When Neutral Isn't Enough: New Research Into Stigmas Around Bisexuality

A recent study, which looked at attitudes toward bisexual men and women among adults in the United States, led by researchers at Indiana University's Center for Sexual Health Promotion, was published in the Journal PLOS ONE at the end of October.

Dr. Brian Dodge, who led the study, graciously agreed to a written interview with bi.org. He is an Associate Professor of Applied Health Science and Associate Director of the Center for Sexual Health Promotion at Indiana University Bloomington School of Public Health. He's also a nationally recognized expert on bisexual health issues and has leadership positions in the Bisexual Research Collaborative on Health (BiRCH), and in Bisexual Health @ IU.

Harrie Farrow: You set out to do a more thorough job than previous studies of looking at the attitudes adult Americans have towards bi people. What is the difference between your study's methods and those of the earlier studies that looked at these attitudes? 

Dr. Brian Dodge: Probability sampling, makes our study both unique and useful. This method gives us the rare ability to make generalizations to the broader U.S. population, which we can call then "nationally representative".  Because it is complicated and very costly to collect this type of data, most social research relies on "convenience sampling", in which participants are recruited where you are able to find them. This does not allow for generalizability.

Our data were collected as part of our ongoing National Survey of Sexual Health and Behavior (NSSHB), a large probability study that we have conducted regularly at the Indiana University Center for Sexual Health Promotion since 2009. Our ongoing survey is one of the most comprehensive nationally representative studies of sexual health and behavior because of the specificity and diversity of sexuality-related topics we are able to explore. Many other national surveys rely on very limited sexuality-related measures, like one-item asking, "did you have sex ..."?

Also, because of the generous support that funds our survey through the year 2020, we are able to work with colleagues each year who have special areas of expertise in new priority areas. For the 2015 wave of data collection, we were fortunate to work with colleagues who have expertise in bisexuality, bisexual health, assessment of attitudes, and population research in order to explore attitudes toward bisexual men and women in the general population of U.S. adults.

How do your findings compare to those of the earlier studies about attitudes towards bi people?

BD: Only one other study done in the U.S. using probability sampling, conducted by Dr. Greg Herek in the mid-1990s, included an assessment of social attitudes toward a range of "minority groups" (including gay/lesbian individuals, bisexual individuals, racial/ethnic minorities, religious minorities, etc.). This study produced some troubling findings. In short, attitudes toward bisexual individuals were more negative than any other social group except injecting drug users.

It is important to note that this study included only self-identified heterosexual participants — so we did not have information on attitudes toward bisexual individuals in the general population of gay, lesbian, and individuals of other identity labels. Since we know that anti-bisexual prejudice "biphobia" is not only enacted by heterosexual people, this was a major limitation of this other study. Last but not least, the data were nearly 20 years old.

Your study was in part a response to the fact that multiple studies have shown that bis have significant health disparities — compared even to gays and lesbians. Would you tell us a bit about these disparities?

BD: This is a big question that we are just now beginning to explore, although a large amount of data from well over a decade have been pointing in this direction. A major limitation of most early health research on "lesbian, gay and bisexual" (LGB) populations is that it was based on combined samples of participants with no attention to separating out sexual identities, particularly in terms of bisexual people. More recent research that is actually separating bisexual participants from gay and lesbian participants shows a wide range of health disparities among bisexual individuals, compared to their exclusively gay and straight peers.

In these studies, bisexual men and women have been found to report the highest rates of a wide range of physical, mental, and other health concerns which are strong predictors of early and excess mortality. It is very important to understand why this is, but research on bisexual health (as well as resources and funding for such research) has been very limited. Thankfully, this situation is slowly changing. It is encouraging that the National Institute of Minority Health and Health Disparities' (NIMHD) recently announced that they will consider "sexual and gender minority individuals" as a recognized minority health population, which will make funds available for more targeted research, hopefully not only focusing on health risk but also on resilience.

