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PubMed2005

Prevention with gay and bisexual men living with HIV: rationale and methods of the Seropositive Urban Men's Intervention Trial (SUMIT).

OBJECTIVES: To provide a public health rationale for prevention with HIV-seropositive gay and bisexual men and to describe the methods of the Seropositive Urban Men's Intervention Trial (SUMIT). DESIGN: A randomized intervention trial. METHODS: Self-identified HIV-positive gay and bisexual men were recruited from community-based venues in New York City and San Francisco. Eligible participants completed an A-CASI baseline assessment, were asked to provide samples for sexually transmitted infection (STI) testing, and were randomly assigned to either a single-session intervention or a six-session enhanced intervention designed to reduce HIV transmission risk and promote serostatus disclosure. Participants who attended the first intervention session were assessed 3 and 6 months post-intervention. STI testing was offered at the 6-month assessment. RESULTS: A total of 1168 self-identified HIV-seropositive gay and bisexual men completed the baseline assessment, and 1110 of these (95%) opted for STI testing. A total of 811 attended the first intervention session, of which 85% were assessed at 3 months and 90% were assessed at 6 months. Of those assessed at 6 months, 92% (670/729) provided a blood or urine sample for STI testing. CONCLUSION: SUMIT demonstrates the feasibility and acceptability of prevention research with HIV-seropositive gay and bisexual men. The study provides new information about the sexual behavior, serostatus disclosure practices, and the efficacy of an intervention to reduce HIV transmission risk.

Adolescent↗
PubMed2005

Social marketing campaign significantly associated with increases in syphilis testing among gay and bisexual men in San Francisco.

BACKGROUND: Between 1999 and 2002, San Francisco experienced a sharp increase in early syphilis among gay and bisexual men. In response, the San Francisco Department of Public Health launched a social marketing campaign to increase testing for syphilis, and awareness and knowledge about syphilis among gay and bisexual men. METHODS: A convenience sample of 244 gay and bisexual men (18-60 years of age) were surveyed to evaluate the effectiveness of the campaign. Respondents were interviewed to elicit unaided and aided awareness about the campaign, knowledge about syphilis, recent sexual behaviors, and syphilis testing behavior. RESULTS: After controlling for other potential confounders, unaided campaign awareness was a significant correlate of having a syphilis test in the last 6 months (odds ratio, 3.21; 95% confidence interval, 1.30-7.97) compared with no awareness of the campaign. A comparison of respondents aware of the campaign with those not aware also revealed significant increases in awareness and knowledge about syphilis. CONCLUSIONS: The Healthy Penis 2002 campaign achieved its primary objective of increasing syphilis testing, and awareness and knowledge about syphilis among gay and bisexual men in San Francisco.

Adolescent↗
PubMed2005

Sexual risk factors among self-identified lesbians, bisexual women, and heterosexual women accessing primary care settings.

OBJECTIVES: There is scant data on the sexual behaviors of women of diverse sexual orientations in a low-risk population. GOALS: The goals of this study were to sample women of all sexual orientations in primary care settings and to evaluate sexual behaviors and risk for HIV and other sexually transmitted diseases (STDs). STUDY: A total of 1,304 women (self-identified as 49% heterosexual, 11% bisexual, and 40% lesbian) were surveyed by anonymous questionnaire at 33 healthcare sites. RESULTS: Among women who recently had sex with men (N = 600), 51% reported ever using condoms. Heterosexual women were at highest risk for acquiring HIV as a result of lack of condom use (P <0.001), particularly in higher-risk situations. Bisexual women reported substance use with sex at a higher rate than lesbians or heterosexual women (P <0.001). Lesbians had higher rates of sex with bisexual men (P <0.001) and injection drug users (P <0.02), but also a higher rate of condom use (P <0.001) compared with bisexual or heterosexual women. CONCLUSION: Women of all sexual orientations, and particularly heterosexual women, engaged in behaviors that put them at risk for HIV and STD.

Bisexuality↗
PubMed2005

Risk and protective behaviours of bisexual minority women: a qualitative analysis.

