Bisexual Men Who Use the Internet to Seek Sex with Other Men: Demographic Characteristics and Sexual Risk Profiles

Background and Purpose: While seeking sex on the Internet may be associated with HIV risk for some men who have sex with men (MSM), little is known about HIV risk and sexual health seeking for bisexual-identified men. We examined: 1) demographic, testing, and behavioural differences between bisexual and other-identified MSM, and 2) condom use during last anal sex among bisexual men.

Methods: From December 2013 to January 2014, MSM aged 16 or older were recruited from Internet sites, mobile-apps, and AIDS service organizations across Ontario to complete a 15-minute anonymous online questionnaire. Eligibility criteria included being at least 16 years of age, living in Ontario, and having had sex or interest in having sex with another man. This online survey examined a number of domains related to online use, sexual health information, experience with online outreach, and demographics. Chi-square and multivariable logistic regression tests were used to assess differences between bisexual-identified MSM and other-identified MSM (e.g., gay, queer). Multivariable logistic regression was conducted to assess associations with condom use during last male anal sex event among bisexual men. 

Results: The survey included 1830 MSM. Of these MSM, 24.0% (n=438) self-identified as bisexual. Bisexual MSM were less likely than non-bisexual-identified MSM to: 1) be HIV-positive (2.4% versus 9.9%; OR=0.23, 95%CI:0.18-0.43), 2) live in the largest major metropolitan area in the province (12.1% versus 34.9%; OR=0.26, 95%CI:0.19-0.35), 3) have a bachelors degree (26.1% versus 43.5%; OR=0.36, 95%CI:0.26-0.51), and 4) have temporary immigration status (2.1% versus 5.3%; OR=0.38, 95%CI:0.19-0.76). There were no differences by racial/ethnic identity (p=0.11). Bisexual men used different websites and mobile apps; they used Squirt (81.7% versus 56.3%; OR=3.47, 95%CI:2.66-4.52) and Craigslist (49.1% versus 40.5%; OR=1.42, 95%CI:1.14-1.76) more, and Grindr less (28.1% versus 68.7%; OR=0.18, 95%CI:0.14-0.23). Bisexual men were less likely to have received sexual health information online (75% versus 85.3%; OR=0.49, 95%CI:0.38-0.64) and to have recently tested for STIs (45.4% versus 65.3%; OR=0.44, 95%CI:0.35-0.55). Bisexual men were more likely to report condom-use during their last male anal sex (65.7% versus 59.2%; OR=1.32, 95%CI:1.02-1.72). Among bisexual men, the only significant predictor of event-level condom use at last male anal sex was substance use (OR=0.50, 95%CI:0.29-0.88). 

Conclusions and Implications: Bisexual men who use the Internet to seek sex with other men may exhibit distinct sexual risk behaviours (decreased rates of STI testing, less sexual health information sought online, increased condom use) compared with other MSM. Social work researchers should pay attention to differences in the sexual health risk profiles of bisexual men who use the Internet to seek sex with other men. Given than bisexual MSM represent a different demographic and may have different health promotion needs compared to other MSM, future social work research should investigate the relationship between HIV risk and sexual health information seeking for this population. In an effort to effectively provide culturally sensitive online outreach services to bisexual MSM, social workers must also attend to the unique experiences of these men, in order to engage them in sexual health education, HIV prevention, and health promotion.