Bisexuality and HIV Risk: Experiences in Canada and the United States

This is an Accepted Manuscript of an article published by Taylor & Francis Group in the Annual Review of Sex Research, available online: http://tandfonline.com/doi/abs/10.1080/10532528.1997.10559920The human immunodeficiency virus (HIV) epidemic has presented unparalleled challenges to sex researchers. Investigators have sought to understand a range of sexual behaviors and have scrutinized their roles in disease transmission. Opportunities have also emerged for developing and evaluating large-scale behavioral interventions to facilitate sexual risk reduction. In this article, we examine a topic of interest to sex researchers and HIV prevention programs, namely the relationship between bisexual behavior and HIV risk. We have gathered the theoretical and empirical literatures from two countries, Canada and the United States, permitting us to describe diverse experiences in countries in which variations in demographics and social norms as well as prevention programs may have consequences for the prevalence and contexts of bisexual behavior and for HIV risk. We begin our article with a review of the theories of bisexual behavior and a critique of methods used to study these populations. These sections provide a foundation for interpreting the empirical literature and for understanding the limitations of research related to HIV risk. We then provide for each country and for each gender a brief overview of data on the prevalence of bisexual behavior, HIV prevalence and AIDS cases, and the prevalence and determinants of HIV risk behaviors. We also review the emerging findings on prevention approaches for each population. Our review ends with a synthesis of the data across countries and genders and a proposed research agenda to increase our understanding of bisexual behavior and HIV risk among men and women who engage in sexual behavior with both genders