BACKGROUND: Public health messages urging women to seek health care services such as sexually transmitted diseases (STD) and cervical cancer screening or family planning services fail to address women who have sex with women (WSW). This negligence may have led to a false sense of security amongst WSW concerning sexual risk behaviour. Research has shown that WSW engaged in more high-risk sexual behaviours than heterosexual women. WSW has been identified as an important vector in the spread of STDs in all populations because of bisexuality. To prevent and reduce transmission of STDs amongst WSW, perceptions of risk for STD amongst WSW need to be understood so that effective interventions may be developed. AIM: To describe the relationship between sexual risk and protective behaviour and STD transmission amongst bisexual minority women with a history of STD. METHODS: Life history methods were used to interview 23 African-American bisexual women with a history of STD. FINDINGS: Various themes unfolded during analysis of the patient interviews, including bisexual women's perceptions of STD risk, the context of sexual relationships with women and STD prevention, screening, and treatment practices. CONCLUSIONS: The contexts of sexual relationships including multiple or concurrent partner relationships with both men and women placed these women at high risk for STD. Regardless of the type of relationship or belief it is possible to get an STD, protection was often not used. These circumstances identify an extremely high-risk population of women with need for more extensive research to identify strategies for health care interventions.

Adult↗
PubMed1993

Testing for HIV infection among heterosexual, bisexual and gay men.

This paper answers the questions: who is and is not tested for human immunodeficiency virus (HIV) antibodies, why, where are they tested, and what do they find difficult about the testing process? The data came from two samples of sexually active heterosexual, bisexual and gay men in Perth (N = 545). Bisexual and gay men were much more likely to be tested than heterosexual men, although the commonest reason for testing for all three groups was risky sex. The three groups differed on reasons for not having the HIV antibody test: heterosexual men most commonly claimed that they were not at risk; bisexual men explained that they had been meaning to go but kept putting it off; and gay men primarily feared a positive test result and lacked trust in the confidential treatment of results. Gay men were more likely to trust their regular doctors than were heterosexual and bisexual men who had more trust in state health clinics. Waiting for test results was the most difficult part of the testing process for all respondents. Few respondents agreed that employers and the police should be notified by a doctor of an antibody-positive test result; nearly all agreed that those who had contracted HIV should be notified; notification of surgeons received moderate support. Knowing one's HIV infection status appears to be strongly associated with safer sex practices, and therefore the HIV antibody test could be promoted as part of a preventive health care program.

AIDS Serodiagnosis↗
PubMed2004

Rates and predictors of mental illness in gay men, lesbians and bisexual men and women: Results from a survey based in England and Wales.

BACKGROUND: There is a dearth of research into the mental health of gay men, lesbians and bisexual men and women in the UK. AIMS: To assess rates and possible predictors of mental illness in these groups. METHOD: A comprehensive assessment was made of the psychological and social well-being of a sample of gay men, lesbians and bisexual men and women, identified using 'snowball' sampling. RESULTS: Of the 1285 gay, lesbian and bisexual respondents who took part, 556 (43%) had mental disorder as defined by the revised Clinical Interview Schedule (CIS - R). Out of the whole sample, 361 (31%) had attempted suicide. This was associated with markers of discrimination such as recent physical attack (OR=1.7, 95% CI 1.3-2.3) and school bullying (OR=1.4, 95% CI 1.1-2.0), but not with higher scores on the CIS-R. CONCLUSIONS: Gay, lesbian and bisexual men and women have high levels of mental disorder, possibly linked with discrimination.

Adult↗
PubMed1996

Sampling homosexuals, bisexuals, gays, and lesbians for public health research: a review of the literature from 1990 to 1992.

