Book review: HIV prevention and bisexual realities

HIV Australia | Vol. 11 No. 2 | July 2013

HIV prevention and bisexual realities by Viviane Namaste, et al. (2012)

Abigail Groves investigates the erasure of bisexuals in HIV prevention and health promotion.

A colleague in the HIV sector once observed that, ‘gay men tend to assume that all bisexual men are really gay, whereas lesbians tend to assume that bisexual women are really straight’.

I was reminded of this remark while reading this book from a group of Canadian researchers, HIV prevention and bisexual realities.

Viviane Namaste and her team question the lack of HIV prevention and education measures targeted toward bisexuals.

In Canada, they maintain, there are simply none. In terms of politics and society, Canada and Australia have much in common. This is also true – to some extent – of the HIV epidemics the two countries have experienced.

Both have low level epidemics in which transmission is concentrated among gay men, though this is less the case in Canada, which has a higher proportion of infections among immigrants (due to its more liberal immigration policies) and among injecting drug users (due to its slower adoption of harm reduction measures).

Namaste and her team cite research which shows that bisexual people are at higher risk of acquiring HIV and other sexually transmissible infections (STIs).

Whether this is the case in Australia I don’t know and am inclined to doubt, though I doubt whether such data is available here.

However, the experiences described by bisexual people who the researchers interviewed and their accounts of attitudes towards bisexuals sound remarkably familiar.

This alone makes the critique of institutional attitudes toward bisexual people and their sexual health needs relevant to the Australian context.

The authors are extremely critical of the disciplines of epidemiology and public health, and also of government and community-based HIV responses, for their failure to respond adequately – or even to identify – the needs of people who have sex with both women and men.

The authors encountered considerable barriers in getting their research funded, a fact which they attribute to institutionalised bias against bisexuals.

The needs of bisexual people, they argue, are minimised or simply ignored in the response to HIV and sexual health promotion more generally.

This erasure of bisexual people continues despite the level of HIV risk that bisexual men at least, face. ‘HIV policy neglects bisexual realities,’ the authors argue, and ‘it (ironically) does so at the precise moment bisexual men are scapegoated as vectors of transmission for heterosexual women’ (p. 199).

The invention of the term ‘men who have sex with men’ was, as the authors point out (p. 24), intended to recognise the experience of those men who have sex with other men but do not identify as gay.

Indeed, it is these men who were, in the early days of the HIV epidemic, identified as the likely locus of transmission of the virus from the gay male community into the ‘general’, heterosexual community.

The term ‘men who have sex with men’ (or MSM) was in turn criticised by gay men, who argued – quite rightly – that it failed to recognise their specific culture and experiences.

This led to one of the sillier tautologies that the HIV epidemic has produced: ‘gay men and MSM’, which is still in common use, at least in HIV circles. However, as the authors point out, while HIV prevention measures that target gay men and MSM are supposed to target both gay and bisexual men, they only reach gay men (p. 102).

Namaste and her colleagues are highly critical of the assumption – explicit in some quarters – that bisexual people can access HIV education targeted toward either gay men or heterosexual people (p. 124).

In fact, as the respondents in their research clearly indicate, the result is that bisexual people access neither.

The authors are equally critical of the erasure of bisexual women in HIV work, noting that there are virtually no education materials available for women who have sex with women.

This book is the first that I have seen to address the glaring contradiction between the safe sex messages given to lesbians – that is, to use dental dams for oral sex – and the fact that virtually nobody actually does so (p. 139).

The authors also point out the importance of incorporating HIV prevention messages into women’s sexual and reproductive health needs more generally: contraception is not just about using a condom, and nor is sexual health.

While the authors’ critique of the erasure of bisexual people in HIV prevention and services is compelling, their analysis of the distinction between identity and behaviour is less well developed.

As the authors readily acknowledge, just as many men who have sex with men do not identify as ‘gay’, many people who have sex with both women and men do not necessarily identify as ‘bisexual’.

However, they themselves slide between the terms ‘bisexual’ and ‘people who have sex with both men and women’.

The text can also be irritatingly repetitive in places – for example, the observations about swinger culture are very interesting, but I became distinctly less sympathetic after the tenth reading.

Nonetheless, the authors’ project appears successful, as they go beyond social research to develop their own sexual health campaign for bisexual people.

The campaign appears to have been very successful, with large numbers of phone calls and website hits being received (p. 197).

Unfortunately, the authors do not provide an analysis of just who the campaign reached, which would be interesting to compare with its objectives.

The real strength of this work is its accessibility. Namaste and her colleagues not only criticise the complex jargon of public health and HIV, but walk the walk themselves.

They explain epidemiological terms such as ‘incidence’ and ‘prevalence’ in everyday terms. They also detail institutional relationships, and the way epidemiology informs research, public health policy and the funding of services.

For readers who do not work in HIV (and even those who do), such explanation is incredibly useful. It is worth being reminded, as the authors do, that not everybody knows what ‘STI’ stands for, or what ‘seropositive’ means.

Overall, for anyone who has noticed the glaring failure of HIV services to genuinely address the needs of bisexual people, ‘HIV prevention and bisexual realities’ is an excellent place from which to start.

Dr Abigail Groves is a freelance writer and a former policy analyst at AFAO.