March is Bisexual Health Awareness Month, and while bisexuals make up the largest part of the LGBTQ+ “pie” (54.6% of LGBT identifiers are bisexuals) they don’t get nearly enough recognition– either culturally or in the health community. Biphobia, bi-erasure, and a significant lack of medical research puts bisexuals at risk for both physical and mental health complications.
And for the millions of bisexuals with multiple marginalized identities, the obstacles only compound. This includes bi people of color, bi people with disabilities, bi transgender people and other intersectional identities who are not only facing the consequences of bi-erause and biphobia, but are combating racism, transphobia, poverty, ableism and other challenges that exacerbate medical disparities and injustices of all kinds.
The Impact of Biphobia and Bisexual Erasure
Biphobia is described as the intolerance or aversion of bisexual people, through thoughts, beliefs, hurtful comments, or even violence. Both monosexual groups, heterosexual and homosexual people, can hold biphobic beliefs.
Bisexual erasure is the dismissal, denial or downplay of the bisexual identity. It’s different from biphobia because it’s not necessarily purposefully biased. Bisexual erasure can be perpetuated by an individual, or by a society as a whole. Some examples of bi-erasure include: asking your bisexual partner to “relabel” their sexuality in a way that reflects your relationship, excluding the bisexual community in conversations about LGBTQ+ advocacy, assuming two women together are lesbians, or that a partnered man and woman are straight. It’s the upholding of the sexual binary, or monosexism, that assumes everyone is either gay or straight.
The tragedy of bisexuality is that in addition to experiencing oppression, we are also disbelieved about its very existence. We are not considered as credible narrators of our own stories. This is yet another sign of bimisogyny: women are disbelieved about their own lives
— Shiri Eisner ??? (@ShiriEisner) February 6, 2023
Bi Problems in the Media
We see bi-erasure across pop culture and media, but because of the nature of bi-erasure it can be hard to detect. Cardi B had to defend her sexuality when one Twitter user (with a now-suspended account) accused Cardi of being one of the “celebrities who come out as bisexual but never dated someone of the same gender.”
Cardi had to contest the accusation and responded “I ate b*tches out before you was born …..Sorry I don’t have razr phone pics to prove it to you.” She also explained she had a girlfriend before she got famous.
I ate bitches out before you was born …..Sorry I don’t have razr phone pics to prove it to you ?? https://t.co/S9mm4yesDU
— Cardi B (@iamcardib) September 19, 2022
No one should have to defend their bisexuality, and Cardi proves that what you see on the surface cannot be used to assume someone’s sexuality.
Fictional characters experience bi-erasure too. Think of the character Willow from Buffy the Vampire Slayer, an early and famous case of bi-erasure. Show creator Joss Whedon admitted that though the character was, in all regards, bisexual, they were not going to say that out loud, thanks to “society at the time.”
Health Inequalities Among Bisexuals
“Bisexual erasure is a form of stigma. And stigma is bad for health, just to put it in a nutshell,” explains Lauren B. Beach, PhD, a faculty member at Northwestern University’s Institute for Sexual and Gender Minority Health and Wellbeing, in an interview with Health.
Bi-erasure and biphobia are not just cultural challenges. Bisexual people experience a range of health disparities, compared to their gay and lesbian peers, due in part to biphobia and bi-erasure in the medical field. Some of these complications include substance abuse, HIV and other sexually transmitted diseases, mood disorders, eating disorders and more. However, bisexual health and wellness is rarely researched, understood, or known by medical professionals.
@s3xtheorywithdee Bi-the way your health matters ? #bisexual #bi #mulisexualidentities #mulitsexual #identity #pronouns #mentalhealth #selfcare #selflove #health #sexeducation #sexualhealth ♬ original sound – S3xTheorywithDee
Bisexuals have the highest rates of smoking out of all orientations, and they report serious pathological distress more than their hetero-or-homosexual counterparts. Bisexual women have double the rate of eating disorders as lesbians do. Bisexual men have high rates of HPV, while bisexual women have low rates of screening for HPV. Bisexual men are less likely than gay men to seek sexual or reproductive health services. It’s even been confirmed that bisexual men are disproportionately affected by the virus because of biphobia, which hinders them in coming out, getting tested, and seeking care.
