Psychosocial Health Disparities Among Black Bisexual Men in the U.S.: Effects of Sexuality Nondisclosure and Gay Community Support

Abstract

Compared with Black gay men, Black bisexual men experience psychosocial health disparities, including depression, polydrug use, physical assault, and intimate partner violence (IPV). Black bisexual men are also less likely to disclose their sexuality, which may result in them receiving less sexual minority community support, exacerbating psychosocial health disparities. We assessed relationships between bisexual behavior, bisexual identity, sexuality nondisclosure, gay community support, and psychosocial morbidities among Black men who have sex with men (MSM). Between 2014 and 2017, survey data were collected from Black MSM ≥ 18 years old (n = 4430) at Black Pride events in six U.S. cities. We differentiated between bisexual-identified men reporting past-year sex with men and women (bisexual MSMW, 8.4%); gay-identified men reporting sex with men only (gay MSMO, 73.1%); gay MSMW (8.0%); and bisexual MSMO (8.4%). Multivariable regressions contrasted these groups by psychosocial morbidities, sexuality nondisclosure, and gay community support. Structural equation models assessed total, direct, and indirect effects. Compared with gay MSMO, bisexual MSMW and gay MSMW were significantly more likely to report polydrug use, depression symptoms, IPV, physical assault, sexuality nondisclosure, and lack of gay community support. Lack of gay community support had significant indirect effects on the relationships between bisexual behavior and psychosocial morbidity (p < .001) and between bisexual identity and psychosocial morbidity (p < .001). Sexuality nondisclosure had significant indirect effects on relationships between bisexual behavior (p < .001), bisexual identity (p < .001), and lack of gay community support. Psychosocial health disparities experienced by Black bisexual men are associated with both bisexual behavior and bisexual identity. Interventions decreasing biphobia will facilitate opportunities for protective sexuality disclosure and access to sexual minority community support.

HIV-Related Stigma Research as a Priority at the National Institutes of Health

“…A great deal of cross-sectional and longitudinal research has found that internalized HIV stigma is one of the most important dimensions associated with adverse HIV outcomes such as ART non-adherence, higher viral load and poor mental health outcomes [ 56 , 64 ]. Other HIV-related stigma studies document the links between anticipated and experienced HIV stigma in health care settings [ 65 – 67 ], the mediating role of social isolation and depression among cisgender women [ 64 ], the role of sexuality nondisclosure and gay community support among Black bisexual men [ 68 ], and the mediating role of stress-contingent emotion regulation [ 69 , 70 ]. Dodge and colleagues are examining how state-level structural stigma impacts HIV prevention outcomes using national survey studies [ 71 ].…”

The New Genetic Evidence on Same-Gender Sexuality: Implications for Sexual Fluidity and Multiple Forms of Sexual Diversity

“…Negative attitudes toward bisexuality have a long history in both mainstream society and the larger lesbian/gay community (Mulick & Wright, 2002;Weiss, 2003;Welzer-Lang & Tomolillo, 2008;Yost & Thomas, 2012), manifested in stereotypes of bisexuals as confused, questioning, experimental, promiscuous, irresponsible, and unfaithful (Brewster & Moradi, 2010;Dyar & Feinstein, 2018). As a result, bisexual individuals often experience marginalization from both heterosexual and lesbian/gay communities, restricting their access to social support and validation (Friedman et al, 2019).…”

A Randomized Trial of an Online Risk Reduction Intervention for Young Black MSM

“…Prior research has found that bisexually identified men may be less attached to gay communities (44,45) and therefore may experience less community support. Stigma experienced by bisexual Black men may influence not only the disclosure of their sexuality to friends, female sex partners and health care providers (46)(47)(48) but also their receptivity to prevention messages (49)(50)(51). Notably, among the seven bisexually identified men who complied with HMP, none reported female sex partners in the three months prior to their baseline interview, while 12 of the 29 bisexual non-compliers (41.4%) did report female sex partners.…”