Nuances and shifts in lesbian women's constructions of STI and HIV vulnerability

HIV and STI Prevention Among Spanish Women Who have Sex with Women: Factors Associated with Dental Dam and Condom Use

The scientific community has systematically ignored the needs of women who have sex with women (WSW). The invisibilization of romantic and sexual relationships between women has caused a profound lack of knowledge about the impact of HIV and other STIs on this population subgroup. This study aims to analyze the frequency of dental dam and condom use in WSW and identify the variables that explain the use of these two preventive methods. The sample is composed of 327 women aged between 18 and 60 years (M = 27.82; SD = 8.10). The results indicate that only 4.7% of those who practice cunnilingus and 5.2% of those who practice anilingus report "always" using dental dam (systematic use). Condoms are used systematically by 37.1% of those who practice vaginal penetration and 37.8% of those who practice anal penetration. Age, high perceived self-efficacy, and adequate assertive communication skills are variables significantly related to preventive behavior. The severity attributed to HIV and the perceived risk of infection are protective factors regarding dental dam use. For condom use, high levels of internalized homophobia and drug use are risk factors. Future preventive strategies should provide information on preventive strategies to WSW who, for different reasons, are not involved in LGBT contexts or associations and, therefore, do not have access to training activities and mistakenly believe that they are invulnerable as they do not have sexual relations with men.

Perceived HIV Invulnerability and PrEP Knowledge and Attitudes among Black Sexual Minority Women

Black women have disproportionate rates of HIV compared to women of all other racial groups. The purpose of this analysis was to investigate perceived HIV risk, HIV and STI testing behaviors, and PrEP knowledge and attitudes among Black sexual minority women (SMW) and examine differences based on their history of male sex partners. Secondary data analysis was conducted using data from the Generations Study. This analysis used a sample of N=149 participants who identified as Black cisgender women. Results showed Black SMW with a history of male sex partners reported a higher perceived risk of contracting HIV and significantly more frequent HIV and STI testing than those without a history of male sex partners. Overall, most of the sample was not familiar with PrEP, but one-third had favorable attitudes towards it, and half felt like they did not know enough about PrEP to form an opinion. Implications for culturally relevant public health campaigns and comprehensive sexuality education that integrate PrEP are included.

'I never realised that sex between two women was not safe': narratives of lesbian safer sex

This paper explores the way in which some lesbians rely on culturally circulated narratives about identity to assess safer sex and their potential risk of sexually transmitted infection (STI) and HIV. A well-established narrative within the literature about lesbian safer sex is that STI risk is non-existent. The implications of this are important because they demonstrate the perception of lesbian identity and notions of safety. This study focuses on how gender and sexuality contextualise an assessment of risk and safety for lesbians. This is vital to understand because there is still a lack of language about lesbian safer sex practices and techniques. Lesbians narrate their assessments of STI and HIV risk through the lenses of gender and sexuality - locating 'risk' in gay men and bisexual women. Using narrative analysis, I find that lesbians assess their risk by constructing characters from culturally circulated narratives steeped in homophobia and biphobia of the sensible lesbian, the risky gay man and the uncertain bisexual.

Dermatologic care for lesbian, gay, bisexual, and transgender persons: Epidemiology, screening, and disease prevention

Lesbian, gay, bisexual, and transgender (LGBT) persons face important health issues relevant to dermatologists. Men who have sex with men (MSM) are at higher risk of certain infectious diseases, including HIV, syphilis and other sexually transmitted diseases (STDs), methicillin-resistant Staphylococcus aureus infections, and invasive meningococcal disease, and might be at higher risk of non-infectious conditions, including skin cancer. Recommendations for preventive health care, including screening for HIV and other STDs, sexual health-related vaccinations, and HIV pre-exposure prophylaxis, differ for MSM compared with non-MSM. Women who have sex with women experience disparities in STDs, including chlamydia and HPV. Transgender patients have unique, and often unmet, dermatologic needs during gender transition (also called gender affirmation), related to hormonal therapy and gender-affirming surgery. Familiarity with LGBT health issues and disease-prevention guidelines can enable dermatologists to provide medically appropriate and culturally competent care to LGBT persons.