While it is important to document the existence of health disparities that exist in our society, we strongly advise that researchers and public health professionals be mindful of their potential role in reinforcing negative stereotypes in their work, which also transfers to how their work is used by advocates and activists. While eliminating health disparities is important in terms of equity, we also need to be careful about how we frame our research findings, and we also need research that also focuses on positive aspects of sexuality and sexual diversity. Since the work that we do at our center has been largely driven by the principles of community-based participatory research (CBPR), we encourage researchers to engage with bisexual individuals and communities in both research design and dissemination in order to make sure that their research does not cause further unintentional damage to these communities.

The study is premised on the idea that these health disparities are likely caused by the way society perceives and responds to bi people; would you explain how negative attitudes translate to health problems?  

BD: A great deal of work has focused on "minority stress", chronically high levels of stress faced by members of stigmatized minority groups. This may be caused by a number of factors but the most well-understood causes of minority stress are interpersonal prejudice and discrimination. I think this is one piece of the puzzle. Research on the causes of health disparities among sexual minority individuals has also shown the importance of social support and material resources as moderators of stigma-induced stress. Bisexual individuals' experiences of biphobia and subsequent marginalization from gay/lesbian, and heterosexual communities (i.e., potential sources of social support and resources) likely places them at elevated risk for physical and mental health concerns. Again, we need more research (and resources to facilitate such research) that can test these causal links specifically for bisexual people.

The headline for the article about the study on the website of Indiana University reads: IU study finds a slight shift in attitudes toward bisexuals, from negative to neutral. For non-research-minded people, it's easy to misunderstand what is meant by "neutral".  Could you explain to our readers why neutral in the case of this study is not ideal, not indicative that people think no better nor worse about bisexuals than how they think about anyone else?

BD: This is part of a broader issue of disseminating scientific research via media. It is often challenging when our research findings are encapsulated in "soundbites". It becomes really difficult to communicate what is meant by "neutral" in a ten-words-or-less headline. For this reason, many scientists choose not to engage with the media. I do understand that more people will likely be reached by mass media than solely by peer reviewed journal articles, so as a researcher I work as best we can to help ensure that these soundbites are packaged in ways that reflect the research findings — but it's not a perfect process.

To clarify about the concept of "neutral" in our study: our participants were asked to respond to a range of negative sentiments and stereotypes about bisexual people. So our respondents being most likely to report neither agreeing nor disagreeing with these negative attitudes is not ideal.

I think it's helpful to consider these findings relative to the fact that positive (not neutral) attitudes have dramatically increased over the past decade in the U.S. in surveys that have examined attitudes toward gay and lesbian individuals among heterosexual individuals. Every demographic group has seen an increase in acceptance of gay and lesbian individuals including religious groups, all political parties, and young people.

What do you speculate about the reason for the high level of "neither agree nor disagree" responses?

BD: The level of "neither agree nor disagree" responses was higher than I would have imagined. Findings from social research suggest that "neither agree nor disagree" responses can be interpreted in a variety of ways, including the participant not knowing, the participant being unsure, or the participant not caring.

That over one-third of participants neither agreed nor disagreed with every scale item may indicate a general ambivalence toward bisexual men and women within the general population. This may be reflective of larger cultural shifts away from expressing explicitly negative or discriminatory attitudes toward minority groups, while implicit biases may still operate. This may be partially due to the relative invisibility of bisexual individuals and positive bisexual role models, relative even to increasing portrayals of gay men and lesbians in media and society. It may also reflect respondents' unfamiliarity with bisexual people as bisexual men and women are significantly less likely than gay and lesbian individuals to disclose their identities and behaviors to friends and family members. In short, we need more research!

Though your study shows that there has apparently been a slight shift away from negative attitudes and towards neutral attitudes, was there still a high rate of negative responses?

BD: Approximately 1/3 of respondents reported attitudes on the more negative side of the scale, another 1/3 fell in the middle and another 1/3 reported attitudes on the more "positive" side of the scale. So, overall, approximately 2/3 of participants did not report "positive" attitudes.

Which questions had the highest rates of negative responses, and what insights do you have about these findings?

