Survey finds sexual health gaps for bi+ Australians
A Kirby Institute survey of more than 2,100 bi+ Australians found high use of sexual health care but poor inclusion, safety and mental health outcomes.
By Tom Brennan · Health & Medicine Correspondent
4 min read
A national survey has found bi+ Australians report poorer sexual health and safety outcomes than the broader population, even though most have used sexual health services. The Kirby Institute at UNSW Sydney said the findings point to health systems that often fail to address the needs of people attracted to more than one gender.
The Bi+ Sexual Health and HIV study examined responses from more than 2,100 people across Australia who identify under the bi+ umbrella, including bisexual, pansexual, queer and fluid identities. According to the Kirby Institute, it is the most detailed Australian account so far of sexual health, relationships and service experiences among bi+ people.
Associate Professor Benjamin Bavinton of UNSW, the study’s chief investigator, said bi+ people make up the largest group within LGBTQ+ communities but have often been left out of research and policy. He said the findings show both diversity within bi+ communities and worse outcomes across many measures than those seen in the general population.
High service use, low confidence in care
The survey found 36% of respondents had been diagnosed with a sexually transmitted infection, compared with an estimated lifetime STI prevalence of about 16% in the general Australian population cited in other research. Nearly nine in 10 respondents said they had used sexual health care at least once.
Despite that contact with services, the Kirby Institute said only about half of participants felt comfortable discussing sexual health with clinicians. Fewer than half described clinics as inclusive or knowledgeable about bi+ people, and one in six said they had received information relevant to bi+ identities.
Bella Bushby, a bi+ woman, Ph.D. candidate at the Kirby Institute and project coordinator, said services often treat patients as gay or straight by default. According to Bushby, that can leave bi+ patients feeling unseen, including in some LGBTQ+-focused sexual health services.
The report found half of respondents thought LGBTQ+ sexual health services could be more inclusive of bi+ people. A quarter said they had avoided or chosen not to use an LGBTQ+ service in the past.
Different risks across bi+ communities
The Kirby Institute said cis bi+ women reported higher engagement with health care, along with higher rates of illicit drug use, STI diagnoses and sexual violence perpetrated against them. Trans and nonbinary or gender-diverse bi+ participants reported stronger connection with LGBTQ+ communities, while also reporting higher rates of poor mental health and sexual violence.
Cis bi+ men stood out in the report for lower connection to LGBTQ+ communities and sexual health care. The study found they reported higher rates of casual partners, group sex and condomless anal sex, while also being less likely to disclose their sexuality to clinicians or to feel comfortable discussing sexual health.
Steven Spencer, vice president of the National Association of People with HIV Australia and a study co-investigator, said bi+ men need inclusive care but often do not feel supported when seeking it. He said services must avoid stigma, including historic stereotypes linking bi+ cis men to HIV transmission between communities.
Sexual violence and distress
The survey found 63% of bi+ participants reported sexual violence since age 18, which the Kirby Institute said was more than four times the rate in the general Australian population. Reported experiences were highest among cis bi+ women, followed closely by trans, nonbinary and gender-diverse bi+ participants.
According to the report, cis bi+ women were more than three times as likely as women in the general population to report sexual violence perpetrated against them. Trans men, trans women and nonbinary or gender-diverse bi+ people were more than 4.5 times as likely as the general population to report it, while cis bi+ men reported rates more than five times higher than men in the general population.
The study also found 28% of respondents met the threshold for probable serious psychological distress, compared with 17% in the general Australian population in other studies. Rates were higher among trans and nonbinary bi+ respondents, according to the Kirby Institute.
Emily Goodnow Bjaalid, a bi+ woman, La Trobe University Ph.D. candidate and co-investigator, said the findings support treating bi+ people as a priority group in sexual violence services and responses.
Community connection
The report said many respondents described biphobia from both straight and gay or lesbian communities. About half were out to family, and 15% were out at work, according to the survey.
Participants were most likely to be out to other bi+ people and to feel included in bi+-specific spaces. The Kirby Institute said respondents were less likely to be out to heterosexual people, colleagues, family and health professionals, or to feel comfortable in heterosexual spaces.
The study was developed by the Kirby Institute with partners including UNSW’s Center for Social Research in Health, La Trobe University’s Australian Research Center in Sex, Health and Society, the University of Sydney and a bi+ Community Advisory Group. UNSW Professor Christy Newman, a bi+ nonbinary co-investigator, said the project was designed to reflect the range of ways bi+ people identify and form relationships.
This story draws on original reporting from Medical Xpress.