.. anyone who was labelled female at birth but who identifies as male.

_{(Inside front cover, in small black on blue writing)}

There is lots to applaud about this guide, from that it exists to much of the content. The idea that sexuality can change over time is in there, for example, and there's lots on talking to partners (albeit sometimes implying that you have one and only one – it'd be better to say 'a partner' or 'any partner' rather than 'your partner', for example – but sometimes explicitly considering you might have more).

Plus for once, I cannot complain that the b-word is only used one time (in relation to a description of the LGBT domestic violence charity, Broken Rainbow UK) because that's the only place the word 'gay' appears too.

So it's talking about risky behaviour rather than sexuality or sexual identity, hooray!

Ah, but what behaviours?

The good news is that it explicitly mentions vaginal sex several times, usually in the context of "vaginal and anal sex". The tip of taking the inner ring out of Femidoms makes a welcome appearance (it's not in the THT website's main sexual health pages). There's even a section on contraception and pregnancy at the back.

Just about the only line in the entire booklet to cause me to raise an eyebrow is:

To reduce the risk from oral sex, avoid letting a partner
ejaculate in your mouth.

Does that include female partners?

I'm not aware of any research about the STI transmission risks of getting female ejaculate into the mouth (and I suspect that it's somewhere between nil and minuscule) but it would be nice to be clearer.

So overall, quite possibly the best booklet from THT for ages. Well done.

We have launched our Gay Man’s Guide To Condoms (Everything they didn’t teach you in school), with the aim of ensuring gay and bisexual men are properly equipped to protect themselves and their partners from infection. What do you think? www.tht.org.uk/summerloving

_{(front page of tht.org.uk and, from the look of it, their Facebook page, 31st July 2012)}

Well, they say 'and bisexual', but going to the page, we see not one mention of the b-word:

The gay man's ⁰ guide to condoms (Everything they didn't teach you in school ¹.)

Every gay man needs to know about condoms ². They’re cheap, simple to use, and the best way to keep you and your partner safe from all kinds of sexually transmitted infections, including HIV.

Terrence Higgins Trust has created the following guide – a short refresher course in the humble condom – that we hope will help you and your partner ³ have a better, safer sex life.

Nice packet

Every guy should have his own personal stash of condoms tucked away somewhere. But it’s unwise to hang on to a condom that’s gone past the expiry date printed on the wrapper. Find out more ⁴.

Size matters

Cocks come in a smorgasbord of shapes and sizes, so it’s important to select a condom that fits yours properly. Read more.

Get it on

The moment has come. Find out more about putting on condoms

Stay slick

A good dollop of water-based lube will make anal sex a far more pleasant experience for both of you ⁵. Find out more.

Grand finale

After coming, hold onto the base of the condom firmly to stop any cum leaking out and to stop the condom coming off inside his ⁶ arse. Then pull out. Use each condom only once.

Wrap the used condom in a tissue and put in a bin. Condoms put in a toilet can block it.

Grab a handful

Free condoms and lube are available from many gay ⁷ bars, clubs, saunas, backrooms and gyms, sexual health clinics, HIV clinics, some doctors’ surgeries and health centres, gay ⁸ social and youth groups, as well as from HIV or safer sex organisations.

Condoms can be bought in many different places such as chemists, supermarkets, late night garages, gay ⁹ shops and vending machines in clubs and pubs. Many websites sell condoms.

0. We know that many bisexually-behaving men do not identify with 'gay', never mind as it. Merely labelling this a 'gay man's guide' excludes many men who we know have high condom education needs: they will not see it as relevant to them. Calling it 'A man's guide to condoms and anal sex' would be more inclusive without the need to mention vaginal sex (that's a whole other argument).

1. Actually, they did. I accept that this the exception, particularly thirty-cough years ago, but perhaps having a bisexual man (a sex ed specialist too) do the sex ed at my school helped.

2. And bisexual men?

3. Note that's singular.

4. Interestingly, the 'find out more' links go to much better material. There aren't any obvious gender or sexuality related howlers, even if there's no direct link to the 'using a Femidom' page which is the main one to mention vaginas – their use in anal sex is just mentioned in the final one sentence paragraph and misses out the crucial tip of removing the inner ring. There's also no direct link to the 'problems with condoms' page, which mentions things like emergency contraception.

5. And vaginal sex? Despite the fact that this is not labelled as a CHAPS campaign, it is only concerned with sex between men, even though it's nominally aimed at 'and bisexual' men too and we also know that many gay-identified men have sex with women. What's the message here? Don't use condoms for anal sex with women? Don't use condoms with women? Real gay men don't have sex with women? All of those?

