Sexual Risk Behaviors of Self- identified and Behaviorally Bisexual HIV+ Men. By: Matt G. Mutchler, PhD; Miguel Chion, MD, MPH; Nancy Wongvipat, MPH; Lee E. Klosinski, PhD; and Summra Shariff

Background  Research has been conducted by Doll and Beeker (1996) highlighting four contexts in which bisexual behavior is associated with HIV risk:  male prostitution.  injecting drug use.  sexual identity exploration.  culturally specific roles in some African American and Hispanic communities.

 Heterosexual women represent an increasing proportion of persons living with AIDS nationally (CDC, 2000) and in L.A. County (DHS, LA County, 2000).  Prior research found that bisexual men report more female sexual partners compared to gay men and more unprotected sex with female partners compared to male partners. (Wold et al., 1998; Ekstrand et al., 1994). Background

 HIV+ bisexual men faced with at least 2 social stigmas:  Bisexual identity.  Living with HIV. Background

Study Design  Cross-sectional, mail administered survey.  Administered in English and Spanish.  Data collected Oct 1999 – Jan  Survey participants were 113 HIV+ self-identified bisexual men drawn from a larger sample.

Survey Domains: 1.Demographic 2.General health 3.Health status 4.Sexual risk behaviors 5.HIV status disclosure 6.HIV medication adherence 7.Tobacco use 8.Drug and alcohol use

Outcome Variables  Unprotected anal or vaginal intercourse  Non disclosure of HIV status to sexual partners

Survey Limitations  Based on self reported information  The findings may not be generalizable to populations outside the sample

Objective  To assess demographic, health, HIV medication adherence, substance use, sexual risk and HIV status disclosure data gathered from self-identified bisexual men.

Guiding Purposes  Analyzing data on factors that significantly correlate with sexual risk behaviors among HIV+ bisexual men.  Reporting HIV disclosure patterns among HIV+ bisexual men.  Providing formative data for intervention studies targeting HIV+ bisexual men.  Outlining a research trajectory.

Statistical Analyses  Univariate analyses performed to provide descriptive statistics.  Bivariate analyses to assess associations between independent and dependent variables.  Used SPSS software

Results: Age & Race/Ethnicity

Relationship Status:

Socio-Economic status:  53.2% of participants reported being at or below the poverty level.

HIV/AIDS Status:

Treatment Adherence  Approximately half (49.5%) of the respondents reported that they were adherent to their HIV medications.

Sexual Risk Behaviors  Among the HIV+ bisexual men, 66.3% reported being sexually active.  Average number of partners was 3.9 in the past 6 mos.  31% reported UAVI in past 6 mos.

 Participant who had sex with men: 62.2% reported UAI 41% reported UAI with HIV negative or unknown partners  Participants who had sex with women: 50% reported having UAVI 38.5% reported UAVI with HIV negative partners of unknown status Sexual Risk Behaviors-cont.

 Non adherence to HIV medications, recreational drug use, tobacco use and feeling the effects of drugs or alcohol during sexual activities were positively correlated with unprotected anal and vaginal sex among the HIV+ bisexual males (P<.05). Sexual Risk Behaviors-cont.

 HIV+ bisexual men more likely to report unprotected sex with seroconcordant male and female sexual partners compared to serodisconcordant male and female sexual partners. Sexual Risk Behaviors-cont.

 Highest rate of unprotected sex reported (23.1%) with self reported HIV disconcordant sexual partners was in the category of unprotected anal or vaginal intercourse with female sexual partner of unknown HIV status Sexual Risk Behaviors-cont.

HIV Status Disclosure  50 % of bisexual men did not always disclose to male sexual partners.  47% of bisexual men did not always disclose to female sexual partners.

 Little data exists to inform HIV prevention interventions about the sexual risk and disclosure behaviors of HIV+ bisexual men and MSMW and the unique implications for transmitting HIV to other male and female sexual partners. Recommendations

 Prevention educators need to consider that HIV+ bisexual men may be very likely to have unprotected sex with female partners of unknown HIV status.  Programs need to impart communication and disclosure skills, especially with female partners. Recommendations-cont.

 Prevention programs should also address substance use issues as well as adherence to HIV medications. Recommendations-cont.

 Prevention efforts should focus on the potential for STD co-infection and possible HIV reinfection among HIV+ bisexual men and their HIV+ male and female sexual partners.

 Complex cultural factors and sexual scripts among particular racial/ethnic groups and in specific geographic context need to be examined to elucidate the HIV risk practices of HIV+ bisexual men and MSMW.  Future research on HIV+ bisexual men and MSMW needs to examine associations between such factors and risk behaviors. Research Agenda

Summary  With the high rates of unprotected sex and low rates of HIV disclosure reported there is an urgent need to focus immediate prevention efforts on this population.  More research is needed to understand contextual factors mediating such behaviors among varied sub-populations.  Self identified bisexual men and MSMW who are living with HIV and AIDS need to be considered as unique groups in particular social, cultural and geographic contexts.

 More quantitative data needed to identify predictors of risk among self-identified and behaviorally bisexual males.  Qualitative data need to identify contexts of sexual risk and HIV disclosure behaviors among these populations.  Such efforts will help curb the continuing spread of HIV and STDs among bisexual men, MSMW and their sexual partners. Summary