Our objective was to examine the representativeness of samples of homosexuals, bisexuals, gays, and lesbians obtained for public health research. We identified journal articles cited in Medline and published between 1990 and 1992 that sampled individuals and classified them as homosexual, bisexual, gay, and/or lesbian. Information was abstracted from these articles to evaluate four components of sample selection affecting the representativeness of samples: (1) how the population is conceptually defined, (2) how the sampled population is operationally identified, (3) the setting from which samples are selected, and (4) the use of probability sampling to select subjects. We identified 152 public health articles published between 1990 and 1992 that sampled homosexuals, bisexuals, gays, and/or lesbians. We found articles (1) rarely (4/152) conceptually defined the population they were sampling, (2) used a range of incomparable methods to identify and select subjects, (3) sampled from settings representative of dramatically different populations, and (4) rarely (3/152) used probability sampling. Overall, we find methods used to identify homosexuals, bisexuals, gays, and lesbians for public health research produce samples representative of different and sometimes unidentifiable populations. To understand these populations from a public health perspective, it is imperative that steps be taken by researchers to standardize population definitions and sampling methodologies.

Bisexuality↗
PubMed2001

Vicissitudes of bisexuality. Crucial points and clinical implications.

The author begins by noting that the heuristic value of the concept of bisexuality can be explored in two directions, involving respectively its role in psychopathology and in the development of creativity and thought. The author concentrates on the first of these aspects, which entails a reconsideration of the 'phallic question'. The status of femininity is investigated on the basis of Freud's and Winnicott's theories of bisexuality and the author here finds an explanation for the repudiation of femininity and for the 'phallic question' thereby implied, which represents the underlying bedrock resulting in interminable analyses. An important element in this rejection is stated to be the maternal aspect of femininity. Particular reference is made to the somatic roots of phallic defences and to their effects on thought and symbolisation. Some brief clinical examples are presented to suggest that the bedrock may be due to the distorted use of sensoriality and of the erotogenic zones. The author contends that the anal zone plays a crucial part in the manifestations of bisexuality and contrasts phallic logic with the logic of triangulation. Numerous literature references and clinical examples support and illustrate her arguments throughout. The author ends with a discussion of the implications of bisexuality for thought and knowledge.

Bisexuality↗
PubMed2005

Use of heavier drinking contexts among heterosexuals, homosexuals and bisexuals: results from a National Household Probability Survey.

OBJECTIVE: Extensive use of specific social contexts (bars and parties, for instance) by homosexuals and bisexuals is thought to be a factor in the higher rates of drinking among these groups. However, much of the empirical evidence behind these assumptions has been based on studies with methodological or sampling shortcomings. This article examines the epidemiological patterns of alcohol contexts in relation to sexual identity, using a large, national, probability population survey. METHOD: We used the 2000 National Alcohol Survey for these analyses. The prevalence of spending leisure time in each of two social contexts (bars and parties) that are associated with heavier drinking is examined by sexual orientation (heterosexual, homosexual, bisexual and self-identified heterosexuals with same sex partners). In addition, we compare levels of drinking within these contexts by sexual orientation within these groups. RESULTS: Exclusively heterosexual women spent less time in these two contexts relative to all other groups of women. Gay men spent considerably more time in bars compared with the other groups of men. Heterosexual women who reported same sex partners drink more at bars, and bisexual women drink more alcohol at both bars and parties than exclusively heterosexual women. For men, there were no significant differences for average consumption in any of these contexts. Entry of background and demographic variables into logistic regression analyses did little to modify these associations. CONCLUSIONS: There is empirical evidence that some groups of homosexual and bisexual women and men spend more time than heterosexual individuals in heavier drinking contexts. The frequency of being in these two social contexts does not appear to be associated with heavier drinking within these contexts for men, but it may be related to heavier drinking in those places among some groups of women.

Adult↗
PubMed2005

[Effects of violence and discrimination on the mental health of bisexuals, lesbians, and gays in Mexico City].

The objectives of this study were to estimate the prevalence of suicidal ideation, suicide attempts, mental disorders, and alcoholism in bisexuals, lesbians, and gays in Mexico City and analyze the possible relationship between violence, discrimination, and the mental health of these population groups. A questionnaire was administered to 506 bisexuals, lesbians, and gays attending support organizations and institutions. Eight forms of discrimination and fourteen forms of violence based on sexual orientation were researched. The study found the following prevalence rates: 39.0% suicidal ideation, 15.0% suicide attempts, 27.0% mental disorders, and 18.0% alcoholism. Prevalence of alcoholism was 21.0% among bisexual and lesbian women, which is higher than in other women. Discrimination was correlated with suicide attempts and mental disorders, whereas violence was a risk factor for suicidal ideation, suicide attempts, mental disorders, and alcoholism. Violence and to a lesser extent discrimination suffered by bisexuals, lesbians, and gays are associated with psychological distress, and policies are needed to counter this situation.