6. Here's a simple example of what they should have done. Change 'his' to 'their' and it becomes gender neutral. Or you could say 'inside them' instead of 'inside his arse' and it covers vaginal/oral sex too (and in fewer words!)

7. Bisexual ones?

8. Bisexual ones? How many gay (as opposed to LGBT..) youth groups are there?

9. Bisexual ones? The really interesting omission here is 'sex' shops.

So, once again, when THT say..

ensuring gay and bisexual men are properly equipped to protect themselves and their partners

..what they really mean is 'ensuring men who identify with "gay" are properly equipped to protect themselves and their male partners'.

The fight goes on.

Update: It's a sign of how strong the cultural norm against withdrawal is that it took me several days to notice something else – the assumption that the condom wearer is going to come inside his partner!

This is despite the current Making It Count framework saying that one of the choices that health promotion aimed at men who have sex with men is supposed to tackle is 'ejaculating outside or inside the body', with the strategic goal of having men choose to do outside their partners more often, thanks to increasing their motivation and power to do so. It was the idea behind GMFA's wonderful 'Come like a pornstar' (i.e. outside your partner) campaign from a few years ago, for example.

Here, you only take your penis outside "after coming".

Update 2: The press release is in the THT website's media section:

Terrence Higgins Trust launches guide to help gay men avoid ‘condom mishaps’

Monday 30 July 2012

As part of a new HIV prevention campaign for gay and bisexual men in London, HIV and sexual health charity Terrence Higgins Trust has launched an online guide to tell men everything they need to know about condoms.

Thirty years on from the beginning of the HIV epidemic, condoms remain the best way to guard against HIV and other sexually transmitted infections (STIs). Terrence Higgins Trust has launched The Gay Man’s Guide To Condoms (Everything they didn’t teach you in school), with the aim of ensuring gay and bisexual men are properly equipped to protect themselves and their partners from infection.

Cary James, Head of Programmes at Terrence Higgins Trust, said: “Condoms are the bedrock of HIV prevention, but with sex and relationships education patchy at best, too many men are being sent into the world with inadequate advice on how to use them. We know most gay men use condoms most of the time, but they may not realise that certain things – like storing condoms in a warm place or using spit as lube – can still cause the condom to break. This new guide aims to help men avoid condom mishaps and enjoy better, safer sex lives.”

The Gay Man’s Guide To Condoms can be found at www.tht.org.uk/summerloving. As well as guidance and tips on the best way to use condoms, the guide also contains links to a special offer on the NHS Freedoms website, offering packs of 24 condoms for the price of £5 for the three month duration of the Summer Lovin’ campaign.

Currently, one in seven men on the London gay scene has HIV.

The Summer Lovin’ campaign, funded by the Pan-London HIV Prevention Programme, will provide information via adverts in gay media and posters in gay venues. Terrence Higgins Trust will also be distributing 5,000 Summer Lovin’ condom packs in clubs and bars across the London gay scene.

So a 'gay' headline, a couple of 'and bisexual's towards the start, then it's gay all the way.

Well, almost all: note the penultimate paragraph talks about "men on the London gay scene" rather than, for example, "gay men on the London scene". Does this mean that gay and bisexual men on the scene have similar HIV infection rates? (Quite possibly, although I strongly suspect that it will depend on whether you're talking about identity or behaviour.) Or does someone think that there are only gay men on the scene?

We do know that bisexually behaving men are less likely to see ads in the 'gay' media and venues.

We also know that bisexually behaving men are less likely to use condoms most of the time they're having sex, but see above…

However she said that around 70-80% of MTF sex workers were HIV+ and gave several reasons for this, including being more vulnerable to taking more money to have (anal) sex without a condom.

She also opined that there was a very high rate of HIV infection in MTF people generally (much higher than the about one in sex or seven for gay men in London).

Now, it may just be the people I know, but this sounds extremely high to me. Had I been at the meeting, I'd have been asking 'Where's the evidence for that?'

Not least because as I understand it most of the surgeons who do gender reassignment won't take HIV+ patients.

In no particular order..

Costs: time and money. Let's say we're a responsible bunch and half of us want to be tested. That's around 100-200 people, and that's likely to be a significant chunk of someone's budget. Would it mean a hundred fewer local residents get access to testing? Is there really that much spare capacity?

It would also take quite a while and/or a significant number of someone's staff to do that sort of number. Memory is telling me that when THT in London do one hour HIV testing at their centres, they limit it to about a dozen people per afternoon/evening.

What tests? Not just what STIs to test for, but which tests to use. HIV would presumably be in the list, even if it is a list of one. The easiest tests to administer are not enormously accurate – better tests need more than a pinprick of blood or a saliva wipe. If the easiest ones are used, then there's going to be '.. and you need to visit somewhere closer to home for another test' said a lot.

