I recently received a heartfelt letter written by a member of an internet support network that I am the creator and administrator (www.Positively-Alive.com). This letter has helped me to be more aware and open to the reality of bisexuality. It is due to his letter that I feel the need to raise awareness to the reality of the issues so many bisexual men and women face. With his permission I will be quoting from his letter throughout this article. The reality of an HIV+ diagnosis and the process and time it requires for any individual to come to terms with the shock of such a diagnosis, highlights the importance of having a support structure or the ability to find people that one can talk to as they can greatly assist the individual through this process.
The author of the anonymous letter writes: “The Positively Alive website and the group’s support/forum meetings proved to be invaluable in my journey. I found out about my status a little over a year ago and met you and the guys two weeks later. Those first days were unimaginable. For quite some time I was even suicidal; it is just so overwhelming, that feeling that I can't explain - None of us can, but we've all been there! Just knowing that you’re not alone makes it easier to see the light at the end of the tunnel. Interaction with other positive guys is essential. It's was the only thing that made the discovery of my HIV status manageable.”
The fact that many people do not disclose their HIV status to loved ones is directly linked to the reality that more often than not, such a disclosure would include the disclosure of ones sexuality. Consider the silence around HIV and how this is increased by the direct feelings of fear of rejection when a young man discovers he is HIV+ and doesn’t tell his parents, because telling them that he is HIV+ would mean disclosing that he is sexually active or a further example would be a husband that does not tell his wife because this will mean a potential disclose of infidelity. Not only does the HIV+ bisexual man have to consider all these real issues but he also finds himself with the added reality that an HIV+ disclosure might also mean revealing the secret of his sexual identity.
Anonymous letter continues: “I haven't come out publically, but I do know that a certain amount of relief comes with letting your loved ones know. I have only been able to tell one family member so far. The huge mental and emotional impact that HIV has on someone is most probably the greatest of all challenges. There are physical ailments which come along with it, most of which can easily be treated; I have learnt so much about my body over the past 12 months. A good diet and exercise is an everyday occurrence in my life. I'm in such a good space and although we know that it has the potential to be a big deal if left untreated when treatment is required, it really isn’t such a big deal at all! Believe me, I do get it, but there’s no point in beating myself up about it for the rest of my life. I need to enjoy life to live long and live strong. If I’m regretting it then I’m holding onto something that overshadows every moment of every day. We can’t allow ourselves to think like that. I know you're "there" and because of you so am I. I was privileged enough to stumble upon some footage of you. I attended the training that you offered, last year. Thank you for everything that you have done for so many of us.”
Men who have sex with men or (MSM)
I have deliberately not been using the term MSM because it is not the term that the author of the letter has selected to use when referring to his sexuality. The term MSM is used by medical experts, psychologists and others to highlight and identity the existence of men who have sex with men. The reality is that the general public does not use the terminology MSM (men who have sex with men). Surely it would be better to ask a person in which manner they prefer to identify themselves sexually? It is important however, that we acknowledge and recognise the existence of men who have sex with men (MSM) and the importance of incorporating their existence into our health and wellness initiatives. According to a research published in the Health4Men’s booklet “MSM IN YOUR POCKET, Sexual Healthcare for Men who have Sex with Men”, up to 50% of men who have sex with men (MSM) identify as heterosexual and have female sex partners. The booklet further describes MSM as follows: Male to male sex occurs throughout Africa, in all cultures, societies and geographical locations. Not all MSM identify as homosexual or gay. Many such men may be married, have children and have sex with women. Many have “masculine” gender identity and cannot be identified as being MSM by their dress, mannerisms or social roles. They may see themselves as heterosexual (or even as the author of the letter indicates as bisexual). The diversity of men included in the term MSM are men who are heterosexual, bisexual or homosexual and who can be either relatively masculine or effeminate in their dress and mannerisms.
Anonymous writes: “I'm not sure if you do know, but I am in actual fact bisexual. This is also something which I've had to accept of myself, there's a large amount of guys who are bisexual but can’t accept this of themselves – this applies mostly to “straight” guys, but also some “gay” guys (guys who are more accepted by the gay community than the straight community). I feel like I’m coming out of the closet all over again. To be attracted to both sexes is quite widely thought of as unusual / odd, etc. often even more so than coming out / labelling yourself as gay. I have had girlfriends in the past and now I have one again. Being with a woman again has raised more concerns in regards to what's safe and what's not with her. Guys and girls do obviously have quite different anatomies. I love every part of my female partners body as I have loved every part of past male partners bodies. Alas, there have been more guys than girls, but for some reason I keep “relapsing” (hahaha) back to women. My partner knows my status and my sexual orientation, she's negative and straight (but that’s beside the point). We've educated ourselves as to what's safe and what's not.”
