The extent of bisexual behaviour in HIV-infected men and implications for transmission to their female sex partners

TLDR

Heterosexual HIV transmission is increasing among women, yet many are unaware of their partners’ acquisition routes. The study examined HIV‑infected men and women to assess men’s bisexual behavior and the proportion of women who reported bisexual male partners. Researchers conducted a cross‑sectional interview of 5,156 MSM and 3,139 women from 1995 to 2000. Among MSM, 34% of black, 26% of Hispanic, and 13% of white participants reported sex with women; 14% of white women, but only 6% of black and Hispanic women, acknowledged bisexual partners; most bisexual men identified as bisexual (59%) or homosexual (26%), and 30% of MSM/MSW had more female than male partners, indicating bisexual activity is common among black and Hispanic HIV‑infected MSM and may be unknown to their female partners.

Abstract

Heterosexual transmission of HIV is a growing problem for women, but many women do not know how their partners acquired HIV. We described a group of HIV-infected men and women, and focused on: (1) sexual identity and bisexual behaviour in men, and (2) the proportion of women who acknowledged having a bisexual male partner. This study examined HIV-infected persons who participated in a cross-sectional interview project from January 1995 through July 2000; 5,156 men who have sex with men (MSM), and 3,139 women. The proportion of MSM who reported having sex with women (MSM/MSW) varied by race: 34% of black MSM, 26% of Hispanic MSM, and 13% of white MSM. While 14% of white women acknowledged having a bisexual partner, only 6% of black and 6% of Hispanic women reported having a bisexual partner. Most behaviourally bisexual men identified as either bisexual (59%) or homosexual (26%). Among MSM/MSW, 30% had more female partners than male partners, while only 10% had more male partners than female partners. These data suggest that bisexual activity is relatively common among black and Hispanic HIV-infected MSM, few identify as heterosexual, and their female partners may not know of their bisexual activity.