Chlamydia and some of the other 'pee test' ones would be good.

Where's it going to happen? The space available (and the cost of that) varies between 'lots and free' and 'not much and not cheap' between venues. In any case, a space may be findable but wherever it is onsite, there are going to be..

Confidentiality issues: Unlike most other testing venues, so many people at BiCon know each other, so confidentiality is much harder.

How do you stop people seeing who's going for testing and who isn't? If there's one hour or similar testing available, people are also likely to be under some pressure to reveal the results to at least some people.

If there is support for people with positive (i.e. they have something) results – and if not, WTF not? – then it will be seen as trivial to see who's got something. Say it's one hour HIV testing. If they go back for a result and are out again in a couple of minutes, then they 'must' be HIV-. If they're there much longer, then they 'must' be HIV+.

Who gets the population data? There's someone who – if I interpret them correctly – wants testing done at BiCon because they want to show that bisexuals are less likely to have various STIs than gay men. I'm very dubious about that, both in terms of our representation of the wider bisexual population and what would be done with results that could be presented as saying that, for example, yes, fewer bisexuals do have HIV and so there's less need for health promotion to us compared to gay men. If someone does this testing, the results are going to be reported to someone and we absolutely need some editorial control.

So, if it is to be done, it needs to be done properly, but that's not going to be easy.

You could, for example, hand some of the pee tests out and let people do them privately (they're 'pregnancy test simple' to do – oh, I'd love to see a pile of pregnancy test kits for people to take: in bulk they cost pennies). There are issues with that ('Hello darling, pee on this for me…') too though.

Much more research is being done on vaginal microbicides, partly because of 'moral' issues (i.e. homophobia and general bigotry) but also because the vagina is a much easier place to get a microbicide to work.

Remember that being on the receiving end of anal sex with an HIV+ man is about fifteen times riskier than being on the receiving end of vaginal sex? Here are some reasons why:

Vagina: thick outer layer of the skin, about forty cells deep
Rectum: one cell layer deep, albeit with thicker cells than the vagina

Vagina: fewer CD4 cells near the surface to be infected by HIV
Rectum: complex and extensive immune structures under surface

Vagina: acidic
Rectum: alkaline

Vagina: an enclosed 'pouch'
Rectum: a long tube, ultimately ending at the mouth. You don't need to go that far, but it's known that lube can be found two feet along, well into the colon, four hours after being placed in the rectum

So there are several trials of vaginal microbicides going on, but it looks like only one potential rectal product is even at a very early stage of trials.

It also doesn't help that understanding of HIV infection in the rectum is still not that well understood, and the rectum and colon are more fragile than the vagina, so there are increased safety issues (it's quite possible that using a vaginal microbicide might not work, and might be actively harmful!)

(Originally published on my blog April 2007)

But it was the ad that made me go 'argh':

"I did it for love" – fine.

"Find out why others do it and share your HIV testing stories today at I DID IT.ORG.UK" – fine (although I hope people don't put the spaces in the URL!)

"Show him you care by taking an HIV test" – arrggghhhh!!!!! Did no-one think what message this sends to "gay and bisexual" men? It's firstly that there is one person (and just one person) and secondly that it's a man. Hello THT? Men without a partner? Men with more than one? Female partners?

July 25, 2011
THT reminds local LGBT community to look after their sexual health at Telford Pride

July 26, 2011
Terrence Higgins Trust reminds gay men to stay safe at Brighton Pride

(italics mine)

Men who want to lower their chances of contracting HIV should be circumcised, the world's leading health experts said yesterday.

Having the foreskin removed lowers the risk of catching the virus by 60 per cent, they said.

(The Metro, London 29th March 2007)

So why not circumcise all men?

The later paragraphs in this story gave some reasons that weren't in all the ones I saw:

.. an additional important intervention to reduce the risk of heterosexually acquired HIV infection in men..

So, not enough on its own, not relevant to the bulk of infections acquired in the UK, and of marginal benefit to women (if fewer men have HIV, fewer women will have HIV+ partners, but if you're a woman and your partner is HIV+, circumcision doesn't help you) but even so, worth trying?

In the UK, the large NATSAL surveys show no difference in STI rates between 'cut' and 'uncut' men, but a 60% reduction in risk sounds a lot – it's about what people are hoping for from a vaccine against HIV, should one be developed – and it comes from three randomised control trials in Africa (you circumcise some men, but not others, and see what happens to them over time) but…

• It's a relative reduction. The absolute reduction was about 1.8% – over the course of the trials, the risk was about 4.8% (uncut) and 3.0% (cut)
• The level of complications was about 1.5% – and these were circumcisions performed in the best conditions they could arrange. Complications vary from serious blood loss and infections, to impotence and total loss of the penis.

