An Australian-first survey has found that bi+ Australians experience significantly poorer sexual health and safety outcomes than the general population, despite being highly engaged with healthcare.
Findings released today by the Kirby Institute at UNSW Sydney provide the most detailed picture to date of sexual health, relationships and experiences with sexual healthcare services among bi+ Australians.
The report, which analyses data from more than 2,100 bi+ Australians, highlights the diversity of experiences within the community. Researchers found that cis bi+ women reported higher levels of engagement with healthcare, but also higher rates of illicit drug use, experiences of sexual violence and STI diagnoses.
Trans and non-binary or gender diverse bi+ participants tended to feel more included in and engaged with LGBTQ+ communities, but also reported higher rates of sexual violence and poorer mental health. While cis bi+ men were less likely to be connected to LGBTQ+ communities and sexual healthcare services.
“Bi+ Australians are the largest population group in the LGBTQ+ community, yet their experiences have been consistently overlooked,” said UNSW Associate Professor Benjamin Bavinton, chief investigator of the Bi+ Sexual Health and HIV (BiSHH) study.
“Our findings reflect a diverse and engaged population. However, across many measures, bi+ people experience poorer sexual health and wellbeing outcomes compared with the general population.”
Bi+ is a community-developed umbrella term used to describe sexual identities characterised by attraction to more than one gender. Identities under the bi+ umbrella include bisexual, pansexual, queer and fluid, among others. Until now, relatively little has been known about this population’s sexual health needs and experiences.
“The findings from this survey reflect both shared experiences and diversity among bi+ people in Australia and point to an urgent need to recognise bi+ Australians as a distinct population with specific health needs,” Associate Professor Bavinton said.
According to the survey, 36 percent of bi+ participants reported having been diagnosed with an STI, more than double the estimated lifetime prevalence in the general Australian population, which is around 16 percent based on other research.
Nearly nine in 10 bi+ Australians reported having accessed sexual healthcare at least once. However, only half felt comfortable discussing sexual health with care providers, and fewer than half felt clinics were inclusive or knowledgeable about bi+ people. Only one in six participants felt they received information relevant to bi+ experiences.
These gaps were also evident within LGBTQ+ focused sexual health services. Half of participants felt these services could be more inclusive of bi+ people, and a quarter reported avoiding or choosing not to use them in the past.
“These findings show that bi+ people are engaging with healthcare, but systems are not meeting them where they are,” said Bella Bushby, a PhD candidate at the Kirby Institute and project coordinator of the study.
Healthcare services often assume patients are either gay or straight, which can cause bi+ people to feel overlooked, she added.
Cis bi+ men and healthcare access
Bi+ men reported poorer outcomes than other participants across comfort, inclusion and engagement with services.
They reported higher rates of casual partners, group sex and condomless anal sex. At the same time, they were less likely to feel comfortable discussing sexual health, less likely to feel included in LGBTQ+ or bi+ spaces, less likely to disclose their sexuality to clinicians and less likely to access sexual healthcare.
Steven Spencer, vice president of the National Association of People with HIV Australia and a co-investigator on the study, said there were clear gaps in service delivery.
“Bi+ men have a high need for inclusive sexual health care but are least likely to feel supported in accessing it.” he said.
Experiences of sexual violence
Overall, 63 percent of participants reported experiencing sexual violence since the age of 18, more than four times the rate reported in the general Australian population.
Cis bi+ women were more than three times as likely as women in the general population to report experiencing sexual violence. Trans men, trans women and non-binary or gender diverse bi+ people were more than 4.5 times as likely to report experiencing sexual violence. While cis bi+ men reported lower rates than other bi+ groups, but still more than five times higher than the general male population.
“These findings highlight the urgent need to recognise bi+ people as a priority population within sexual violence services and responses,” said Emily Goodnow Bjaalid, a co-investigator on the study.
Additionally, 28 percent of participants met the threshold for probable serious psychological distress, more than double the rate observed in the general Australian population. Rates were higher among trans and non-binary bi+ people.
Community connection
Many bi+ people reported experiencing biphobia from both heterosexual and gay or lesbian communities. Only half of respondents were out to their families, and just 15 percent were out at work.
Participants were most likely to be open with other bi+ people and to feel included in bi+ specific spaces. They were less likely to feel comfortable or open in heterosexual spaces, including with family members, colleagues and health professionals.
“We know that connection and belonging increase the likelihood of bi+ people seeking and receiving relevant sexual health information,” Bella Bushby said. “There is a clear need to improve visibility and access to safe and inclusive spaces.”
Study collaboration
The BiSHH study was developed by the Kirby Institute at UNSW Sydney in partnership with multiple institutions and the bi+ community, including a Community Advisory Group involved in the study’s design and analysis.
UNSW Professor Christy Newman, a co-investigator on the study, says the findings confirm long-held insights about the diversity of bi+ communities in Australia.
“The BiSHH study confirms what we have long anecdotally known about bi+ communities in Australia. We are diverse in age, gender and relationships, and come from all walks of life,” Professor Newman said. “It’s particularly affirming to see these outcomes from a survey deliberately designed to be inclusive of the diverse ways bi+ people identify and connect to others through relationships and sex.”