BD: Participants were most likely to agree that bisexual men and women are at a heightened risk for HIV and other sexually transmitted infections (HIV/STI). This finding is in line with prior studies on attitudes toward bisexual men and women in terms of "sexual riskiness", as well as descriptions of "sexual irresponsibility", and as a commonly reported anti-bisexual experience among bisexual individuals. This sentiment is likely an artifact from the early days of the HIV epidemic, when bisexual men, in particular, were stereotyped as a "bridge population" between their male partners and their presumably unaware female partners. Bisexual individuals have also been commonly stereotyped as sexually "promiscuous", part of a broader view that any form of non-monogamy (which many believe is associated with bisexuality) is "risky" in terms of HIV/STI. Overall, I think this shows that such stereotypes are still pervasive, and quite simply that many people may not understand bisexuality as a sexual orientation/identity.

The study references the sexual orientation of the participants as falling into the categories of "Heterosexual, Gay/Lesbian, Other". Please explain the Other" category and any interesting findings among that group. 

In addition to the widely used identity labels of heterosexual, gay/lesbian, and bisexual, we offered participants the opportunity to indicate other identities. We were particularly interested in examining attitudes among other-identified individuals because, just as bisexual individuals have problematically been lumped together under "sexual minorities", a number of non-monosexual identities (e.g. pansexual, queer) are sometimes subsumed under the label of "bisexual", and experiences of anti-bisexual prejudice have been found to differ based on the label endorsed by the individual. We also included asexual individuals and those who do not identify as any sexual orientation under "other".

I think one of the most important findings of this study is that individuals who self-identify as "other" reported the most positive attitudes toward bisexual men and women, significantly more than gay/lesbian and straight people. I think this finding is really interesting and important, and probably due to the fact that those who have questioned their identity — and do not define within "traditional" binary categories — may relate to and be more sensitive about similar stereotypes. It stands in direct contradiction to recent mass media coverage that presents a false "bi vs. pan dichotomy". I think it can be really destructive to elevate celebrities as experts (like Miley Cyrus' recent quote "I always hated the word 'bisexual'"), which is not representative of the broader bi+ community.

What did you find about the difference between how men and women perceive bi people?

BD: Not surprisingly, women's attitudes toward bisexual people were more positive than men's attitudes. These findings are consistent with the larger body of research on attitudes toward "LGB" populations, in which women consistently demonstrate more positive attitudes toward sexual minority groups than men. This may be because, overall, women tend to be less conservative and look more favorably upon social issues related to equality.

What was found about the differences in how bi women were perceived versus bi men, and what do you think are some of the possible reasons for these differences?

BD: Overall attitudes toward sexual minority women are less negative than those towards sexual minority men,

so it was not surprising that overall attitudes toward bisexual women were more positive than bisexual men. There could be several explanations for this "gender gap", including the sexualization of bisexual women. More women identify as bisexual than men, and women have also been thought to be more sexually fluid than men. It is possible that women are less judgmental about bisexuality because many have considered their own bisexuality and/or sexual fluidity. Since men are also traditionally expected to more rigidly conform to heteronormative norms and stereotypes, their attitudes may be markedly less "fluid" than women's, though attitudes about traditional masculinity expectations are changing in youth populations.

What do you think is the most important finding of your research?

BD: My own personal reaction is that, overall, the U.S. population still has a long way to go in terms of creating and maintaining a social climate that is tolerant of sexual and gender diversity.

Was there anything you were especially surprised to see?

BD: I was surprised by the proportion of participants who neither agreed nor disagreed with negative stereotypes about bisexual women and men. I wish we had more positive outcomes to report, but this appears to be the current situation in the general population of the U.S. I think it points to the importance of nationally representative probability data in terms of guiding how and where researchers and practitioners may prioritize taking action in terms of the next steps.

We have also collected data from a nationally representative probability sample of self-identified bisexual men and women on their perceptions of others' attitudes toward their bisexualities, including brief open-ended descriptions. While we are still going over these data, it is incredibly interesting to me that preliminarily their reports seem to line up almost identically with the stereotypes we assessed in our original measures. This would seem to me that these stereotypes are very real for bisexual men and women in the general population of the U.S. We are excited to publish these data in another paper as soon as we are able.