So in order to get about a 1.8% reduction in HIV cases in that time, 1.5% of men had problems, some serious. If somewhere in Africa decided to circumcise every man and boy, the complications would increase (these countries have higher priorities for their health budgets than paying for first world standards of circumcision!)

And… the trials were all cut short (sorry! 'terminated early') and this will mask any delaying effect. Imagine that all circumcision did was delay catching HIV by a year, on average. Stopping a three year trial after two years would show a substantial reduction in relative risk – you'd miss all the cut men who caught HIV in the third year! I'd expect at least a decade's follow-up before anyone should consider recommending it in this way.

So it's not particularly surprising to find out that the people running the trials had long track records of favouring circumcision.

And it gets worse: in order to maximise what benefit there is, you'd need to do this in infancy, but there are serious consent issues – you're performing an unnecessary operation with possibly some major complications on someone who can't give consent themselves in the hope that, fifteen or so years later, there might be some benefit.

If they turn out to be gay or bisexual, it will be of no benefit. If a medical advance happens in another prevention technology, there may be no benefit. And if they ask you for advice, you're still going to say 'use condoms'!

Circumcision, just say 'not for everyone'.

TMI disclaimer: I have a foreskin, and I'm very happy with it. There would need to be a serious reason for me to want to lose it and as you might guess, I'm not booking any surgery soon.

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.

It asks about relationships, sex life, risks and precautions, and use of health services. One of the goals is to describe what influences the choices men make during sex.

For those who want to know more about the panel, they are told that 40% of the panel live alone, 27% with a male partner, while "others are living with friends, parents, female partners, children and a range of other people (and pets)."

All of you are attracted to at least some men, and 41% are currently in a steady relationship with a man, about a quarter of which are in a Civil Partnership (or 11% of all Panel Members). 20% of you are also sexually attracted to at least some women, of which a quarter are in a steady relationship with a woman, most of whom are married (about 5% of all Panel members are married to women).

So, a fifth of the panel are bisexual men – going by the attraction definition – and the number actually married to a woman is about half of those in a civil partnership to a man. (UK law means you can't currently be both in a civil partnership and a marriage, evidence that the former is really the latter by a different name.)

What are all the questions about?

About sex with men

Panellists are asked about how many men they've ever had sex with, how many since their last STI test, and when they last have any kind of sex with a man. They're then asked about ‘Regular sex partners’ – people you keep having sex with – vs ‘Casual sex partners’ – everyone else.

We appreciate life is more complex than this, but we would like you to decide whether each of the men you have sex with are regular or casual partners. Please count each man as either a regular or a casual partner.

They're asked about when they last had any kind of sex with a regular male sex partner, and with a casual male sex partner.

It then moves onto what happened in January 2011. Did they have sex with a man then? If not, what were the advantages and drawbacks of not having done so?  It's emphasised that it's "sex (with a man)" that the survey is asking about.

For those who did, how many different regular sex partners were there? Do they have the same HIV status? Did they have anal intercourse with them in January? If not, what were the advantages and drawbacks of not having done so? If they did, there are questions on being ’active’, condom use then, how many times it happened without a condom, and if their cum ever ended up in their bum. Repeat for being 'passive' with them.

Repeat for casual male sex partners in January, with added questions about where they were met. Interestingly, the options given are

A gay community centre, gay organisation or gay social group / A gay café, pub or bar / A gay dance club / A backroom of a bar, gay sex club, a public gay sex party / A gay sex party in a private home / A gay sauna / A porn cinema / A cruising location (street, roadside service area, park, beach, baths, lavatory) / A website for gay or bisexual men / Grindr (or similar GPS device) / Elsewhere

So, given that the website is "gay or bisexual" we can see that when it only says "gay" for the rest of them, it's not bi-inclusive. It's as if bisexual sex clubs didn't exist, never mind the social groups, or the sex parties (no link, but trust me!) or the rest.

They're also asked about disclosure / asking about HIV status with casual partners.

The next set of questions are about the last time they had sex with a new male sex partner. When was it? Was it part of group sex? How they met (same options as above) and where the sex took place (same, plus each other's or a friend's "place")? How long was it between first contact and having sex? Disclosure and knowledge about HIV status before or during sex? Did they have a regular sexual partner at the time they had sex with this new partner? What kinds of sex did they have on that occasion? Condom use and where did the cum end up? Were poppers used? What other drink or drugs? How much control would they say they had and how responsible would they say they were over what happened? How much risk of HIV transmission do they think there was and how much risk of terms of other STIs? Finally, they're asked to rate it from one to ten, and say what was good and not good about it.