[Vulnerability to sexually transmitted infections of women who have sex with women]

The scope of this study was to assess the degree of vulnerability to sexually transmitted infections of women who have sex with women. It involved a cross-sectional study of 150 women between 2015 and 2017. A structured questionnaire was applied, and a gynecological examination was performed to diagnose Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis and papillomavirus. Blood tests were conducted to detect HIV, hepatitis B and syphilis. The outcome variable was sexual infection and the independent variables comprised the vulnerability level in the individual, social and programmatic dimensions. Data analyses were performed through logistic regression. The results showed a high prevalence of infections (47.3%) and only variables of individual vulnerability were associated with the outcome. The incidence of infection was four times higher among women who had had prior infections. The fact of never having had a blood test tripled the chance of having sexually transmitted infections. The fact of also having sexual intercourse with men in the previous 12-month-period increased the risk of the outcome by a factor of approximately nine. The conclusion drawn is that these women are vulnerable to sexually transmitted infections due to their individual vulnerability.

Why Girls Choose Not to Use Barriers to Prevent Sexually Transmitted Infection During Female-to-Female Sex

PURPOSE

Using data from a national qualitative study of lesbian, bisexual, and other sexual minority adolescent girls in the U.S., this study examined their awareness of the risk of sexually transmitted infection (STI) and opportunities for barrier use.

METHODS

Online asynchronous focus groups were conducted with lesbian and bisexual (LB) girls ages 14-18 years. Girls were assigned to online groups based on their self-identified sexual identity and whether they were sexually experienced or not. Two moderators posed questions and facilitated online discussions. Interpretive description analysis conducted by multiple members of the research team was used to categorize the results.

RESULTS

Key factors in girls' decisions not to use barriers with female partners concerned pleasure, sex of sexual partner, lack of knowledge of sexual risk or of barrier use for female-to-female sexual activities, and use of STI testing as a prevention tool.

CONCLUSIONS

Addressing knowledge and access gaps is an important first step for improving sexual health. Prevention priorities should focus on helping LB girls understand their risk of STI transmission in both opposite and same-sex relationships. Tailoring messaging to move beyond heteronormative scripts is critical to engaging LB girls and equipping them with the skills and knowledge to have safer sex regardless of the sex of their partner.

Sexual Norms for Lesbian and Bisexual Women in a Culture Where Lesbianism Is Not Acceptable Enough: The Japanese Survey About Sexual Behaviors, STIs Preventive Behaviors, and the Value of Sexual Relations

This study aimed to identify key factors preventing STIs among women who have sex with women in Japan. This description is based on survey and open-ended responses from participants. The questionnaire contained participants' background, sexual behavior, STI prevention behavior, experience and knowledge of STIs, and the value of sex with women. 104 responded, and 92 (88.5 %) reported having sexual experience with women. A variety of sexual behaviors were reported. Regarding STIs, 14.4% of participants had an STI in past. Almost half of the participants cited measures to prevent STIs included hygienic activities. Participants believed that sexual relations accompany partnership with females.

Navigating unintelligibility: Queer Australian young women's negotiations of safe sex and risk

Australian public health promotion positions safe sex as a biomedical, heteronormative concept. Consequently, there is a dearth of scholarly research examining queer young women's sexual health. To fill this knowledge gap, this article considers how Australian bisexual and queer young women understand 'safe sex' and conceptualise 'good' sexual citizenship. Drawing on qualitative interviews with 15 participants in Tasmania, findings reveal that although queer women understand heterosexual safe sex, there is little awareness of safer sexual practices with female partners. We argue that gendered sexual scripts shape perceptions of sexual health risk whereby queer women adopt multiple situation-dependent approaches to safer sex.

