High-Risk Sexual Behaviors and Health Services Needs Among Bisexual Men in Peru: A Cross-Sectional Study.

Objectives: This study aims to describe sexual behaviors and access to health care services among self-identified bisexual men and to examine differences between those who reported recent sexual intercourse with a woman (MSMW) and those who did not (MSM). Methods: We conducted a cross-sectional study with 560 self-reported bisexual men who responded to a semi-structured survey. Those who reported having intercourse with a woman in the year prior to the survey were classified as MSMW. Results: MSMW behavior (48.9%) was associated with being 36 years or older and engaging in sexual intercourse under the influence of alcohol (OR: 2.90, 95% CI: 1.65 - 5.10, p < 0.01; OR: 3.33, 95% CI: 2.13 - 5.21, p < 0.01; respectively). Conversely, MSM behavior was significantly associated with self-reporting HIV positive status and engaging in unprotected anal intercourse with any male sexual partner (OR: 0.43, 95% CI: 0.19 - 0.95, p: 0.037; OR: 0.69, 95% CI: 0.46-1.02, p: 0.04; respectively). Conclusion: Bisexual self-identification does not necessarily correlate with intercourse with both men and women. Instead, it relates to various psychosocial factors that result in distinct behavioral patterns and health needs. It is crucial to develop prevention strategies targeting bisexual men, considering their limited access to health services, sociodemographic characteristics, and the prevalence of high-risk sexual behaviors.