bisexual health AN INTRODUCTION AND MODEL PRACTICES FOR HIV/STI PREVENTION PROGRAMMING by Marshall Miller, Amy André, Julie Ebin and Leona Bessonova Cover photo: Kuwaza Imara, RN, Highland Hospital Emergency Room, Lavender Caucus SEIU 616 (Service Employees International Union), co-founder 3x3 Bisexual People of Color, 1989 NATIONAL GAY AND LESBIAN TASK FORCE POLICY INSTITUTE THE FENWAY INSTITUTE AT FENWAY COMMUNITY HEALTH BINET USA BISEXUAL HEALTH The National Gay and Lesbian Task Force Policy Institute is a think tank dedicated to research, policy analysis and strategy development to advance greater understanding and equality for lesbian, gay, bisexual, and transgender people. Washington, DC Cambridge, MA 1325 Massachusetts Ave NW, Suite 600 1151 Massachusetts Avenue Washington, DC 20005-4171 Cambridge, MA 02138 Tel 202 393 5177 Tel 617 492 6393 Fax 202 393 2241 Fax 617 492 0175 New York, NY Miami, FL 80 Maiden Lane, Suite 1504 3510 Biscayne Blvd Suite 206 New York, NY 10038 Miami, FL 33137 Tel 212 604 9830 Tel 305 571 1924 Fax 212 604 9831 Fax 305 571 7298 Los Angeles, CA Minneapolis, MN 8704 Santa Monica Blvd, Suite 200 810 West 31st Street West Hollywood, CA 90069 Minneapolis, MN 55408 Tel 310 855 7380 Tel/Fax 612 821 4397 Fax 310 358 9415 [email protected] www.theTaskForce.org The Fenway Institute BiNet USA Fenway Community Health 4201 Wilson Blvd. #110-311 7 Haviland Street Arlington, VA 22203-1859 Boston, MA 02115 1-800-585-9368 617-927-6400 [email protected] www.thefenwayinstitute.org www.binetusa.org © 2007 The National Gay and Lesbian Task Force Policy Institute When referencing this document, we recommend the following citation: Miller, M., André, A., Ebin, J., and Bessonova, L. (2007). Bisexual health: An introduction and model practices for HIV/STI prevention programming. New York: National Gay and Lesbian Task Force Policy Institute, the Fenway Institute at Fenway Community Health, and BiNet USA. ii This publication is dedicated to the memory of Dr. Fritz Klein [1933-2006]. Dr. Klein was one of the first people to research bisexuality in the United States. He established the credibility of research on bisexuality, fostered interna- tional networking and generously supported grassroots organizing among bisexuals. He was also the founding editor of the Journal of Bisexuality and founder of the American Institute of Bisexuality. iii BISEXUAL HEALTH this page intentionally left blank iv contents FOREWORD VII exeCutiVE suMMARY 1 INTRODUCtiON AND liteRatuRE REVieW 8 Timeline: The Bisexual Health Movement in the US 10 What is bisexuality? 10 Who is a bisexual person? 11 What does it mean to have, or be open to having, sex with partners of a same or different gender? 13 Theories describing bisexuality 14 Gender, sex and bisexuality 15 Race, ethnicity and bisexuality 17 Biphobia, bi-invisibility and health 23 Bisexual youth 29 Why focus on bisexual health? 30 Bisexuality and social science research 32 Sexual prejudice: A case study on the erasure of bisexuals in academia and the media 34 What are bisexual health issues within the context of HIV and STI prevention? 38 the bihealth PROGRAM at FENWAY COMMUNitY health IN BOstON, MassaChusetts 44 Introduction 44 The beginnings of BiHealth 46 Putting theory into practice 57 Additional challenges and benefits of a BiHealth Program 83 NEXT STEPS 88 Current bisexual health projects and resources 88 What you can do 90 v BISEXUAL HEALTH ENDNOtes 95 APPENDix a 106 Top Ten Bisexual Health Issues APPENDix b 112 Tips for health care providers when working with bisexual clients REFERENCes 114 ACKNOWleDGMENts 120 tasK FORCE FUNDERs 124 vi foreword BY Luigi FeRRER, M.S. Former President, BiNet USA Board Member, Bisexual Resource Center It is with great pleasure and a deep sense of appreciation for the National Gay and Lesbian The bisexual point of Task Force, The Fenway Institute at Fenway Community Health and all those involved in view has been and this project that I sit down to write this foreword. The document you are about to read was born out of the grassroots efforts of countless bisexual activists, organizers, nurses, doctors, is still sorely missing patients/clients, researchers, health educators and HIV-prevention workers, who for more from the public than 35 years have struggled to bring about greater visibility, understanding and inclusion health discourse of bisexuality. The bisexual point of view has been and is still sorely missing from the public in our country and health discourse in our country and throughout the world. throughout the world. The fact that bisexual people and people who have sex with more than one gender exist is undeniable. However, there is still considerable controversy as to the size of these segments of the population, how to define them, and what the public health implications of bisexual identity or of having sex with more than one gender (with or without a bisexual identity) really are. Most public health officials appear to be at a loss to understand these issues and dismiss them as unimportant because “they affect