Sexual Health in a Social and Cultural Context: a Qualitative Study of Young Latina Lesbian, Bisexual, and Queer Women

Previous research on sexual minority and Latina women suggests that Latina lesbian, bisexual, and queer (LBQ) women may be at high risk for sexually associated and transmitted infections, but research on the sexual health and practices of this population is limited. This qualitative study explored the knowledge, attitudes, and values related to sexual health among a purposive sample of Latina LBQ women living in Seattle, WA. Latina LBQ women (N = 14) were recruited to participate in in-depth interviews about their sexual health through community organizations, flyers posted on college campuses, email and social media advertisements, and participant referrals. In-person semi-structured interviews were conducted and transcribed; transcripts were coded by two independent coders and reviewed for prominent themes. Four main themes emerged: 1) Latina sexual minorities' sexual health is shaped by their social and cultural contexts, 2) they lack needed sexual health knowledge, 3) their sexual health behaviors vary depending on the relationship status and gender of their partners, and 4) they value taking responsibility for their own sexual health. Further research is needed to better understand sexual health among Latina LBQ women and to identify ways in which their values can be leveraged to promote positive sexual health outcomes.

Addressing Health Care Disparities Among Sexual Minorities

There is evidence of health disparities between sexual minority and heterosexual populations. Although the focus of lesbian, gay, bisexual, and transgender health research has been human immunodeficiency virus/acquired immunodeficiency syndrome and sexually transmitted infection among men who have sex with men, there are health disparities among sexual minority women. Using the minority stress framework, these disparities may in part be caused by individual prejudice, social stigma, and discrimination. To ensure equitable health for all, there is urgent need for targeted culturally sensitive health promotion, cultural sensitivity training for health care providers, and intervention-focused research.

The importance of health(ism): A focus group study of lesbian, gay, bisexual, pansexual, queer and transgender individuals’ understandings of health

This study investigated understandings of health among lesbian, gay, bisexual, pansexual, queer and/or transgender people, who are under-represented in research. The study involved 12 focus groups in Aotearoa/New Zealand with 47 participants who identified as lesbian, gay, bisexual, pansexual, queer and/or transgender and responded to an advert inviting participants without chronic illnesses. Three themes were inductively formulated: health is important because education and protection efforts are seen as required to preserve health, health is seen as holistic, and contextual factors are seen as creating health risks. These findings provide insights into how lesbian, gay, bisexual, pansexual, queer and/or transgender people’s understandings of health draw upon notions of healthism.

Sexual rights but not the right to health? Lesbian and bisexual women in South Africa's National Strategic Plans on HIV and STIs

Synergies between securing sexual rights and the right to health have been pursued where there are clear public health gains to be made, such as lowering incidence of HIV and other sexually transmitted infections (STI). South Africa's 1996 Constitution outlawed discrimination on the basis of sexual orientation and promoted the right to health. This qualitative health policy analysis sought to understand why and how interventions to improve sexual health of lesbian and bisexual women and address sexual violence were initially proposed in the HIV & AIDS and STI Strategic Plan for South Africa 2007-2011 and why and how these concerns were deprioritised in the National Strategic Plan (NSP) on HIV, STIs and TB 2012-2016. A conceptual framework considered several determinants of political priority for the inclusion in NSP development in 2007 and 2011 around sexual health concerns of women who have sex with women. This article presents findings from 25 in-depth key informant interviews and document review and highlights results of application of categories for a framework on determinants of political priority for lesbian and bisexual women's issues to be included in South Africa's NSP including: actor power, ideas, political context and issue characteristics. The article demonstrates how the epidemiological and structural drivers of lesbian and bisexual women's vulnerability to HIV and STIs, including sexual violence and other violations of their sexual rights, have been expressed in policy forums and whether this has made an impact on lesbian and bisexual women's ability to claim the right to health.

SCREENING FOR SEXUALLY TRANSMITTED INFECTIONS (STIs) AMONG A HETEROGENEOUS GROUP OF WSW(M)

OBJECTIVES

This study explored predictors of STI screening among a heterogeneous group of women who have sex with women and men.

METHODS

Following bivariate analyses, a multivariate logistic regression model was conducted to assess the relationship between testing and sociodemographic, relationship characteristics.

