HMN 2026: How study of bi+ people’s sexual health uncovers critical gaps

The national survey of 2,100 bi+ people—which includes identities like bisexual, pansexual, queer and fluid—provides crucial information to inform better health policy and services.

An Australian-first survey has found that bi+ Australians experience significantly poorer sexual health and safety outcomes than the general population, despite being highly engaged with health care.

Findings released today by the Kirby Institute at UNSW Sydney provide the most detailed picture to date of sexual health, relationships and experiences with sexual health care services among bi+ Australians.

The report, which analyzes data from more than 2,100 bi+ Australians, reveals an incredible diversity of experiences among bi+ people. For example:

• Cis bi+ women had higher levels of engagement with health care, but also higher rates of illicit drug use, sexual violence perpetrated against them, and STI diagnoses.
• Trans and nonbinary/gender-diverse bi+ participants tended to feel more included in and engaged with LGBTQ+ communities, but also reported higher rates of sexual violence perpetrated against them and poor mental health.

Cis bi+ men were less likely to be connected to the LGBTQ+ community and sexual health care in general

“Bi+ Australians are the largest population group in the LGBTQ+ community, yet their experiences have been consistently overlooked,” says UNSW Associate Professor Benjamin Bavinton, chief investigator of the Bi+ Sexual Health and HIV (BiSHH) study, who led the research. “Our findings reflect a diverse and engaged population. However, across many measures, bi+ people experience poorer sexual health and well-being outcomes compared to the general population.”

Bi+ is a community-developed umbrella term used to describe sexual identities that are characterized by attraction to more than one gender. Common identities under the bi+ umbrella include bisexual, pansexual, queer, fluid and many more. Until now, very little has been known about this growing population’s sexual health needs and experiences.

“The findings from this survey reflect both shared experiences and diversity among bi+ people in Australia and point to an urgent need to recognize bi+ Australians as a distinct population with specific health needs,” says Bavinton. “The more we understand about people with bi+ identities, the better equipped we are to challenge historical and harmful stereotypes, combat stigma and design better health services.”

High engagement with health services, but services don’t reflect bi+ needs

According to the survey, 36% of bi+ participants had been diagnosed with an STI, more than double the estimated lifetime STI prevalence in the general Australian population (around 16%), as indicated in other research.

Nearly 9 in 10 bi+ people living in Australia have accessed sexual health care at least once in their lifetime. Yet only half felt comfortable discussing sexual health with care providers, and fewer than half felt clinics were inclusive or knowledgeable about bi+ people. Fewer still (1 in 6) felt they received relevant bi+ information.

These gaps are also evident within LGBTQ+-focused sexual health services, where half of participants felt LGBTQ+ sexual health services could be more bi+ inclusive, and a quarter had chosen not to use or had avoided using an LGBTQ+ service in the past.

“These findings show that bi+ people are engaging with health care, but systems are not meeting them where they are. Health care services tend to assume you are either gay or straight by default, which can make many bi+ people feel invisible in these services,” says Bella Bushby, a bi+ woman and Ph.D. candidate at the Kirby Institute, UNSW, and project coordinator of the study.

Cis bi+ men experience significant barriers to appropriate health care

Bi+ men experience consistently poorer outcomes than other members of the bi+ community across comfort, inclusion and engagement with services.

Cis bi+ men report higher rates of casual partners, group sex and condomless anal sex. At the same time, they are least likely to feel comfortable talking about sexual health, least likely to feel included in LGBTQ+ or bi+ spaces, less likely to disclose sexuality to clinicians, and less likely to have accessed sexual health care at all.

Steven Spencer, vice president of the National Association of People with HIV Australia, is a bi+ man and co-investigator on the study. “Bi+ men have a high need for inclusive sexual health care but are least likely to feel supported accessing it,” he says.

“This is particularly concerning because bi+ cis men face historical stigmatization as being a bridge for HIV transmission from gay to heterosexual communities. It’s essential that services do a better job of creating nonstigmatizing health care access for bi+ men.”

Experiences of sexual violence high among bi+ people

Sixty-three percent of bi+ participants reported experiencing sexual violence since age 18, more than four times the rate in the general Australian population. Experiences of sexual violence were highest among cis bi+ women, followed closely by trans and nonbinary and gender-diverse bi+ people.

• Cis bi+ women were more than three times as likely as women in the general population to have experienced sexual violence perpetrated against them.

• Trans men, trans women, and nonbinary/gender-diverse bi+ people were more than 4.5 times as likely to have had sexual violence perpetrated against them as the general population.

• Cis bi+ men were half as likely to have had sexual violence perpetrated against them compared with bi+ people of other genders in the study, but their reported experiences were still more than five times higher than in the general male population.

“These findings highlight the urgent need to recognize bi+ people as a priority population within sexual violence services and responses,” says Emily Goodnow Bjaalid, a bi+ woman, co-investigator on the study and Ph.D. candidate at the Australian Research Center in Sex, Health and Society, at La Trobe University.

Additionally, 28% of bi+ participants met the threshold for probable serious psychological distress, more than double the rate in the general Australian population (17%) observed in other studies. Rates were even higher among trans and nonbinary bi+ people.

Bi+ and LGBTQ+ community connection

Many bi+ people experience biphobia from both straight and gay and lesbian communities. Only half of respondents were out to their families, and only 15% were out at work.

Many participants shared that connection to community spaces that recognized and accepted their bi+ identity was highly valued in their lives.

Participants were most likely to be out to other bi+ people and feel included in bi+-specific spaces, followed by LGBTQ+ people and mixed LGBTQ+ spaces, and were less likely to be out to heterosexual people, family, colleagues and health professionals, or feel comfortable in heterosexual spaces.

“We know that connection and belonging increases the likelihood of bi+ people seeking and receiving relevant sexual health information, so it is essential to increase the visibility of safe spaces and networks for this community. As it stands, there is a significant gap in bi+ inclusion within sexual health services, including LGBTQ+-focused ones. The results from this survey show a need for greater understanding and inclusion of bi+ communities within these settings,” says Bushby.

Survey a major achievement for bi+ information and collaboration

The BiSHH study was developed by the Kirby Institute at UNSW Sydney in close partnership with the Center for Social Research in Health at UNSW, the Australian Research Center in Sex, Health and Society at La Trobe University, the University of Sydney, bi+ community, and with strong support from allies. A bi+ Community Advisory Group co-developed this research and was actively involved throughout the design and analysis of the study.

“The BiSHH study confirms what we have long anecdotally known about bi+ communities in Australia. We are diverse in age, gender and relationships, and come from all walks of life,” says UNSW Professor Christy Newman, a bi+ nonbinary person and co-investigator on the BiSHH study. “It’s particularly affirming to see these outcomes from a survey deliberately designed to be inclusive of the diverse ways bi+ people identify and connect to others through relationships and sex.”

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