By Leanne Cusitar
When was the last time you went to the doctor for a check-up or got your teeth cleaned?
Do you get regular STI and pap tests? Prostate exams? Mammograms?
Do you practice testicular or breast self-exam?
If you’re shuffling your feet and hoping I don’t call on you for fear I’ll make you tell us all just how very long it’s been, never fear. You’re in good company.
Research shows many bi folks don’t seek health care for themselves or their families for fear they’ll encounter discrimination, including being denied service, humiliated or otherwise stigmatized. When we do use services, many of us don’t mention we’re bi, both for the reasons stated above and out of concern we’ll be outed. In parts of the world where same sex contact is still illegal, being open about your bisexuality can lead to beatings, imprisonment or death.
It’s All About the Determinants of Health, Baby!
So how exactly does being bisexual make accessing health services different than if we were straight? Or, for that matter, lesbian or gay?
As bisexuals, we live in societies designed to maintain and promote the status quo – which of course means keeping those with privilege in power. Those of us who are also poor, immigrant, transgendered/transsexual, people of colour, or some other combination of marginalised identity grow up surrounded by inequality and discrimination based on all of these identities. From the time we’re children we’re told, based on these different elements of who we are, that we’re deviant and somehow ‘less than’ the more mainstream folks around us, be that at school, in our places of worship, or when we lose our jobs, housing or access to our children. Most of the barriers to health services we encounter, much why we’re unhealthy in the first place, can be traced back to the influence of the determinants of health.
Mainstream (a.k.a. Straight) Health Services: It’s All About Myth Management
The barriers bi folks encounter when seeking services in mainstream society fall neatly into the same tired old myths we already dealing with every day:
Bisexuality doesn’t really exist: This means it’s okay if to assume we’re straight and to not bother checking if we have same sex partners. It also saves them the bother of locating and making available bi-themed posters, pamphlets or information, or to develop inclusive medical history forms or policies. Of course, this myth wouldn’t have anything to do with the research that indicates bi folk are less likely than gays and lesbians to come out to their health care providers, would it? Or that one primary barrier we encounter is accurate information on safer sex with both male and female partners?
Bisexuality is no different than being straight: When we do come out to our doctors, their discomfort is often crystal clear. Bi men are told ‘use a condom’, where women get either the ambiguous ‘be safe’ or, more likely, the assumption that whatever we’re doing can’t be dangerous because it’s not really sex, so there’s no need to discuss safer sex. Further discussion about the complexities of bisexuality as it relates to our ability to maintain our health is, sadly, often out of the question. There are some exceptions to this rule, however. Sam recalls seeing a straight doctor for the first time and expecting to have to educate her about safer sex with women, only to find the opposite was true. “She knew stuff I didn’t know, like about Hepatitis and safer fisting. And she wasn’t the least bit embarrassed, either!”
Bisexuals are promiscuous: Even if we say we’re monogamous, don’t believe us – everybody knows bisexuals are incapable of being faithful to one person at a time – their sex drive is way too high! After all, if they weren’t having sex with both men and women they wouldn’t really be bi, would they? Bi women, who are already hypersexualized in our society, often have to contend with inappropriate comments and voyeuristic questioning regarding their sex lives. Maria was shocked when “one doctor even asked which I liked better, women or men. How creepy is that?”
Bisexuals are diseased: Bi men have been called the ‘bridge’ for HIV transmission from gay men to the straight communities (a theory that was largely unfounded), making them not only vectors of disease but also dangerous to their female partners. Kory got into an argument with a doctor who refused to believe she always had safer sex. “She just kept saying, ‘now, everybody slips up now and then, let me do an STI test just in case’, but I kept on saying no.”
Lesbian and Gay Health Services: Still More Myth Management!
