Self-Reported Health Concerns and Healthcare Experiences among Diverse Bisexual Men: An Exploratory Qualitative Study

Abstract

Bisexual individuals have disproportionately higher rates of physical and mental health concerns compared to both heterosexual and gay/lesbian individuals. Few studies have examined diverse bisexual-identified men’s perceived health concerns for themselves and other bisexual men or their experiences in healthcare settings. This qualitative study explored health and healthcare experiences among cisgender and transgender bisexual men, most of whom were also men of color. Data were collected through semi-structured interviews. Participants included 31 self-identified bisexual men from the Chicago area. Participants were asked questions surrounding bisexual men’s health and healthcare experiences in general and their personal experiences, drawing connections between intersecting bisexual and racial/ethnic identities. Interview transcripts were analyzed using thematic analysis. Participants reported sexual health and mental health as the top health concerns for bisexual men. Participants viewed their bisexual identity as a motivator for seeking healthcare services and adopting safer sex practices. Mental health challenges faced by respondents were connected to bisexual stereotypes and fear of disclosing bisexual and transgender identities. Furthermore, perceptions of masculinity amongst bisexual men of color were particularly salient in connecting to their mental health experiences. The intersection of participants’ transgender and bisexual identities impacted their healthcare experiences in general healthcare settings, with many participants reporting a lack of cultural competence and provider knowledge concerning their identities. LGBTQ Federally Qualified Health Centers, however, were described as providing compassionate care. Our findings suggest the need for more interventions that account for bisexual men’s intersecting identities. Furthermore, increased provider training is necessary for providing affirmative care to bisexual men.

Keywords:

• Bisexual men
• healthcare experiences
• health concerns
• transgender men
• qualitative

Acknowledgements

We express our deepest appreciation to the special issue journal Editor, Dr. Brian Feinstein, for his wisdom and guidance throughout the publication process, and for his vision for this special issue. During the writing of this manuscript, Drs. Bostwick and Dodge were supported by the National Institute on Minority Health & Health Disparities grant R21 MD012319 (Wendy Bostwick/Brian Dodge, Co-Principal Investigators). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

We would also like to thank our participants for sharing their life experiences with us.

Disclosure statement

We have no conflicts of interest to disclose.

Additional information

Funding

During the writing of this manuscript, authors were supported by the National Institute on Minority Health and Health Disparities Grant R21 MD012319 (Wendy Bostwick/Brian Dodge, Co- Principal Investigator). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Notes on contributors

Deana Williams

Deana Williams, MPH, is a doctoral candidate in the Department of Applied Health Science and at the Center for Sexual Health Promotion at the Indiana University School of Public Health Bloomington. She is a sexual and reproductive health researcher and an associate instructor for sexuality education. Her research is devoted to advancing the wellbeing of individuals, especially those who are Black, Indigenous, and people of color.

Brian Dodge

Brian Dodge, PhD, is a Professor in the Department of Applied Health Science and at the Center for Sexual Health Promotion at the Indiana University School of Public Health-Bloomington. He has authored and coauthored over 150 scientific publications on sexual health and behavior in a wide range of underserved populations. For nearly two decades, his research has maintained a specific emphasis on health among diverse groups of bisexual men, women, and gender diverse individuals. This line of work resulted in some of the first ever National Institutes of Health (NIH)-funded studies focusing on sexual health specifically among bisexual men, relative to their exclusively heterosexual and homosexual counterparts. His research continues to demonstrate that bisexual individuals face numerous unique forms of stigma, across multiple levels, from both heterosexual and especially gay/lesbian individuals. He also recently co-chaired, along with Dr. Wendy Bostwick of the University of Illinois at Chicago, the first ever NIH Workshop on Bisexual Health Research, sponsored by the NIH Sexual & Gender Minority Research Office along with a variety of institutes and centers, in September 2019.

Bria Berger

Bria M. Berger, MSW, LCSW, has worked for the University of Illinois at Chicago managing two separate NIH-funded studies focused on bisexual women's and men's health. A licensed clinical social worker, Bria has previously worked as a case manager with unstably housed families affected by HIV. She is currently a Research Manager at Feeding America where she works to support food banks in their evaluation projects and produces population-level research on vulnerable groups.

Alex Kimbrough

Alexander Kimbrough, MPH, is a graduate of the University of Illinois at Chicago with his Master's in Epidemiology. He currently works as a data/quality manager for a clinic system for people living with HIV at the Hektoen Institute, LLC. He has a passion for studying health disparities that affect minority people of color and sexual/gender minorities.

Wendy B. Bostwick

Wendy Bostwick, PhD, MPH, is an Associate Professor and Associate Department Head in Population Health Nursing Science, College of Nursing, at the University of Illinois Chicago. She conducts research related to health disparities among sexual and gender minority populations, with a focus on mental health and substance use among bisexual groups. Her current work, funded by two separate NIH grants, explores how microaggressions associated with race, gender, sexual orientation and their intersection may affect mental and physical health among racially and ethnically diverse bisexual women and men. Her research has been supported by the National Institute on Drug Abuse, the National Institute on Minority Health and Health Disparities, and the American Institute of Bisexuality, among others. Her work has appeared in the American Journal of Public Health, Archives of Sexual Behavior, Culture, Health & Sexuality, LGBT Health, and Journal of Bisexuality. In 2019, Dr. Bostwick Co-Chaired the first-ever NIH workshop on bisexual health research, with Dr. Brian Dodge.