| Your
foot has been sore for a week and your insurance
recently changed, so you make an appointment
to see a doctor for the first time through
your new HMO. You tell the physician you're
here about your foot, but in the process
of taking an extensive initial medical history,
she learns you're bisexual. Suddenly, all
she wants to talk about is an HIV test.
You tell her you had a negative one recently
at your last doctor's, but she spends the
rest of the visit trying to get you to sign
the consent form for another. When you limp
out, nothing has been done about your aching
foot.
Should you even tell
your doctor that you're bisexual? Some bisexual
patients don't tell their primary care providers
about their sexual practices, choosing instead
to go to free public clinics when sexual
health issues arise. "I do discuss
sexual matters with my regular doctor,"
says former BiNet USA President Barry Saiff,
"and sometimes use his services. But
at other times, for STD screening and so
on, I go to a public health clinic that
specializes in that kind of thing."
"I usually get
my STD tests done at public health clinics,"
says Paul Mobbs of San Francisco. "They
tend to be cheap, somewhat anonymous, don't
require appointments, and often have specialists
who deal with health-related issues."
But is having two sources of medical care
always the best option for bisexual people?
"In a small town
like where I practice, everybody knows everybody
else's business," says Marlene Sachs,
an internist in rural Vermont. "People
tell you what they can, but they can't tell
you everything. And not all doctors can
handle such disclosures in the best way.
I have a colleague who's a great doctor,
a really good physician. But he's Catholic,
and he has a hard time getting his mind
around the idea of sex between men."
Maryland family practitioner
Len Raucher thinks going to a separate clinic
for sexual health issues can dangerously
fragment your care. "The free health
clinic may be treating problems that could
be in conflict with other problems you're
being treated for by your regular doctor,"
says Raucher. "If one person doesn't
know what the other is doing, there's no
way of knowing drug X interacts with drug
Y. It's always best to be getting all your
care in one place if that's possible."
Dr. Charles Moser, author
of Health Care Without Shame: A Handbook
for the Sexually Diverse and Their Caregivers,
writes: "You must tell your health
care practitioner about any sexual behaviors
that might be affecting your health. He
cannot provide you with an acceptable level
of care if he doesn't have enough information
to do so."
It's actually up to
the doctor to get a relevant sexual history,
points out Fritz Klein, a psychiatrist and
author of The Bisexual Option. "So
it's not a question of, 'should you be open?'
It's the job of the doctor to take a good
history." A doctor who is not comfortable
with bisexuality, however, may not be able
to elicit an adequate history or give the
best care. Cheryl Dobinson, a Toronto bisexual
activist and author of a study on health
care services for bisexuals in Ontario (see
the resource list at the end of this article),
had an unpleasant experience when she was
honest about her sexuality with a caregiver.
"I had a health
provider who just didn't get it," says
Dobinson. "He couldn't grasp that bisexuals
could be monogamous, and also asked things
like, 'What do you think you can get from
women that you can't get from men?' Yuck.
I didn't continue treatment with him for
long." In her study she mentions another
bisexual patient who felt uncomfortable
after coming out to a provider who joked,
"the more the merrier."
How easily you can find
a doctor who is sensitive and nonjudgmental
about your bisexuality may depend on where
you live. Many large cities have public
health clinics where the staff specializes
in providing safe, supportive, confidential
health care to sexual minorities. One such
clinic is the Fenway Community Health Center
in Boston, Massachusetts. "We do HIV
prevention and education, safer-sex outreach
and safer-sex counseling," says Julie
Ebin, the manager of Fenway's Bi Health
Program. "We also run a Bi and BiCurious
Men's Support Group." Fenway has GLBT-sensitive
therapists as well as physicians, and their
Bi Health Program is a model for others
like it in many major cities.
In a small town, you
may have to depend on word of mouth to lead
you to a doctor with a reputation for being
nonjudgmental about her patients' sexuality,
like Sachs in Windsor, Vermont. Dobinson
says the best way for a person in Canada
to go about finding a physician sensitive
to bi issues is "through referrals
from bi friends or other bi people or groups."