So where can does a health-conscious bi peep go when they’re looking for the better way? For a lot of us, to lesbian and gay health services. While research indicates bisexuals are more likely to be happy with health services provided by the lesbian and gay community than those in the straight world, many gay and lesbian practitioners still hold outdated stereotypes about us:
Bisexuality doesn’t really exist: Dunstan remembers this attitude well. “I figured, hey, at least they wouldn’t freak out because I sleep with men. Instead I got a doctor who, when he heard I was in a relationship with a woman, asked why I was using their services when there were lots of doctors out there for ‘people like me’.” Of course there’s no such thing as a real bisexual. It’s just a phase on the way to coming out as gay or lesbian, a way to get some same-sex fun without giving up your heterosexual privilege or a quick walk on the wild side before fleeing back to the suburbs. It also means it’s fine for them not to stock bi-specific resources – after all, we are the ‘B’ in LGBT, a tacked-on afterthought to the issues of gays and lesbians, despite evidence that our health issues are quite distinct.
Bisexuality is no different than being gay or lesbian: It’s safe to assume that the experiences, concerns and priorities of we bi folk are interchangeable with those of your gay and lesbian patients. No need to educate yourself about the specific challenges for us, despite research indicating we experience higher levels of anxiety and depression than both straights and gay/lesbians. Or that we experience more current adverse life events, childhood abuse, have less support from family and friends and a higher frequency of financial problems. Not to mention some research suggests we’re at higher risk of both suicidal thoughts and attempts than both straights and gay/lesbians. And, of course, it’s fine to let your grasp on all things related to contraception slide cause everybody knows birth control’s not an issue in our community, right?
Bisexuals are promiscuous: Don’t believe bi folks if they tell you they’re in a long-term monogamous relationship, particularly if it’s with the opposite sex. Likwe remembers one STI counselor in particular. “He leaned forward like we were old buddies sharing a secret, winked and said ‘now hon, everything you say here is confidential. You and I both know there’s no such thing as a cock-loving guy who doesn’t go out and get a little on the side now and then’.” Sally was particularly upset at a doctor she went to see for the morning after pill six months after a checkup during which she’d been in a relationship with a woman. “The doctor acted like I’d deceived her somehow, even challenging me and saying ‘I thought you were a lesbian!’. I mean, life goes on, partners change!”
Bisexuals are diseased: Bisexual women are considered to be more likely to get and transmit STIs to their female partners as a result of having had sex with men. This despite ample evidence that STIs are already prevalent in the lesbian community, and are quite transmissible through girl on girl sex. Men, on the other hand, sometimes see the ‘bridge theory’ of HIVtransmission rearing its ugly head, as it did for Justin. “The nurse actually told me bi men gave the rest of the community a bad name by giving straight women HIV.”
Whither Access?
The answer is not an easy one, particularly since this struggle is far from over.
Many of us live in countries where our bisexual rights are only partially protected, if at all, and we may feel as though our search for equality is like pushing ice cream through a brick wall. If we’ve seen improvements in the bi competency of health care services we probably live in large cities located in countries where queer and other human rights protections are available.
Remember that change takes both time and determination. It can be as small as printing this article off and giving it to your doctor, midwife or local health centre.
Since most of us don’t face the death penalty for telling our health care providers we’re bi, I’d say that’s an excellent reason to join Amnesty International in protesting the treatment of those of us who do.
***
References:
A Positive Space Is A Healthy Place Making Your Community Health Centre or Public Health Unit Inclusive to Those of All Sexual Orientations and Gender Identities
www.opha.on.ca/resources/SexualHealthPaper-Jun06.pdf
Meyer, Ilan H.& Northridge, Mary E. (Eds.) (2007) The Health of Sexual Minorities: Public Health Perspectives on Lesbian, Gay, Bisexual and Transgender Populations. Springer.
Leanne Cusitar is a polyamorous femme gal who works as a sex educator, social worker and general rabble-rouser. One of the founding members of the Toronto Women's Bath House Committee, In all her spare time she writes, does performance, and tries to catch up on her sleep!
(c) Copryight 2006 Leanne Cusitar
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Re: Pushing Ice Cream Through a Brick Wall: The Search for Bi-Competent Health Care
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Re: Pushing Ice Cream Through a Brick Wall: The Search for Bi-Competent Health Care
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Rocsteady baby.... 
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