They estimate that between 20,000 and 34,000 men tried to ring them in the eight weeks the number was operating – 2,500 and 4,250 a week, and thousands more than respond to their annual Gay Men's (sic) Sex Surveys – but they only had the resources to speak to just over a thousand, of whom three quarters were interviewed.

To their surprise, virtually all the callers had indeed been sexual with both men and women in the past year. The researchers were struck by the way that the mean number of partners in that time – six – was the same as their cohort of gay men. Half of the partners of the bisexual men were women, and they were having more anal sex – often without condoms – with women than reported figures for heterosexual men.  They were a strikingly homogeneous bunch: with just two exceptions, there was no significant correlation between behaviour and any of their demographic characteristics. (It was only the number of male partners with whom anal intercourse occurred that was linked: men living with women did so with a slightly lower average of men, and – as can be expected – older men had a lower average as well.) Contrary to the mythology of the 'deceived wife', many of the women involved with the men knew about his same-sex activities and were themselves sexually sophisticated and adventurous.

When asked, 'How do you think of yourself, in terms of your sexuality?' at the end of the interview, over half could not answer and needed to be prompted with a second question: 'What term would you use to describe yourself, sexually?' I was not surprised that even then less than half of the total sample had a bisexual (or similar) identity – many bisexually behaving men simply do not have a 'sexual identity' in the way that activists do. Indeed, more than one in eight identified as straight, despite having just talked about their bisexual behaviour. Fewer than 1% had a gay identity, one reason why materials explicitly aimed at gay men will simply not be seen as relevant by this population.

Looking at the report's conclusions fifteen years on, what is striking is how little has been done since.

  • It pointed out that many aspects of the findings could not have been predicted from previous studies, and said that more research had to be undertaken so that many of the new or unanswered questions could be addressed. Nope: research has overwhelmingly concentrated on men reachable via the gay community
  • While the authors thought gay men were a higher priority, having a higher known HIV prevalence, this population 'merit higher priority than a number of groups which have been, and continue to be, targeted for health promotion'. Nope: it is also possible that the bisexual men have a higher prevalence than reported, as testing levels were half that for gay men. Equally, government reporting of HIV prevalence makes no distinction between the two populations.
  • They said the men 'will not react well to advertisements that overtly refer to homosexuality and/or identify their target group as gay or bisexual men'. Nope: the vast majority of information for men who have sex with men continues to be labelled 'for gay men'.
  • Health promotion had to use the media seen by the men: mainstream publications, not the gay press. Nope: if I wanted to reach bisexual men in London, I'd use the Metro and Evening Standard newspapers, plus put ads on public transport. All of these are far more expensive (because they have a much greater readership) than the gay press, and this is one reason why it has not been done.
  • Community development work was vital 'to facilitate the exchange of information and experience and the formation of interest groups' outside the existing gay community. Nope: the bisexual community, while not perfect, remains almost totally unfunded in comparison to 'gay' or 'gay and..' groups.

If any recommendations have been ignored the most, it is probably (emphasis mine):

The received wisdom within health promotion has been that the gay community would act as a 'natural' vector of health promotion for bisexual men since they would, presumably, be having sex with gay men at some time. The demographic make-up of this group, their sexual identities (or lack thereof), and their lack of identification with, and use of, the gay community make this an increasingly untenable proposal. .. The main problem when addressing this group of men is that they will not identify with material produced for 'out' gay men. They also may feel themselves not well served by the material prepared for conventionally straight men, because of their greater perceived sexual sophistication and/or specialised tastes.

The report finished by saying that the attitude towards bisexual men and their needs was based 'largely on prejudice and pejorative assumptions backed up by scientific and behavioural research that has, on the whole, failed to ask questions which challenge those assumptions.' That remains true today.

In 1995, the report was given to the HEA.

Oh no! Proof that there is indeed a massive population of bisexual men, having large amounts of potentially risky sex, most of whom are unreachable by going via the gay community! What to do?

Colonel Harry Brighton: Look, sir, we can't just do nothing.
General Allenby: Why not? It's usually best.

Robert Bolt and Michael Wilson's screenplay for Lawrence of Arabia

The report was sat on for about a year. Each time the bisexual development group asked, the publication date was always "in the next couple of months". During that time, some of the findings were leaked to one newspaper, which did a small story on them. Then there was yet another delay. So when it was finally officially published, in April 1996, it was old news and no-one cared. Coverage was minimal and you can judge how much notice was taken of it by reading the rest of this site.

Before long, it went out of print and has remained so ever since. Even Sigma Research dropped any mention of it from their website. It was almost forgotten.

So when someone wanted a copy, I decided to scan mine, OCR it, and convert it to HTML. Some years later, a freely downloadable PDF of the report appeared on library.nhs.uk. So, not least as that version is not searchable (it's a series of scans), and also because I'd added comments to mine, my copy is now here.

Enjoy, and – especially if you're bisexual – get angry.


* No-one at the HEA seemed to care about bisexual women or lesbians, and I wonder if they had even heard of trans people.

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