Corey Prachniak is an LGBT rights, HIV policy, and healthcare attorney. He serves on the Steering Committee of the Network for LGBT Health Equity and tweets @LGBTadvocacy.
This is a series of posts covering Corey’s work in Puerto Rico for the Salud LGBTT conference.
Earlier this week, before coming to Puerto Rico, I gave a presentation on diversity within the LGBT community – and how we can protect and strengthen that diversity instead of trying to homogenize the community or focus on assimilating into non-queer social structures. One issue that’s being highlighted here at the Salud LGBTT conference in San Juan is bi health, which is an important topic given that bi people are often forgotten within the LGBTT community.
First, let’s start with terminology. Caleb Esteban, M.S., one of the presenters on this subject, states that (in my opinion, not unlike the trans community) there are many terms that bisexual people choose to identify as. Many prefer “bi” to “bisexual,” fearing that the latter overly sexualizes them – so that is the term that I will use in this post. Some prefer terms like heteroflexible or homoflexible. The ability to identify as one feels, and to have others respect and reflect back that identity, is one that we should all be able to relate to.
Bisexuals, he explains, find that they are met with judgment and a lack of knowledge when seeking medical care. People think that bisexuals are transitioning to homosexuality, are sexually and/or emotionally immature, and not people with a unique and complex orientation of their own.
And this mentality is not limited to heterosexual, cisgender people, according to the second presenter, Miguel Vázquez Rivera, PsyD. Rather, bisexuals face “double discrimination” – they are discriminated against not only by heteronormative society but also by others within the LGBT community.
One concern with bi women is that they believe sex with other women is not risky, which is not the case. The medical community does not know enough about these issues, especially with respect to the bi community, to effectively communicate preventative health strategies for bi women or to properly manage their care with the right types of screening and monitoring.
He explains that the bisexual community, compared to gays and lesbians, have higher rates of depression, anxiety, suicide, use of alcohol and drugs, and experiences of violence. This partially results from the lack of knowledge by healthcare providers, and is exacerbated by this problem.
Bi people are also more likely to identify as polyamorous. 33% are in polyamorous relationships, and 54% see this as the ideal for them, Dr. Vázquez Rivera says. This has an impact on all areas of their health and requires an extra level of competence and understanding by providers and those working in the public health field. This understanding is often hard to find, and this dual status as a sexual minority (both bi and poly) compounds discrimination and incompetent provision of care.
Elle Auguston, one of the Georgetown Law students who has been helping me research LGBT health policy this year, found research from a 2010 study in Washington State establishing that bi women, compared to Lesbian women, have higher rates of poverty and lower rates of insurance coverage. So not only do bi people have unique healthcare needs that providers do a poor job meeting, but they have a harder time receiving care at all.
So, according to Dr. Vázquez Rivera, the path forward is a combination of training medical professionals, ending biphobia (perhaps starting within the LGBT community), and ensure that data collection and programming recognize the distinctiveness of the bi community. Sounds to me like a good way to tackle disparities!
Stay tuned to the Network blog and my twitter account, @LGBTadvocacy, for lots of live coverage of the summit!