Alcoholism↗
PubMed1994

Are bisexually identified men in San Francisco a common vector for spreading HIV infection to women?

OBJECTIVES: This article examines sexual risk taking among self-identified bisexual men in San Francisco and whether risk reduction has occurred, with respect to both homosexual and heterosexual behaviors, among human immunodeficiency virus (HIV) antibody-positive and HIV antibody-negative men. It also examines psychosocial correlates of unprotected anal and vaginal intercourse. METHODS: The participants were members of a population-based longitudinal cohort of 1034 single men aged 25 through 54 years recruited from the 19 census tracts in San Francisco that had the greatest prevalence of the acquired immunodeficiency syndrome in 1984. Of the total sample, 140 subjects initially identified themselves as bisexual; 85% of these men remained in the study. RESULTS: The participants reported dramatic reductions in sexual risk taking. Prevalences of unprotected anal sex with men were similar among HIV-positive bisexual men (89% in 1984-1985 and 18% in 1988-1989) and those who were HIV negative (65% and 20%). The prevalence of unprotected vaginal sex was much lower for HIV-positive men (16% in 1984-1985 and 2% in 1988-1989) than for HIV-negative men (35% and 20%). Unprotected intercourse was associated primarily with situational and interpersonal factors. CONCLUSIONS: Striking reductions in risk behaviors were reported. This subgroup of single, bisexually identified men appears unlikely to be a common vector for spreading HIV infection to women.

Adult↗
PubMed1995

Sociodemographic characteristics and sexual behavior of bisexual men in France: implications for HIV prevention. The French National Survey on Sexual Behavior Group.

The French National Survey on Sexual Behavior was used to identify sociodemographic characteristics and sexual behavior of bisexually active men, as distinct from both homosexually and heterosexually active men. In regard to number of partners and frequency of unprotected vaginal sex, bisexuals were similar to multipartnered heterosexuals. On sociodemographic criteria, they differed from both homosexuals and heterosexuals. Bisexual men reported fewer partners than homosexuals but seemed more likely to engage in risk behavior related to the acquired immunodeficiency syndrome (AIDS), and they were less likely to have ever had a human immunodeficiency virus (HIV) test. These results justify prevention efforts specially adapted for bisexuals.

Adult↗
PubMed1995

HIV seroprevalence and risk behaviors among lesbians and bisexual women in San Francisco and Berkeley, California.

Few data are available on human immunodeficiency virus (HIV) infection and risk behaviors among lesbians and bisexual women. A total of 498 lesbians and bisexual women was sampled from public venues in San Francisco and Berkeley, Calif, during 1993. The overall HIV seroprevalence was 1.2%. Ten percent of participants reported injecting drugs since 1978. Forty percent of the participants reported unprotected vaginal or anal sex with men during the past 3 years, including unprotected sex with gay and bisexual men and male injection drug users. The high rates of injection drug use and unsafe sexual behaviors suggest that lesbians and bisexual women frequenting public venues in San Francisco and Berkeley are at risk for HIV infection.

Adolescent↗
PubMed1989

A potential source for the transmission of the human immunodeficiency virus into the heterosexual population: bisexual men who frequent "beats".

Fifty-four actively bisexual men with recent sexual experiences with both men and women were interviewed as part of a wider study of 176 homosexual men, many of whom frequented "beats" (public toilets, parks and isolated roads where men meet for homosexual encounters). Forty-six per cent of the bisexual men were engaging in unsafe sexual practices with at least one man and one woman. Three of these men knew that they were seropositive for the human immunodeficiency virus, with two of these men engaging in unsafe sexual practices with some of their partners. Fewer than one-quarter of the bisexual men identified with or participated actively in aspects of organized, overt "gay" culture. So-called "closeted" bisexual men are suggested to be a major, but neglected, target for educational efforts against the acquired immunodeficiency syndrome.

