Brian Feinstein on Nuance and Resilience in Bisexual Male Youth Health Research

Brian Feinstein, Ph.D., is a research assistant professor at the Institute for Sexual and Gender Minority Health  and Wellbeing (ISGMH). Feinstein’s research focuses on understanding and reducing the health disparities affecting sexual and gender minority populations, especially bisexual and other non-monosexual individuals. He is currently the principal investigator on the Bi+ Youth Project at ISGMH.

We sat down with Feinstein to discuss his research on bisexual male youth, the importance of speaking about the positive aspects of being bisexual, and how the National Institutes of Health is supporting research on bisexual populations.

Much of your current research centers on health disparities among bisexual male youth. Why did you choose to focus on this population, and what have you learned so far?

I started doing work focused on bisexual male youth and sexual health because there’s been a lot of research on HIV prevention among young men who have sex with men (YMSM), but historically this research hasn’t distinguished between men who identify as gay and men who identify as bisexual. We’re now starting to see that there are meaningful differences between those two groups. For example, we know that bisexual men are less likely to get tested for HIV, less likely to use PrEP as prevention for HIV, more likely to engage in certain risk behaviors, and more likely to use substances before/during sex compared to gay men. Overall, we know that bisexual men have sexual health concerns with unique risk factors, but most HIV prevention interventions are designed for gay men. These interventions typically focus on risk and prevention related to sex with cisgender men, and they do not provide sufficient detail on risk and prevention related to sex with partners of other genders. Furthermore, they typically do not mention or address bisexuality, including the unique ways in which it is stigmatized and the range of sexual health needs among bisexual people (e.g., pregnancy prevention).

On top of that, very little research focuses on bisexual youth specifically. I wanted to get a better understanding of young bisexual boys in high school, what they deal with, what their unique concerns are, and how can we teach them what they need to know about sexual health before they start having sex. I’ve been working on adapting an online intervention to teach bisexual boys ages 14 to 17 what they need to know to have safe and healthy sexual and romantic relationships, how to embrace their sexuality, and how to feel comfortable with their sexuality. I don’t want to just focus on risk and HIV prevention, but also on the stigma and discrimination bisexual people face. I want to explore how we can teach youth to embrace their sexuality, feel comfortable coming out to people if they want to, and meet other people like them.

What makes researching and reaching out to bisexual youth particularly important today?

We see that more and more people are coming out as LGBTQ in some way at earlier ages, particularly high school youth identifying as bisexual. It’s a group that’s becoming more visible, which means the need for this research will become even greater when it comes to trying to instill healthy behaviors, prevent problems, and give people the skills and information they need to be healthy earlier on rather than waiting until they engage in risky or problematic behaviors. Adolescence is, in a lot of ways, the perfect time to address sexual health issues because young people are starting to explore their identity, have sex, date, and form relationships. It’s the prime time to teach young people how they can do all of this safely.

Your research looks at individuals who identify as bisexual, not just those who have sex with partners of different genders. How does that differ from how research on bisexual people has been done before?

Almost all research on bisexual men takes the perspective of looking at behaviorally bisexual men, which only looks at men who have sex with men and women, regardless of whether those men actually identify as bi or not. There are large groups of bisexual men, including adolescents, who aren’t being reached by the work that’s being done. It’s important to focus on the behaviors that people engage in, but we must also be aware of the challenges that people face when they identify as bisexual and their needs for finding community and affirmation. With the Bi+ Youth Project, we’re focusing on adolescents who identify as bi, pan, or queer (which we refer to as bi+), regardless of what behaviors they’ve engaged in. Some participants have never had sex, some have had sex with male partners, female partners, and/or partners of other genders or with non-binary identities.

My overall message is that we as a health research field need to include and focus on the experiences of young bisexual men who have unique health needs, yet are rarely the focus of this work. Their voices need to be heard so interventions can be designed with them in mind. We have the opportunity to fill this research gap, and I hope my work and the work of everyone involved in researching young bisexual men can help to address these issues.

What role does resilience or positivity play in the health interventions you are developing for bisexual youth?

We don’t want to only focus on the health disparities affecting bisexual people, but also what’s positive about belonging to this community and how to embrace and affirm that identity. I think this is important for everyone, but particularly the bisexual community. We know from this research that bisexual men are less likely to be open and disclose their sexuality compared to bisexual women. Attitudes towards bi men tend to be more negative than attitudes towards bi women as well. That’s why this is an important group to be communicating messages of positivity towards. We want to help them with their heath, sex, and relationships, but we also want them to know that they’re valid as people. Being bi—being a bi man—is something you can feel proud about.

We have only recently started to see greater interest in funding research on bisexual health. Can you speak about how the National Institutes of Health (NIH) is supporting this research?

Historically, bisexual health has been a difficult area to research because of limited resources, but we are seeing a recent positive shift with the NIH. It’s important to have the backing of the NIH because so much research in general, including the Bi+ Youth Project, is funded by them. In September of 2019, the NIH hosted the inaugural Bisexual Health Research Workshop, which aimed to bring together experts in the field of bisexual health research and members of bi+ communities to discuss what we know, the gaps in knowledge, and initiatives to advance this line of work and improve bisexual people’s health. I attended the meeting together with my ISGMH colleagues Dr. Lauren Beach and Dr. Christina Dyar. Prior to this meeting, only a small number of NIH-funded projects focused specifically on bisexuality. This meeting was the start to messaging within and outside of the NIH, who fund most health research in the U.S., that bisexual people as a population experience health disparities and are worthy and deserving of research focused on them. This is particularly meaningful because, in the recent past, some researchers have experienced biphobia even in the grant review process, which has prevented good ideas from getting funded. This meeting was huge because it shows the NIH is shifting how they’re thinking and is building internal knowledge on this topic to support and fund future research.

Further Reading

Meeting the Sexual Health Needs of Bisexual Men in the Age of Biomedical HIV Prevention: Gaps and Priorities
Brian A. Feinstein, Brian Dodge 

The Positive Aspects of a Bisexual Self-Identification
Sharon Scales Rostosky, Ellen D.B. Riggle, David Pascale-Hague, LaWanda E. McCants