Of course, not all of these health disparities are a direct result of prejudices toward the bisexual community. But those phenomena make it less likely for a doctor to ask about a patient’s sexuality, or for a patient to disclose their sexuality to the doctor. That means there’s a chance the doctor won’t make connections about symptoms, and potentially miss a diagnosis that could have been identified easier with additional information about the patient’s bisexuality.
“Societal biphobia — negative attitudes and behaviors toward bisexual individuals — is more prevalent than antigay sentiment,” said author William Jeffries of the Division of HIV/AIDS at the CDC’s National Center for HIV/AIDS in a press release. “It is sometimes perpetrated by lesbians and gay men, and public health professionals who interact with bisexual men. Biphobia can manifest in erroneous beliefs that they are closeted gay men and, particularly for black men, responsible for HIV transmission to women.”
New in @CDCMMWR: Gay and bisexual men account for 2 out of 3 #HIV diagnoses each year. Ensuring gay and bisexual men with HIV are connected to needed healthcare services and given appropriate treatment to suppress the virus can prevent HIV transmission: https://t.co/05viFqX9ZP. pic.twitter.com/gvzMHCM9Vo
— CDC (@CDCgov) September 24, 2020
Mental and Social Health Challenges
But what about mental health? What about communal or social health? Bisexuals face greater challenges in these areas as well.
Bisexuals are at increased risk for mental health problems, and this is due in part to stigma and discrimination. The predominant conceptual framework that explains some of the mental health challenges bisexuals face is called the minority stress theory. The theory surmises that bisexual stigma and discrimination can increase the risk of long term chronic stress, which of course leads to a myriad of mental, social and psychological challenges.
Stigmas perpetrated by both monosexual groups are dangerous, but it’s particularly harmful coming from other LGBTQ+ community members as TikTok user @chrystalwithanh explains:
@chrystalwithanh With ALLLLL due disrespect! #spreadawareness #alphabetmafia #lgbtq #bisexual?️? #bisexualtiktok #mentalhealthmatters #ItsOurHome #foryoupage #fypシ ♬ original sound – Chrystal
45% of bisexual women have considered or attempted suicide, a higher rate than gay or straight men and women. Bisexual women have higher rates of mood/anxiety disorders than straight or gay women. Bisexual men have higher rates of mood/anxiety disorders than straight men, and at similar rates to gay men. Bisexual youth are less likely than lesbian and gay youth to report having supportive adults that they could turn to if they were sad. Only 5% of bisexual youth reported being very happy, compared to 8% of lesbian and gay youth and 21% of non-LGBT youth.
inspired by a recent Twitter thread. just sk you know, anti-bi rhetoric is literally TERF ?.
Socially, bisexuals struggle to find community, an important and necessary part of social health and safety. While many queer groups have found and forged communities to connect, heal, and grow, it’s nearly impossible to find spaces run for and by bisexuals, outside of monosexual (straight or gay/lesbian) environments.
Insight shared by the Society for the Psychology of Sexual Orientation and Gender Diversity shows that “efforts to make more spaces bi-affirming can aid in increasing bi+ people’s social health, such as having more affirming families of origin, chosen queer families, partners, geographic areas and continuing to build a bi-affirming field of psychology.”
Advocating For Yourself and Others
Self-advocacy is an unfortunate reality for many queer people. A healthcare equality index survey from 2020 found that around 70% of transgender or gender non-conforming people and 56% of lesbian, gay, or bisexual patients say they’ve experienced some type of discrimination in healthcare.
Advocating for yourself can be an act of empowerment. A good place to start is trying to find queer health professionals, but that’s not always possible depending on where you live and what kind of insurance (or lack thereof) you have. Self-advocacy could mean correcting your doctor’s language, putting your pronouns or sexuality on your record, bringing a friend who can speak up when you’re feeling intimidated, or asking for a patient advocate at your facility.
Unless we have a complete legislative flip-flop where healthcare is accessible, free and inclusive, finding the tools and support to advocate for yourself in and out of the doctor’s office can go a long way in ensuring you receive the care you require as a bisexual person, or as any person who faces discrimination in healthcare.
If you are looking for LGBTQ+ affirming doctors, physicians, clinicians, and healthcare providers, check out outcarehealth.org to search by location and speciality.
Top photo by cottonbro studio via Pexels