Almost finally, they're asked about when they last saw or heard any information about HIV or STIs specifically for men who have sex with men, any information about HIV in a magazine or newspaper, actively looked for information about HIV or STIs on the internet, and when they last called a telephone helpline for information about HIV or STIs. Next comes a question on using Skype, including video conversations. (Are Sigma wondering about replacing in-person research with Skype calls?) Then, they're asked about the year and month of their birth.

Do you have any comments on this first (and longest) of the surveys?

Why yes, I do Despite having a panel that's 20% bisexual, and going into great detail about sex with men, at no point are any questions about sex with women asked… As you can guess from the rest of the site, I'm not saying that's not typical, but I do say that it's not right.

None. (I don't count various wishy-washy 'all in it together' themes as being inclusive, any more than only saying 'gay' as bi-inclusive.)

Aids was first recognised in gay and bisexual men. Homo- and biphobia are a big reason why the majority of HIV infections in the UK are still of gay and bisexual men. (When you read that now more people in the UK were infected heterosexually, that's down to the people who were infected in sub-Saharan Africa and later migrated here.) To have that explicitly acknowledged just once would be nice.

Page xv sets out the standard against which it wants to to be judged: "What this book is about: The primary aim is to support improvements in service delivery to lesbians, gay men and bisexuals by offering a foundation of sound information… it takes a more critical perspective on sexuality generally .. all sexualities are seen as being in need of explanation." [Emphasis in the book.]

However, it almost immediately opts out of doing so (page xvii) "Bisexuality is not often specifically mentioned in this book. This is not out of any desire to exclude bisexuals. However, the marginalisation of bisexuals within the dominant culture is determined by the 'homosexual' rather than the 'heterosexual' component of their sexualities. Moreover, the concept of bisexuality is often used by those who wish to reinforce the idea that there is something 'real' about dividing people up into homosexual or heterosexual. In this strategy, 'bisexual' becomes what is called a 'residual category', a kind of theoretical rag-bag into which you simply toss anything that does not neatly fit your schema. There are, therefore, compelling theoretical reasons for not falling back on the 'lesbian, gay and bisexual' formula, so I have referred to bisexuals only where the context demands it."

The rest of the paragraph, as well as the rest of the book, provides strong evidence that it is, in fact, out of an offensive desire to exclude bisexuals.

So, for example, it is not true to say that the marginalisation of homosexuality is determined solely or even mostly out of the 'homosexual' component – she is ignoring (and in fact reinforcing) the dominant monosexual binary divide and the presumed non-monogamy issue (the latter is why bisexuality is considered "inherently wrong" by the Church of England which is accepting of the leity's monogamous homosexual relationships).

The "concept" (and reality) of bisexuality is something that threatens those who wish to "reinforce the idea that there is something 'real' about dividing people up into homosexual or heterosexual"!

Try translating it into a racial context: "In this strategy, 'mixed race' becomes what is called a 'residual category', a kind of theoretical rag-bag into which you simply toss anything that does not neatly fit your black or white schema." Ouch.

To go onto cite "compelling theoretical reasons" for exclusion in a book that purports to be particularly inclusive, without any acknowledgement of the biphobia involved is, perhaps, the most offensive single extract.

The exercises are a perfect example of how the offensiveness permeates the entire book:

Page 10: Readers are asked to name as many well-known gay men and lesbians as they can think of, with the comment that they'll probably find the former easier. Bisexual people? "If you yourself are lesbian or gay, how did it make you feel…" Bisexual readers are left feeling non-existent!

Page 33: "Take note of any articles that deal with lesbian or gay issues…" Bisexual issues? She then asks about images of opposite sex / same sex couples without mentioning one of the central issues around bisexual visibility: how do you show 'bisexuality' without showing three (or more) people?

Page 34: "Now obtain a few copies of gay publications (.. Diva, Gay Times.. ) .. How easy was it for you to get hold of these publications?" Bisexual publications?

The next exercise mentions "gay, lesbian and bisexual" readers, so we can see that the "only where the context demands" omission of 'bisexual' elsewhere is probably deliberate.

As in page 47: "For heterosexual readers .. For lesbian or gay readers". Both ask the reader to consider "lesbian and gay readers". In both cases, what about bisexual readers?

Page 81: "Write down a list of slang terms of 'gay man' [and] 'lesbian'." Slang terms for bisexuals? It's not as though there aren't any.

Page 84: After asking to arrange sexual acts into those which may be done by two women, two men or a man and a woman, "What does this tell you about the sexual practices of lesbians, gay men and heterosexuals?" Bisexuals?