RESULTS

The majority of participants reported not receiving STI screening in the past year. Gender expression, and not sexual orientation, was a significant predictor of screening. For each increase in masculinity, participants had lower odds of receiving an STI test.

CONCLUSIONS

More research is needed to understand how gender expression of WSW(M) relates to preventative health behaviors.

"I thought we are safe": Southern African lesbians' experiences of living with HIV

HIV-prevention and service programmes have long either ignored or overlooked lesbians. The experiences of lesbians with HIV have similarly been unrecognised and unreported. This erasure has contributed to the invisibility of lesbians in relation to HIV and related health risks. This community participatory study, based on in-depth interviews with 24 self-identifying African lesbians living with HIV in South Africa, Zimbabwe and Namibia, focuses on their personal experiences and circumstances. Women's experiences shed light and challenge popular notions around lesbian risk. In particular among this group are lesbians who self-report exclusive sexual relationships with women. For these women, experiences of living with HIV are challenging as they struggle to understand the possibility of female-to-female transmission. While battling with their own perceptions of invulnerability and accepting their HIV-positive status, they have to deal also with wide-ranging misconceptions about risk. The paper argues that within the context of HIV, lesbians cannot be regarded as a 'no-risk' group. Health services and health providers are encouraged to respond to the health needs of lesbians living with HIV.

Forced sexual experiences as risk factor for self-reported HIV infection among southern African lesbian and bisexual women

Even though women who have sex with women are usually understood to be at no or very low risk for HIV infection, we explored whether lesbian and bisexual women in a geographical area with high HIV prevalence (Southern Africa) get tested for HIV and whether, among those women who get tested, there are women who live with HIV/AIDS. The study was conducted in collaboration with community-based organizations in Botswana, Namibia, South Africa and Zimbabwe. Data were collected via written surveys of women who in the preceding year had had sex with a woman (18 years and older; N = 591). Most participating women identified as lesbian and black. Almost half of the women (47.2%) reported ever having had consensual heterosexual sex. Engagement in transactional sex (lifetime) was reported by 18.6% of all women. Forced sex by men or women was reported by 31.1% of all women. A large proportion of the women reported to ever have been tested for HIV (78.3%); number of lifetime female and male partners was independently associated with having been tested; women who had engaged in transactional sex with women only or with women and men were less likely to have been tested. Self-reported HIV prevalence among tested women who knew their serostatus was 9.6%. Besides age, the sole independent predictor of a positive serostatus was having experienced forced sex by men, by women, or by both men and women. Study findings indicate that despite the image of invulnerability, HIV/AIDS is a reality for lesbian and bisexual women in Southern Africa. Surprisingly, it is not sex with men per se, but rather forced sex that is the important risk factor for self-reported HIV infection among the participating women. HIV/AIDS policy should also address the needs of lesbian, bisexual and other women who have sex with women.

Lesbian and bisexual women's human rights, sexual rights and sexual citizenship: negotiating sexual health in England

Lesbian and bisexual women's sexual health is neglected in much Government policy and practice in England and Wales. This paper examines lesbian and bisexual women's negotiation of sexual health, drawing on findings from a small research project. Themes explored include invisibility and lack of information, influences on decision-making and sexual activities and experiences of services and barriers to sexual healthcare. Key issues of importance in this respect are homophobic and heterosexist social contexts. Drawing on understandings of lesbian, gay and bisexual human rights, sexual rights and sexual citizenship, it is argued that these are useful lenses through which to examine and address lesbian and bisexual women's sexual health and related inequalities.

What you think you know can hurt you: perceptual biases about HIV risk in intimate relationships

The use of heuristic biases and the false consensus effect can lead individuals to misperceive risk of HIV infection. The current paper presents the results of two studies which sought to examine whether individuals, (a) weigh risk relevant information accurately in their assessments of HIV risk, and (b) are susceptible to the false consensus effect in their assessments of actual intimate partner risk behaviors. The results of the first study support the hypothesis that individuals do not use objective risk information based on probability statistics in their assessments of HIV risk. In addition, the results of the second study find that female partners exhibit the false consensus effect regarding sexual risk behaviors, whereas male partners did not. Discussion centers on the role of perceptual biases in HIV risk behaviors among individuals in intimate relationships.

