Psychosocial Health Disparities Among Black Bisexual Men in the U.S.: Effects of Sexuality Nondisclosure and Gay Community Support

Abstract

Compared with Black gay men, Black bisexual men experience psychosocial health disparities, including depression, polydrug use, physical assault, and intimate partner violence (IPV). Black bisexual men are also less likely to disclose their sexuality, which may result in them receiving less sexual minority community support, exacerbating psychosocial health disparities. We assessed relationships between bisexual behavior, bisexual identity, sexuality nondisclosure, gay community support, and psychosocial morbidities among Black men who have sex with men (MSM). Between 2014 and 2017, survey data were collected from Black MSM ≥ 18 years old (n = 4430) at Black Pride events in six U.S. cities. We differentiated between bisexual-identified men reporting past-year sex with men and women (bisexual MSMW, 8.4%); gay-identified men reporting sex with men only (gay MSMO, 73.1%); gay MSMW (8.0%); and bisexual MSMO (8.4%). Multivariable regressions contrasted these groups by psychosocial morbidities, sexuality nondisclosure, and gay community support. Structural equation models assessed total, direct, and indirect effects. Compared with gay MSMO, bisexual MSMW and gay MSMW were significantly more likely to report polydrug use, depression symptoms, IPV, physical assault, sexuality nondisclosure, and lack of gay community support. Lack of gay community support had significant indirect effects on the relationships between bisexual behavior and psychosocial morbidity (p < .001) and between bisexual identity and psychosocial morbidity (p < .001). Sexuality nondisclosure had significant indirect effects on relationships between bisexual behavior (p < .001), bisexual identity (p < .001), and lack of gay community support. Psychosocial health disparities experienced by Black bisexual men are associated with both bisexual behavior and bisexual identity. Interventions decreasing biphobia will facilitate opportunities for protective sexuality disclosure and access to sexual minority community support.

Keywords: Black/African American; Male bisexuality; Psychosocial health; Sexual orientation; Sexuality disclosure; Social support.

Figure 1

Structural equation model showing total and indirect effects pathways between bisexual behavior, sexuality nondisclosure, lack of gay community support, and psychosocial comorbidities among sexually active Black men in the POWER study, 2014–2017. t=p<.10; *=p<.05; **=p<.01; ***=p<.001. Path coefficients and standard errors (parenthesized) are shown for total effects pathways. Dashed lines indictate non-significant (p>.05) total effects pathways. Italicized path coefficients and standard errors (parenthesized) are shown for indirect effects pathways. Models adjusted for year, city, age>39, Hispanic ethnicity, and socioeconomic status. Covariate paths and path coefficients and latent path coefficients are suppressed for interpretability. SRMR=0.027.

Figure 2

Structural equation model showing total and indirect effects pathways between bisexual identity, sexuality nondisclosure, lack of gay community support, and psychosocial comorbidities among sexually active Black men in the POWER study, 2014–2017. t=p<.10; *=p<.05; **=p<.01; ***=p<.001. Path coefficients and standard errors (parenthesized) are shown for total effects pathways. Dashed lines indictate non-significant (p>.05) total effects pathways. Italicized path coefficients and standard errors (parenthesized) are shown for indirect effects pathways. Models adjusted for year, city, age>39, Hispanic ethnicity, and socioeconomic status. Covariate paths and path coefficients and latent path coefficients are suppressed for interpretability. SRMR=0.025.