Page 150: "How many of the stories are written by a lesbian or gay man .. What overall image of lesbians and/or gay men is put across?" How many by a bisexual? What image of bisexuals?

The next exercise includes "lesbian, gay or bisexual service users", but only "the lesbian and gay community". The bisexual community?

Not that the reader is given any clue that the latter exists. The "substantial" list of resources on page 190 onwards includes sections on history, but fails to reference any on bisexual history; on autobiographies, but fails to reference any by bisexuals; on professional and practice issues but only two books include the b-word in their title (one is LG&B, one L&B women); on "exploring different avenues" (none bisexual); on "exploring lesbian and gay studies" (ditto); and "journals" (ditto).

Finally "sources of information" mentions the London Lesbian and Gay Switchboard (which at the time of writing the book excluded anyone with a bisexual identity from being a volunteer) and the London Lesbian Line (ditto) but not the Bisexual Helpline which had then been running for fourteen years. Even when the organisations which are listed explicitly include bisexuals in their title or subtitles, such as Parents' Friend, it is excluded from the listings.

It's also (again largely by omission) in the index – apart from the passages in the introduction, there's only one 'bisexuality' reference, to page 20, where after a (far too short) bit on Kinsey, mentioning Humphreys' The Tearoom Trade, the idea that sexual identity often does not indicate behaviour, and the fact that the boundaries are not fixed, she says "It is clear from these accounts that such experiences" – having sex with both men and women! – "do not fit into the category of bisexuality." It was at this point that I threw the book across the room.

"Indeed," she goes on, " 'bisexuality' is itself a complex question, about which there is much debate and disagreement" and then gives two inadequate references.

Compare that to about sixty references for both 'gay men' and 'lesbians', and again imagine translating this into a race context: what would you say about a book on race issues in health that acknowledges that there were differences, said it was going to cover all ethnic minorities but which had sixty references to Afro-Caribbean people issues and one on South Asian people?

(Example picked because while both are minorities, there are more people of South Asian origin in the UK than Afro-Caribbean origin, just as there are more behaviourly bisexual people than exclusively homosexual ones.)

The body text contains numerous more examples – such as the repeated division of men into "gay and non-gay": it's entirely unclear where bisexual men are in that binary divide – but I would hope this is enough to show why it wins an 'offensive biphobic crap' award even without its stated aim of treating all sexualities equally.

it's important for you to know about [the healthcare system], even if you are not ill, and why being gay or bisexual is relevant to your healthcare.

and says 'More detailed information is available at www.tht.org.uk/gpsandgaymen'.

That link currently redirects to gpsandgaymen.chapsonline.org.uk (thus proving they can do redirections when they want to rather than break links) which, as the URL implies, is headlined 'GPs and Gay Men' and even changes the 'gay or bisexual' phrase above to 'why being gay or lesbian is relevant to your health'. (My emphasis.)

While this is quite possibly the only time CHAPS money has been spent considering women's health! The argument repeatedly given to me is that CHAPS is about sex between men, and thus women are irrelevant…

My first reaction on reading that was "Erm, what would do that, apart from spermicide?" (Which I hope you all know is a no-no for this as the damage it does to the skin – the main one was originally designed as an industrial cleaner – outweighs any theoretical benefits to such an extent that it can lead to more infections amongst frequent users!)

But a quick Google reveals that there was indeed a study published in 2001 which named Astroglide (Silken Secret is the same stuff except in an applicator), Vagisil and ViAmor as including 'two' substances which had an effect on HIV in a test tube over 24 hours. It got quite a bit of coverage at the time.

Helpfully, the journal in which this was published is currently free (for all of December only) so you can look it up for free:

What I found particularly odd is how few other articles have cited this one. If it really was significant, I'd expect rather more than five in the past five years. (Journals have a vested interest in pointing out how often their articles are cited elsewhere, so they tend to be good at listing as many as they can.)

The other odd thing was how few other sexual lubricants there were in their tests. Most of the rest of the 22 listed are 'mild vinegar' douches!

So it was off to the Astroglide website, which lists the ingredients for Silken Secret, and I couldn't see anything that's obviously different from lots of other lubes. They also don't make any 'kills HIV' claims for it either.

..and looking up one of the five articles that references this study, it looks like I was right: it's that they were lubricants (as opposed to, say, douches) which is significant, rather than any inherent quality of those three named lubricants.

Someone else looked at a different variety of lubes and vaginal treatments and found they all had the same basic effect. KY Jelly is the most famous one the second survey rather than the first.