As a gay man I am open about my homosexual identity and have disclosed my sexuality to my family, employers and friends and have been received with love and acceptance. It is very sad that we are not more tolerant and so many of us simply consider bisexual men to simply be a man that has not come to terms with his sexuality. The gay community has over many years fought hard to be accepted for who we are, bisexual and gay rights are protected by the constitution of South African. The South African constitution provides for freedom, tolerance and acceptance of our rights to live in a society free from discrimination based on sexual orientation, yet how intolerant we can be towards others if they are different to ourselves. If someone identifies as being bisexual we are quick to dismiss the idea and respond with intolerance and a total lack of acceptance and understanding. How often have we uttered the words “another gay man not able to accept that he is actually gay and is just in denial?” Bisexuality has as much right to exist and be recognised as my desire to be recognised as being gay, or whatever sexual orientation I might classify myself as. The letter has opened my eyes and I hope it too will help to open yours. I think we all can take the time to evaluate or responses, health services and employee wellness interventions by answering the following questions:
- Is your programme tolerant of bisexual men/women or does it embrace and include messaging directed towards the needs of bisexuals?
- Do your healthcare workers and practitioners, through ignorance and a lack of understanding, label bisexual men as being gay when they do not classify themselves in this way, hence causing them to feel excluded and misunderstood?
- Do your wellness interventions, peer educator programme and EAP services provide a confidential and safe environment where bisexual men/women are accepted and understood?
- Do ignorance and a lack of understanding of those providing care and support services cause bisexual men/women to experience feelings of isolation and intolerance?
- Do we make bisexual men/women feel incorporated and do we directly address them in communication strategies, awareness and information messaging, or are your HIV intervention and other health and wellness messages only directed towards heterosexuality and homosexuality people?
- Have we made an effort to understand what the needs of bisexual men/women are?
- Do we listen and are we educating ourselves so that we have a better understanding of the needs of the general and sexual health issues as well as the psychological needs of bisexual people?
- Do we dictate our own values and principles on others, thereby contributing to their isolation and victimisation?
Consider the following - Discrimination is prejudice in action. Now with an open mind, read more from the anonymous letter below and I trust that if this honest and open hearted letter might help us all to become better loving and more tolerant human beings.
Anonymous writes: “My point is, although the site says it caters for all spectrums of men who have sex with men (MSM, the gay community seems opposed to this label. As a bisexual man I am also capable of falling in love and having meaningful relationships with both sexes. I’m sure that MSM should be viewed as a medical term only and that the emotional and spiritual aspects of us as gay / bi men should be left out of it. My perception is that everyone who attends the support group meetings is gay. Please correct me if I’m wrong? Bisexual guys are a bit different to gay guys... I’m the only bisexual guy I know who’s openly bisexual. Kind of like being the only gay in the village – LOL”
I have felt quite isolated at times, The Triangle Project has been absolutely amazing for me, and they have provided free counselling but also seem more geared toward the more mainstream (gay) positive guys.”
According to Health4Men statistically, it is likely that every service provider seeing more than 20 male clients per day has interacted with an MSM. It is often assumed that, unless male clients are openly gay, that they only have sex with women. MSM may be reluctant to volunteer their sexual history to a healthcare provider who is perceived to be judgemental, and may fear being embarrassed or ashamed in hostile communities where there is doubt about confidentiality at the healthcare facility. The following could be useful for healthcare providers when working with a male client:
- Any male client could potentially be an MSM. Don’t assume that a male client only has sex with women.
- A professional, non-judgemental attitude must be maintained.
- Confidentiality must be discussed with clients, especially in a hostile community. The client’s sexual identity and related information may be omitted from the file.
- Learn about the local MSM scene and associated terms and words. Peer educators and non governmental organisations are often helpful. Talk to your MSM client to learn more about their lives and lifestyles.
- Be sensitive when interacting with male clients. Do not automatically use feminine pronouns such as “she” when referring to sexual partners.
- Be sensitive with transgender clients, Transgender people experience a level of conflict with their birth sex (male or female), and may incorporate factors such as dress, roles or mannerisms usually associated with the other gender in their daily lives.
- When dressed as a woman, a man may feel more comfortable being address as a female. If unsure, ask the client how they would prefer to be addressed.
MSM guidelines for healthcare providers can be obtained from the www.Health4Men.co.za website or by contacting them on 021 421 6127.
Compiled by: Alan Brand
For more on the Positively Alive support network for HIV+ Gay, Bisexual, Transgender or MSM visit www.Positively-Alive.com