Acquired Immunodeficiency Syndrome↗
PubMed2001

The importance of parental support in the lives of gay, lesbian, and bisexual individuals.

This article underscores the very important role that parental acceptance and support plays in furthering the psychological well-being of gay, lesbian, and bisexual individuals. Parents, Families, and Friends of Lesbians and Gays (PFLAG), an organization dedicated to this goal, has as its mission the support for family members, education of the public, and advocacy for equal rights for lesbians, gay men, and bisexuals. By "coming out" themselves, straight parents and relatives-including those in the mental health field-not only can extend the support they offer to their gay/lesbian/bisexual children and relatives but also play a significant role in reducing the stigma of being gay, lesbian, or bisexual and in mainstreaming gay, lesbian, and bisexual issues.

Female↗
PubMed1976

Bisexuality in women.

In-depth interviews with women having a history of bisexual behavior and/or a bisexual self-identification revealed only moderate correspondence between behavior and identity. A general description is provided of the sexual relationships of the respondents. The major focus is on the wide diversity of self-identified bisexual women, especially in terms of self-perceived sexual and emotional needs, circumstances precipitating heterosexual and homosexual behavior, and ideological supports for a bisexual life style. Heterosexual behavior among homosexual women is discussed in terms of economic necessity, experimentation, and the response of the lesbian community. Homosexual behavior among heterosexual women is discussed in terms of responses to different kinds of situational exigencies and the rationalizations used to deal with the experience while insulating the heterosexual self-identification.

Adult↗
PubMed1994

HIV prevention education for lesbians and bisexual women: a cultural analysis of a community intervention.

AIDS is increasing almost four times as fast among women, yet lesbians and bisexual women are among the least studied, least understood and most elusive populations affected by the AIDS epidemic. This paper reports the results of community-level HIV prevention research designed: (a) to examine the knowledge, perceptions, social contingencies and political constraints affecting the HIV risk taking of lesbians and bisexual women; and (b) to offer them context specific HIV prevention education. The study was a peer educator-based intervention project situated in San Francisco's women's bars, dance clubs, and sex clubs to reach socially and sexually active lesbians and bisexual women in natural settings. Between June 1992 and May 1993, ethnographic interviews were conducted with 626 women attending the bars and clubs; group presentations at these locales reached 1,315 women. The structure of the intervention was effective in prompting interest in HIV prevention information and intent to change behavior. The resultant cultural analysis details risk behaviors lesbians and bisexual women participate in, myriad constraints they face in trying to enact safer behaviors, gaps in knowledge, difficulties comprehending the relevance of HIV prevention, and risk reduction strategies commonly employed.

Adult↗
PubMed2002

Genetic diversity and the phylogeography of parthenogenesis: comparing bisexual and thelytokous populations of Nemasoma varicorne (Diplopoda: Nemasomatidae) in Denmark.

The millipede, Nemasoma varicorne, represents a textbook example of geographic parthenogenesis with thelytokous populations being distributed north, east, south and west of the distribution of the bisexual ancestor in the deciduous forests of central Europe. We here describe variation in amplified fragment length polymorphisms (AFLP's) in sympatric bisexual and thelytokous populations of N. varicorne in Denmark and compare the relationships of Danish populations with animals from The Czech Republic, England and Poland. Thelytokes from Denmark, England and Poland form a monophyletic cluster that differs from bisexuals from Denmark and Czechia for about 30% of the fragments. A single clone is widely spread over Denmark (34 of 38 localities), with rare clones being detected at four other localities. The phylogenetic pattern implies strongly that thelytoky evolved prior to the post-glacial colonization of northern Europe. This further suggests that the two forms have interacted extensively during this colonization and that the thelytokes have been excluded from older forests by competition with the bisexual forms. Our results further suggest that the success of the thelytokous form, at least in Denmark, is not due to abundant clonal diversity as hypothesized by the frozen niche variation model.

Animals↗