They also looked at what ingredients had this effect and considered that most had some effect, but it was the gelling agents that had the most effect.

As two of the three products (three out of four, considering that Astroglide = Silken Secret) in the first study were by the same manufacturer, I wonder if they did some PR to push the results to give their products a boost.

Incidentally, another one of the five articles is about finding a neutral placebo product to test against in such trials. They killed a lot of bunny rabbits (to look at the effects on rabbit vaginas of their candidates) and infected quite a few primates (just to make sure it had no preventative effect) before coming up with something. Ah, the joys of medical research.

And the other one of the five studies to cite the original one was about being cruel to mice, erm, giving them Ketamine (!) and then sticking various lubricants up their bottoms to see what effect that had (!!)*

Interestingly, the three lubes mentioned as having some adverse effect on (mouse) rectal tissue – though not as bad as spermicide – were… Silken Secret, Vagisil and ViAmor. Oops.

Oddly enough the makers have kept bloody quiet about this study but, again, those three were the only three sexual lubes tested (out of seven substances: two spermicides, these three, a designed-to-be-neutral placebo and a proposed new lube) and it's quite possible most have the same effect.

Moral of the story? Look up the original report and don't trust the press release.

Oh, and try to do your research without killing primates in particular, and mammals in general.

(*) But reading the Sigma Research reports on their annual sex surveys, I suppose that taking K and sticking lube up their bottom does indeed reflect the reality of life for some gay men

In comparison to the large and instant flow of stories following last month's conviction of Sarah Porter – where someone she'd had sex with heard rumours about her being HIV+, knew they hadn't been infected, but complained to the police who launched a year-long investigation into her sex life until they found one who had been – I can only find three reports on this on Google News.

But see what they are:

Relationships and Sex for Gay Men – perhaps surprisingly, the first edition of this did have "to have children" as one of the reasons why "some people with HIV say they either have sex or want to have sex?" for readers to say they share or really disagree with… and "to avoid having a child" as a possible answer to "why would a person with HIV want to have safer sex?"

The text is definitely aimed at gay men though – I can find lots of "other gay men" and "you're not the only gay man who.." and no use of the word "bisexual".

(I can't find this one on the current website.)

Relationships and Sex for Straight Men – now in its third edition. It doesn't mention having sex with other men, yet we know that's crap. My favourite spotted personal ad: "straight man seeks other straight men to have sex with" (ITV Teletext!)

So it's "when we talk about sex between men and women…" – and it doesn't talk about any other sort, remember – and "if a woman without HIV sucks your cock", rather than "if someone".

Surprisingly, while "to have children" is listed here too as one of the reasons why "other men with HIV say they either have sex or want to have sex?", there's no mention of "to avoid having a child" as a possible answer to "why do other HIV men want to have safer sex?" (Another missing option is "to keep the sheets clean"!)

In its second and third editions at least, this is a shorter booklet than the ".. for gay men" one: 20 pages vs 28.

You'll find it here.

(Note different naming style of the actual file compared to the CHAPS ones.)

and

Relationships and Sex for Women – despite not having a sexual orientation in the title, it still also only explicitly mentions "When we talk about sex between men and women…".

You're presumably supposed to guess that, immediately after talking about "as a woman with HIV you perform oral sex on a man", that the "someone" who "performs oral sex on you" might be a woman.

It does mention "I like them to use condoms, then I don't have to worry about contraception" as a reason for other HIV positive women to say they want to have safer sex in its 20 pages.

Here for this one.

Note the missing title!

So which does THT think is true:

• That bisexual men don't get HIV?
• That bisexual men with HIV don't have relationships and sex?
• That bisexual men with HIV's relationships and sex aren't worth mentioning?

Given that gay-identified men's relationships and sex with women – which, again, Sigma has been saying for years happens in larger numbers than some of the behaviours THT is prepared to talk about – is consistently ignored, I wonder.

The front page has "gay men" four times, plus "gay scene" and "gay pubs and clubs".

The gay scene section has nothing to say about mixed gender venues or the existence of 'no bisexuals' door policies in some places.

The coming out section says "Coming out as gay or bisexual can be very daunting…" and says that "On the following pages you can read real life accounts from other young gay and bisexual men" but then goes on to ask "Have you tried saying 'I'm Gay' out loud to yourself?"

Apparently "If you find that you can't say the words out loud then maybe you should take a bit more time to think about how comfortable you are with your sexuality."

What message does that send to bisexual people? 'If you can't say "I'm gay", you aren't comfortable with your sexuality'?

"Maybe you could think about checking what your friends/ family attitudes are to gay men…" Well, the attitude to bisexual men is clear, as is the attitude to lesbian and bisexual women: despite recommending it as an example of THT's LGB work, there is almost nothing here for women.

