News release

From: Kirby Institute, UNSW Sydney

Australia’s first study of bi+ people’s sexual health uncovers critical gaps

An Australian-first survey has found that bi+ Australians experience significantly poorer sexual health and safety outcomes than the general population despite being highly engaged with healthcare.

Findings released today by the Kirby Institute at UNSW Sydney provide the most detailed picture to date of sexual health, relationships, and experiences with sexual healthcare services among bi+ Australians.

The report, which analyses data from over 2100 bi+ Australians, reveals an incredible diversity of experiences of bi+ people. For example:

• Cis bi+ women had higher levels of engagement with healthcare, but also higher rates of illicit drug use, sexual violence perpetrated against them and STI diagnoses.

• Trans and non-binary/gender diverse bi+ participants tended to feel more included in and engaged with LGBTQ+ communities but also reported higher rates of sexual violence perpetrated against them, and poor mental health.

• Cis bi+ men were less likely to be connected to LGBTQ+ community and sexual healthcare in general.

“Bi+ Australians are the largest population group in the LGBTQ+ community, yet their experiences have been consistently overlooked,” says UNSW Associate Professor Benjamin Bavinton, chief investigator of the Bi+ Sexual Health and HIV (BiSHH) study, who led the research. “Our findings reflect a diverse and engaged population. However, across many measures, bi+ people experience poorer sexual health and wellbeing outcomes compared to the general population.”

Bi+ is a community-developed umbrella term used to describe sexual identities that are characterised by attraction to more than one gender. Common identities under the bi+ umbrella include bisexual, pansexual, queer, fluid and many more. Until now, very little has been known about this growing population’s sexual health needs and experiences.

“The findings from this survey reflect both shared experiences and diversity among bi+ people in Australia and point to an urgent need to recognise bi+ Australians as a distinct population with specific health needs,” says A/Prof. Bavinton. “The more we understand about people with bi+ identities, the better equipped we are to challenge historical and harmful stereotypes, combat stigma, and design better health services.”

High engagement with health services, but services don’t reflect bi+ needs 

According to the survey, 36% of bi+ participants had ever been diagnosed with an STI, more than double the estimated lifetime STI prevalence in the general Australian population (around 16%), indicated in other research.

Nearly nine in 10 bi+ people living in Australia have accessed sexual healthcare at least once in their lifetime. Yet only half felt comfortable discussing sexual health with care providers and fewer than half felt clinics were inclusive or knowledgeable about bi+ people. Fewer still (one in six) felt they received relevant bi+ information.

These gaps are also evident within LGBTQ+ focused sexual health services, in which half of participants felt LGBTQ+ sexual health services could be more bi+ inclusive, and a quarter had chosen not to use or avoided using an LGBTQ+ service in the past.

“These findings show that bi+ people are engaging with healthcare, but systems are not meeting them where they are. Healthcare services tend to assume you are either gay or straight by default which can make many bi+ people feel invisible in these services,” says Bella Bushby, a bi+ woman and PhD Candidate at the Kirby Institute, UNSW, and project coordinator of the study.    

Cis bi+ men experience significant barriers to appropriate healthcare 

Bi+ men experience consistently poorer outcomes than other members of the bi+ community across comfort, inclusion and engagement with services.

Cis bi+ men report higher rates of casual partners, group sex, and condomless anal sex. At the same time, they are least likely to feel comfortable talking about sexual health, least likely to feel included in LGBTQ+ or bi+ spaces, less likely to disclose sexuality to clinicians and less likely to have accessed sexual healthcare at all.

Steven Spencer, vice president of the National Association of People with HIV Australia, is a bi+ man, and co-investigator on the study. He says “bi+ men have a high need for inclusive sexual health care but are least likely to feel supported accessing it.

“This is particularly concerning because bi+ cis men face historical stigmatisation as being a bridge for HIV transmission from gay to heterosexual communities. It’s essential that services do a better job to create non-stigmatising healthcare access for bi+ men.”

Experiences of sexual violence high among bi+ people

63% of bi+ participants reported experiencing sexual violence since age 18, more than four times the general Australian population. Experiences of sexual violence were highest among cis bi+ women, followed closely by trans and non-binary and gender diverse bi+ people.

• Cis bi+ women were more than three times as likely as women in the general population to have experienced sexual violence perpetrated against them.

• Trans men, trans women, and non-binary/gender diverse bi+ people were more than 4.5 times as likely to have had sexual violence perpetrated against them than the general population.

• Cis bi+ men were half as likely to have had sexual violence perpetrated against them compared with bi+ people of other genders in the study, but their reported experiences were still over five times higher than in the general male population.

“These findings highlight the urgent need to recognise bi+ people as a priority population within sexual violence services and responses,” says Emily Goodnow Bjaalid, bi+ woman, co-investigator on the study and PhD Candidate at the Australian Research Centre in Sex, Health and Society, at La Trobe University.

Additionally, 28% of bi+ participants met the threshold for probable serious psychological distress, more than double the rate in the general Australian population (17%) observed in other studies. Rates were even higher among trans and non‑binary bi+ people.

Bi+ and LGBTQ+ community connection 

Many bi+ people experience biphobia from both straight and gay/lesbian communities. Only half of respondents were out to their families, and only 15% were out at work.

Many participants shared that connection to community spaces that recognised and accepted their bi+ identity were highly valued in their lives.

Participants were most likely to be out to other bi+ people and feel included in bi+ specific spaces, followed by LGBTQ+ people and mixed LGBTQ+ spaces and were less likely to be out to heterosexual people, family, colleagues and health professionals or feel comfortable in heterosexual spaces.

“We know that connection and belonging increases the likelihood of bi+ people seeking and receiving relevant sexual health information, so it is essential to increase the visibility of safe spaces and networks for this community. As it stands, there is a significant gap in bi+ inclusion within sexual health services including LGBTQ+ focused ones. The results from this survey show a need for greater understanding and inclusion of bi+ communities within these settings,” says Bella Bushby.

Survey a major achievement for bi+ information and collaboration 

The BiSHH study was developed by the Kirby Institute at UNSW Sydney in close partnership with the Centre for Social Research in Health at UNSW, the Australian Research Centre in Sex, Health and Society at La Trobe University, the University of Sydney, bi+ community, and with strong support from allies. A bi+ Community Advisory Group co-developed this research and was actively involved throughout design and analysis of the study.

“The BiSHH study confirms what we have long anecdotally known about bi+ communities in Australia. We are diverse in age, gender and relationships, and come from all walks of life,” says UNSW Professor Christy Newman, a bi+ non-binary person and co-investigator on the BiSHH study. “It’s particularly affirming to see these outcomes from a survey deliberately designed to be inclusive of the diverse ways bi+ people identify and connect to others through relationships and sex.”