Mary Smith of Fremont, California, got such
matter-of-fact, sensitive care from her
physician that she recommended her to other
bi friends. "Dr. Miller said, 'Are
you sexually active?' I said yes. She said:
'Men? Women? Both?' I said: 'Wow, um, both.
I'm amazed you asked. I've never been asked
"both" before.'"
Mary's friend Joe Decker
now goes to see Dr. Miller, too. "Being
able to be at ease about my relationships
and sexuality really makes health care work
better for me," says Decker. "There's
no incentive to hold back information that
might be important."
Briana Cavanaugh of
Oakland, California, chose her obstetrician-gynecologist
partly because she heard she was good with
queer issues. "I hadn't realized it
could be this easy. I just told her that
I slept with men and women and that I'm
not monogamous, and she didn't flinch,"
said Cavanaugh. "I was impressed and
recommend her to all my friends."
Klein, Ebin and other
experts recommend interviewing potential
health care providers to screen out biphobia.
"If you're willing to put on your educator's
hat, it's a great opportunity to educate
your health care provider and make them
more aware and sensitive," says Marshall
Miller, the former manager of Fenway's Bi
Health Program and an independent consultant
on bisexual health issues. "If you
live in a small town, though, and you're
not out and it's not safe to be out ...
well, you have to make decisions based on
your own safety and privacy and what's ultimately
going to give you the best care."
Several organizations
have Internet-based referral lists for health
care providers sensitive to the needs of
sexual minorities (see resource list). However,
keep in mind that being friendly to one
sexual minority doesn't make a physician
necessarily sensitive to another. Raucher,
in fact, suspects homosexual physicians
as a group may be even more discriminatory
toward bisexuals than heterosexual physicians.
"There are a number of people in the
homosexual community who believe that there
really isn't bisexuality, that if you are
bisexual it's because you are seeking society's
favor or that you haven't made your mind
up yet," he explains.
It may still be best
to ask a doctor or a therapist from a GLBT,
kink or poly list, as Ebin recommends: "Do
you have bisexual clients? How comfortable
are you with your bisexual clients?"
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It's
always good to have a nonjudgmental doctor,
but why else might bisexual patients need
their doctors to be educated about bisexuality?
Health educators Ebin and Miller point out
that with respect to health, it may be better
to focus on behaviors than on identity.
Plenty of people who identify as lesbian
or gay have sex with people of the opposite
sex, while people who identify as bisexual
may or may not be having sex with same-sex
partners at any given time. One bisexual
man was turned away as a blood donor even
though he had been in a monogamous relationship
with a woman for years and had recently
tested negative for HIV. Another was subjected
to an extensive and invasive work-up for
STDs (that included drawing blood) only
after he admitted he was bisexual, even
though he repeatedly told his doctor that
his physical experience with men at the
time was limited to a little mutual masturbation.
"I learned a valuable
lesson," says Randy Ray. "Don't
tell the doctor, unless you've fucked another
man fairly recently. It's just not worth
the hassle."
Everyone, say the health
educators, deserves safer-sex education
that doesn't make assumptions about whom
they may be having sex with. Fenway Health
distributes nationally a brochure entitled
Safer Sex for Bisexuals and Their Partners,
the contents of which are almost identical
to their more general brochure simply entitled
Safer Sex. "If you as a doctor put
the bisexual brochure on your rack,"
says Miller, "you're telling your patients
who identify as bisexual, or who are questioning
whether or not they might be bi, that you're
comfortable with the topic. You're sending
the most subtle yet very direct nonverbal
message that you're aware that bisexual
people exist and that's something you're
willing to discuss."
Many of the health issues
for men who have sex with both men and women
are the same as those for men who have sex
only with men. According to Ebin, Fenway
Health screens both groups for HIV and other
STDs such as syphilis, gonorrhea and herpes.
Both groups also should be vaccinated against
Hepatitis A and B. People who engage in
receptive anal sex, she says, should have
an anal pap smear for HPV (Human Papilloma
Virus), the virus which causes venereal
warts and which can also contribute to anal
cancer in men and cervical cancer in women.