In the study's write up, it's acknowledged that there are genders beyond the male/female binary but you chose to only ask participants about bi men and women, would you explain this decision?

BD: While numerous gender identities exist outside a male/female binary, we specifically measured attitudes towards bisexual individuals who identify as men and women, without specific mention of whether these men/women are transgender or cisgender (or other) since prior studies have documented significant differences in attitudes toward bisexual men and bisexual women. We talk about this as a potential limitation and also recommend that future research would benefit from exploring attitudes toward bisexual transgender, non-binary, gender-queer, and other groups of individuals who may not identify as male or female. While researchers may not have included these non-binary gender identities in previous studies on bisexuality, due to the assumption that the numbers of people who would report these identities is too low, it may be the case that we simply have not afforded individuals the option to report such identities consistently in research.

Q: You've been quoted in the BiStories piece about you, as saying:

"...if we don't address bisexuality in health and policy, we'll continue to just be erased... I see it firsthand, all the time. It's been challenging for me at times because as a scientific researcher, there are some people who believe you can't be a scientist and an activist at the same time. But if we're not advocating and doing some good with our work in public policy, it's pointless. If we don't have people bringing up these issues to light in research and policy, we are going to continue being erased". 

That's a powerful statement that speaks to truth and responsibility yet goes against traditional scientific narrative. Would you elaborate a bit more on that, and how the concept of data-driven advocacy has intersected with your work?

BD: I guess that depends on what one considers "the traditional scientific narrative". If we are defining "science" by the arcane "five-step hypothesis-driven scientific method", with a scientist on one side of a microscope and a specimen on the other, that is a concern in and of itself. (One of my favorite learning tools on this idea is a TED Talk by Dr. Stuart Firestein, Chair of the Department of Chemistry at Columbia University, who provides some interesting and fun alternative frameworks for understanding "science"). I have always struggled with "binary" distinctions, in general, and I have never understood why some people dichotomize "science" and "advocacy" as polar opposites. This is especially true in public health, in which advocacy (in addition to assessment, policy development, and assurance) is a core component of the work that we do.

I am a research scientist and I feel much more comfortable sharing my work in peer-reviewed journals than in media or community reports — but I think it is important to step outside your comfort zone every now and then. For example, a number of us researchers contributed to a series of community and policy briefings at the White House over the past year, which I see as "data-driven advocacy". I do not understand how ensuring that scientific data is included in these conversations would go against any fundamental laws of "science". From my experience, this sort of "data-driven advocacy" is not likely to occur without having scientists at the table to advocate for the inclusion of scientific data in ongoing discussions.

What do you hope the study's findings will contribute to the bi community?

BD: My biggest hope is that this line of research will continue to bring visibility and validation to issues that impact bisexual individuals and communities.

You've been instrumental in a lot of AIDS/STI research, much of which has focused on the bi community; what do you see as the bi community's most pressing needs in the area of AIDS/STI?

BD: My biggest concern related to HIV/STI is related to our flawed surveillance systems. For example, regarding men, categories like "men who have sex with men (MSM)", based on sexual behavior rather than sexual identity, were originally conceptualized based on the reality that many peoples' sexual behaviors are not necessarily congruent with their sexual identities. However, to then collapse any man who reports sexual behavior with another man into the category of "MSM" and completely disregard their sexual behaviors with female or other partners does not provide an accurate reflection of sexuality. I think this led to the original and flawed concept of the "bisexual bridge", which has yet to be substantiated with sound epidemiological data. I also feel that bisexual women continue to remain relatively invisible in HIV/STI research, though we see that stereotypes about their being "vectors of disease transmission" still persist. Last, I feel we need more information on gender non-binary bisexual people, in general, including related to sexual health.

In the BiStories piece, it's explained that your father has played an instrumental role in your acceptance of your sexual identity. What would you most like to say to parents of people who belong to a sexual and/or gender minority, and specifically to parents of bisexuals?

BD: If I were able to say one thing to parents of all children, bisexual or otherwise, it would be to love, accept, and be there for your children unconditionally. I feel most fortunate that I have been blessed with such parents in my own life.