We're then told that "there are several groups around the country run by parents of lesbians and gay men" – I'll check to see if it's still the case, but for many years, the main national support group was run by the mother of a bisexual man – but "there are still people in the world who believe being gay is wrong". Are we expected to think that such people believe that being bisexual is ok?

(If you look at, for example, "Issues in Human Sexuality", the statement of the Church of England's House of Bishops, you'll see that it's often worse. While they can accept monogamous homosexual activity, "it is clear that bisexual activity must always be wrong".)

The coming out to your family section is gay-only, e.g. "Gay men often say that coming out to parent's [sic] is more challenging than any other aspect of the coming out process" and the suggested responses to the "few typical thing's [sic] that parents say when their son come's [sic] out" includes "I have met lot's [sic] of girls but i [sic] am not attracted to them, i [sic] can't change the way i [sic] am."

You may have heard the scream when I read that for the first time.

Similarly, the section on friends: gay only. "You may feel like you are the only gay in the village" and are told to meet "other gay men". Now, of course I recognise the Little Britain reference, but this is funded by money for gay and bisexual men. What's worse? Thinking you're the only gay in the village, or being told you don't exist?

Meeting people: gay only. ".. another gay man..". "Gay men are everywhere.." plus five others.

Sex: gay only. Your "first time" (unqualified!) is assumed to be with a man.

Education: ooh, the workers – at another agency! – "are looking for young gay and bisexual men to tell their stories". I wonder if that agency wrote those paragraphs.

Celebs coming out: six men, all presented as being gay. What on earth is the excuse for not including bisexuals here? Particularly as one of them came to fame for playing a bisexual character.

Youth Group listings: That's interesting. Some of THT's own youth groups are inclusive, while others are not.

Links: the site's content for "young lesbians and bisexual women" is a link to www.gingerbeer.co.uk – which advertises itself as "the lesbian guide to London".

Health information: more of the same. For example 'Wellbeing' says "Young gay men are often made to feel bad about themselves by a range of different sources". And bisexual men aren't? "Young gay men don't have a lot of role models in society". There are six in the coming out section, but no bisexual ones, remember.

".. you may find that others have a problem with [your sexuality]." Quite.

The HIV section, surprisingly given the rest of the site, does mention vaginal intercourse. Even if it does have as headings

How is HIV transmitted?
Sperm
Blood
Ways You Can't Catch HIV

with the implication that everything apart from sperm and blood is in the latter.

Similarly, the rest of the STIs section looks inclusive. Yay. But given the rest of the site, it's a very quiet yay.

So, this SRE Education Sector Summary Report. I agree entirely with the basic idea – that SRE needs to be improved and represent the true diversity of lives pupils will lead.

But…

The first sentence talks about "lesbian, gay and bisexual (LGB) pupils." The second only talks about "gay issues". 'LGB' is the same length as 'gay', why not use that? (And why ignore trans issues throughout?)

But it's clearly systemic: paragraphs three and five have "the needs of gay pupils". Paragraph six has "gay teenagers", while paragraph seven goes back to "gay pupils".

The first paragraph on page two says "LGB pupils" for only the second time, before talking – probably not aware of the irony – of "tokenism" in the next.

The same page has "homosexuality" twice and talks about "lesbian and gay pupils" once, reminding us that 'gay' is not being seen as inclusive of other orientations.

Page three has "lesbian, gay and bisexual" and "LGB" twice but then goes on to talk only of "lesbian and gay writers" and "lesbian and gay figures" as worthy of inclusion in lessons.

The last page says THT's work for LGB people is wonderful, but then uses the author's ygm.org.uk site as the example. (See the next post for why this was unfortunate.)

The conclusion goes back to bisexual invisibility:

we hope that this report will enable teachers to think more about issues around lesbian and gay sexuality throughout the curriculum. [..] All young people have the right to learn about the society they live in. Gay people are part of that society, whether as adults or young people. When schools ignore the needs of lesbian and gay pupils [..]

As a former bisexual pupil, I feel ignored by this.

Here's the link to the original. I'll do one with some unofficial highlighting soon.

True Colours was first published in 1997, with a second edition in 1999.

Apart from a superficial redesign, the only three differences between the two I can spot are

• a mention in the second edition that the age of consent will be equalised
• the first edition says THT's website for gay and bisexual men is… www.chaps.org.uk
• some of the helpline listings have been updated.

I can't find a PDF of these booklets – I'll scan them in at some point. In the meantime, have part of the third paragraph of the section on diversity:

Although attitudes are changing, if you decide you're bisexual you may experience prejudice from some gay people.

Quite.