Bisexual men and condom use at last sexual contact: Results from a national survey

Introduction: Epidemiological studies suggest that bisexual men, due to inconsistent condom use, are at high risk for HIV and other sexually transmitted infections (STIs). Risk behaviors that mediate bisexual men's condom use include intravenous drug use (IDU), sex work, engaging in sex while using substances, and having multiple sexual partners. Yet, little is known about condom use among bisexual men as distinct from homosexual and heterosexual men. Moreover, previous research on bisexual men has relied on non-probabilistic, high-risk samples with limited generalizability.

Methods: We used the 2002 cycle of the National Survey of Family Growth, a nationally-representative, area probability sample of 4,928 men. We operationalized behavioral sexual orientation based upon the gender(s) of sexual partners in the past year. Using only weighted data, we performed bivariate and multivariate logistic regression analyses.

Results: Bisexual men had significantly more IDU, sex work, sex while using substances, and sexual partners than heterosexual and homosexual men. However, bisexual men did not report using condoms less than other men. Indeed, with female partners, bisexual men reported higher rates of condom use than homosexual and heterosexual men did with their male and female partners, respectively. The relationship between sexual orientation and condom use persisted when race/ethnicity, age, marital status, socioeconomic status, sexual identity, and risk covariates were controlled.

Discussion: Our study suggests that caution should be taken when using non-probabilistic samples to examine condom use among bisexual men. We discuss the implications of our study for HIV/STI prevention among bisexual men in the United States.