How sexual health clinics are failing bisexual men

When I was single I made sure, like any responsible adult, to go for regular sexual health checks. Over the years, I’ve visited clinics across the UK and found varying levels of professionalism and compassion. I’ve had moralising lectures from prim nurses and engaging tête-à-têtes on the contradictions of the gay community with tattooed health workers. I’ve been offered tea and magazines in a warm, music-filled room, and hand sanitiser and badly-subtitled BBC News in a bleak, sterile cube. Quite often I’ve been sent away with enough condoms and/or lube to last me a millennium, which is funny because the last thing I want to do after going to one of these places is have sex ever again. 

Yet, what has been clear in almost every case is that I, as a bisexual man, didn’t quite fit. Attending a run-of-the-mill men’s walk-in clinic, I found myself having to ask for an HIV test – not because I considered myself particularly at risk at the time, but because I wanted the full MOT and the resultant peace of mind. But these services rely on a form of risk assessment that treats the population as if it falls neatly into two categories. As such, faulty assumptions around both the higher promiscuity of gay men and the prevalence of riskier practices among them abound. It’s a sad fact that until recently straight men weren’t routinely offered HIV and hepatitis tests. In some places they still aren’t.

Yet in my own personal experience, straight people are just as promiscuous and far less likely to reach for a condom. The moralising, dogmatic spirit is so deeply ingrained in this aspect of medicine that going to many clinics without symptoms is a bit like going to confession. It too has its rituals, power dynamics and interrogative methods. 

Calling up a sexual health centre in Edinburgh to make an appointment a few years ago, they asked me whether I was “straight or gay?” Feeling decidedly excluded, I said, in between. “Oh! So, you’re bisexual…” a receptionist rasped down the line. In my case, the answer is very much yes. I’m comfortable in my identity and in that label as an accurate descriptor of my own sexual behaviour. So why on earth wasn’t that an option?

Not that her faux surprise was anything new to me. I’ve heard that line during consultations in both general and gay men’s clinics. It’s always followed by the flicking of pages and rapid scrawling in margins. While I appreciate that the NHS is trying to determine which information and advice would most benefit me, with some of the reactions I’ve had you’d be forgiven for thinking that the bisexual – when actually existing – is an abhorrent and undiscriminating vector of venereal disease.

Little wonder then that, for the sake of ease, some bisexual men go to clinics designed for either straight or gay men, according to the majority sex of their recent sexual partners, glossing over any discrepancies. But this isn’t always conducive to the right care. Some genito-urinary infections, like trichomoniasis, can be sexually transmitted from women to men but not between men. If you’re a healthcare professional operating under the assumption that the man presenting with symptoms is exclusively gay, you are less likely to consider an infection that should, in theory, be impossible for him to get.

Things are complicated even further by the fact that the words 'straight', 'bi' and 'gay' are often quite useful indicators of someone’s sexual identity, but they’re totally unreliable guides to past and present sexual behaviour. As even the most cursory glance at the internet will tell you, some cis-men who confidently and whole-heartedly identify as straight are also having sex with men. More often than you think. 

It has to be said that most young people are proactive about getting themselves checked. Yet, even if you, like me, identify as bi, when faced with that figure in the white coat or creased shirt and lanyard, nameless, disinterested, the entire weight of social expectation and heteronormativity bears down on you. Given this, it takes a herculean effort to correct “and was she British?” to “he wasn’t, no.” All that work to be responsible is undone in the face of stern, clinical authority. The truth is glossed over or watered down, the casualty of a practice that already has a pamphlet up its sleeve and a specialist to deal with cases like you.

The last time I went to a specialist, I found some things I was asked genuinely shocking: “Do you or have you ever exchanged sex for money? Have you ever used drugs, if so, which? Have you ever used drugs during sex?” These questions had been introduced since my previous visit, and while I knew that everyone was being asked them, I couldn’t help but feel somehow accused. It felt like because I had gone to an outreach centre for men who have sex with men (MSM), it was assumed that I was a part of a world I had no interest in whatsoever. All the questions that are asked of MSM should either also be asked of straight men or not at all. When rates of HIV in Edinburgh are 'higher' (presumably than other comparably-sized cities), why aren’t straight-identifying men being asked the same questions, or, at the very least, educated about the existence of HIV preventative medication, PrEP?

We know from surveys that fewer and fewer young people consider themselves exclusively heterosexual. But this doesn’t mean that I want a once-a-week session for bi men introduced. Far from it. It’s high time for a holistic sexual health service that considers and includes the totality of society. Not just one section of the community but the entire community as an integrated, interactive and interdependent whole. Because the bottom line is that a truly effective, truly inclusive sexual health service needs to abandon outdated reliance on the validity of categories better suited to the last century.