such a small number of people.” Sadly, more often than not, they honestly believe that there are more pressing priorities. I was 21 in 1979 when I was infected with HIV as I began to explore my sexual desires for men for the first time. This was before any of us had heard of GRID (1981), AIDS (1982) or HIV (1983), and long before there was an HIV test available to the general public (1985) or any sort of treatment (i.e. AZT monotherapy in 1987). I lived through the dark ages of the early days of the AIDS pandemic, lost too many dear friends, and survived. In the 21 years since my HIV-positive diagnosis in 1985, I helped build a thriving bisexual community in Miami, served as executive director of an AIDS services organization, worked on a number of lesbian, gay, bisexual and transgender (LGBT) community building and political organizing projects and have served on numerous local, state and national health care advisory boards and health services policy, planning and evaluation groups. I came to this work reluc- tantly and at times feeling unprepared, but I was drawn to it by my personal need for support and information and by the needs and encouragement of my gay, lesbian, bisexual, transgender, vii BISEXUAL HEALTH The bottom margins HIV-positive and Latino/a brothers and sisters. Antiretroviral medications keep me alive, but it’s of the pages of the strength and support of community that allows me to thrive in the face of adversity. this publication Today, as part of a team of peer facilitators for a coming-out support group for bisexuals, also include a brief I find it troubling to not have answers to simple questions, like: What is the prevalence timeline of the of HIV among sexually active bisexuals? Are bisexuals (or people who have sex with more bisexual health that one gender) at greater risk for HIV or sexually transmitted infections (STIs) than the movement’s history. average person on the street? Are bisexual women at greater risk than bisexual men? The list of questions goes on and on. Given that the way most public health data are collected and analyzed in this country does not allow us to answer these basic questions, I am also troubled when I hear public health officials assert that “the needs of bisexuals are already addressed by prevention efforts for men who have sex with men,” that “bi women, for example, are probably at low risk” or that “bi women are not a priority population.” There is a great deal of work to be done in the emerging field of bisexual health. Throughout the past 20 years I have been the only out bisexual voice at far too many meetings. I appreciate the progress we have made, but I also know how far we still need to go and how critical it is that out bisexuals are at the table and part of the discourse. I came on the scene just as BiNet USA was formed and was honored to serve as one of its six initial national coordinators. By then, BiNet USA and bisexual movement leaders had made presenta- tions to the board and staff of the National Gay and Lesbian Task Force and were a visible presence at the annual Creating Change conference. In 1995 BiNet activists worked with the Task Force to create a professional press packet which produced a cover story on bisexuality in Newsweek magazine that was the first balanced portrayal of bisexuals in the mainstream media. In the pages that follow, celebrated author and sex educator Amy André provides an introduc- tion to the topic of bisexuality, which is followed by a brief review of some of the available academic literature on issues affecting the health of bisexuals, with a focus on HIV and STI prevention. The second half of this publication outlines the work of Marshal Miller and Julie Ebin at the BiHealth Program at Fenway Community Health in Boston, Mass., with the goal of providing model policies and practices that healthcare providers and activists can replicate around the country. In order to increase the visibility of and acknowledge the accomplish- ments of bisexual activists and leaders, the bottom margins of the pages of this publication also include a brief timeline of the bisexual health movement’s history. I hope this publication will inspire a new cohort of bi-health activists here in the US and throughout the world. Enjoy! viii executive summary INTRODUCtiON • Who are bisexual people? • Why do some people who have sex with both men and women choose not to identity as bisexual and how can HIV and sexually transmitted infection (STI) prevention programs be more effective in reaching them? • What are the particular sexual health issues that affect bisexual people and how can agen- cies, funders, researchers, counselors and activists help bisexual people to address them? The National Gay and Lesbian Task Force Policy Institute, the Fenway Institute at Fenway Community Health in Boston, Mass., and BiNet USA created this report to answer these questions and offer a model practice HIV/STI prevention program that successfully educates bisexuals and those who have sex with both men and women but do not identify as bisexual.