Raucher also screens bisexual and gay men
in his practice for Hepatitis C, a disease
that is only very rarely transmitted sexually
and then only when there is blood-to-blood
contact. There is no vaccine for Hepatitis
C, but treatment is available in the form
of alpha-interferon.
Bisexual women, depending
on their activities and partners, may also
need safer-sex counseling, STD screening,
birth control, abortion counseling, prenatal
care or help with infertility. Dobinson's
Ontario study quotes a bisexual patient
who told her doctor that she was seeing
a woman. "A few months later I came
in and said I needed the morning-after pill.
She put her pen down and said, 'I thought
you told me you were a lesbian.'" Another
patient in the same study says: "I'm
afraid to go see my doctor and ask to go
on the pill. I had been planning to have
children with my last partner through donor
insemination. He'll raise his eyebrows ...
going from fertility drugs to birth control."
Another worry for bisexuals
who are polyamorous or have same-sex partners
is whom the medical system considers your
family. Who is allowed to visit you in the
hospital? Who gets medical information,
and who is involved in decisions about your
care? According to Miller: "The Joint
Commission on Accreditation of Health Care
Organizations (JHACO, pronounced 'JAY-co')
now has standards saying that the definition
of family may include people who are not
related to the patient by blood or marriage.
Lambda Legal offers excellent information
online about how to hold hospitals accountable
to the standards set by their own accrediting
organization." (See resource list.)
You can protect yourself and your partners
by telling your doctor or hospital whom
you consider family before you get ill,
by naming health care proxies, and by creating
durable powers of attorney.
The biggest health concern
for many bisexual women and men may be their
mental health. "These people are hurting,"
says Sachs. "They're not accepted either
by their straight or gay partners."
Klein agrees. "They're
not accepted by both communities. They're
hidden. Some of them are truly confused.
Some of them don't understand it. Some of
them think they're gay when they're really
not. They have very little support in general.
You know, you've got to live in a city like
New York or San Diego if you're going to
find any sort of bi support. If you're living
in Podunk, there is none."
Dobinson's study summarizes
the findings of several others regarding
emotional problems of bisexual youth: "In
terms of health risks, behaviorally bisexual
high school students are more likely to
report suicide attempts, drug use, unhealthy
weight-control practices, and experiences
of being harassed, threatened or injured
by others."
Luckily, therapists
as a group are probably ahead of medical
doctors in accepting bisexuals and bisexuality.
The American Psychological Association has
its own Committee on Bisexual Issues in
Psychology. Several major metropolitan areas
now have online referral bases of GLBT-friendly
therapists like San Francisco's GAYLESTA,
and the Bisexuality-Aware Professionals
Web site lists bi-friendly therapists in
twenty states in the U.S.A. as well as in
Canada and the Netherlands. Klein suggests
asking prospective therapists: "What
do you think about bisexuality? What experience
do you have with it in terms of doing therapy?
Have you had many patients along those lines?
Are you totally aware of what it means to
be bisexual?"
One piece of good news
is that identifying as bisexual and seeking
support from a bisexual community may improve
your mental health and decrease your health
risks. Mary Boulton's 1992 AIDS Care study
of behaviorally bisexual men in the United
Kingdom found that men who were in contact
with a bisexual community and who actively
identified as bisexual were more likely
to use safer-sex precautions with their
partners than were men who had sex with
both men and women but identified as straight
or gay.
Research and education
about bisexual health are both expanding.
The first Bi Health Summit was held in San
Diego in 2003, and the recent 8th International
Conference on Bisexuality in Minneapolis
offered a number of workshops in a Health
and Wellness Track. Medical schools are
now starting to offer more training to students
in the areas of sexuality and sexual health.
The large American Health Maintenance Organization
Kaiser-Permanente has distributed A Provider's
Handbook on Culturally Competent Care for
the Lesbian, Gay, Bisexual and Transgendered
Population to its health care providers.
Check out the resources below, stay in touch
with your bisexual community online and
off, and you may be taking your biggest
step toward better health. |