Sexual behaviors and sexually transmitted infections among self-identified lesbian and bisexual college women

Sexually transmitted infections (STIs) are a significant health issue for lesbian and bisexual women. Older age and having a history of sexual intercourse with males are primary risk factors for STIs among this population. However, little research has been conducted to assess sexual risk among lesbian and bisexual college women exclusively. A cross-sectional Internet survey was conducted with 230 self-identified lesbian and bisexual female college students to examine their sexual risk and to determine with which, if any, STIs they had ever been diagnosed. Eight percent of lesbian and bisexual college women reported ever being diagnosed with an STI; the human papillomavirus, bacterial vaginosis, and genital herpes accounted for 84% of STI cases. Number of lifetime sex partners was significantly associated with an STI diagnosis among this population. Older age, engaging in penile-vaginal intercourse with a male (lifetime), and younger age at first same-sex experience were significantly associated with a greater number of lifetime sex partners. Results may be useful to sexual health programs targeting lesbian and bisexual college women and/or their providers.

Absent sexual scripts: lesbian and bisexual women's knowledge, attitudes and action regarding safer sex and sexual health information

Despite recent evidence demonstrating that lesbian and bisexual women are at risk of sexually transmitted infections (STIs), there is a common perception that STIs cannot be transmitted between women. This paper reports on a study in which a self-report questionnaire, completed by over 300 lesbian and bisexual women and a comparison group of heterosexual women, was undertaken to determine lesbian and bisexual women's levels of knowledge about the human papillomavirus (HPV) and their attitudes toward the HPV vaccine and cervical smear testing. Alongside this, a series of in-depth interviews with lesbian and bisexual women explored how they perceive their level of HPV risk, the reasons why they do or do not feel at risk and how they manage their sexual health in relation to their lesbian or bisexual identity. The study concludes that lesbians generally feel at low risk for STIs because they are excluded from dominant sexual scripts that inform the negotiation of safer sex practice. Lesbians are unlikely to engage with sexual health promotion targeted toward gay men or heterosexual women, yet lesbian-specific sexual health promotion does not adequately construct an alternate discourse on safer sex that lesbians can relate to their own sexual practice.

Present but not accounted for: exploring the sexual risk practices and intervention needs of nonheterosexually identified women in a prevention program for women with HIV/AIDS

Nonheterosexually identified (NHI) women may be present, but not accounted for, in HIV and sexually transmitted infection (STI) prevention interventions. This study used quantitative and qualitative methods to examine the sexual risk behaviors and intervention needs of NHI women in Protect and Respect, a safer sex intervention for HIV-positive women. Study participants (n=32) were predominantly Black, low income, and between 28 and 51 years old. Although NHI participants were more likely than heterosexual participants (p < .05) to report obtaining their income from sex work, hustling, or selling drugs; and having a higher median number of male sex partners, qualitative analyses revealed that the intervention often neglected NHI women's experiences and unique safer sex needs. Heterosexist HIV and STI prevention programs may hinder NHI women's ability to protect themselves and their partners from reinfection and infection respectively. We discuss the implications of our research for future HIV/AIDS and STI research, services and interventions for NHI women.

HIV/STI associated risk behaviors among self-identified lesbian, gay, bisexual, and transgender college students in the United States

An Internet survey was conducted during the 2001-2002 academic year to examine the health risk behaviors, including HIV/STI associated behaviors, of self-identified lesbian, gay, bisexual, and transgender (LGBT) college students in the United States. A total of 450 LGBT college students completed the entire online survey. Most respondents attended a 4-year (96.9%), coeducational (98.6%), non-religiously affiliated (87.5%), public (68.6%) institution. Eighty-nine percent reported having sex with someone of the same sex and 45% had multiple (6 or more) sex partners during their lifetime. Most reported using a condom consistently during penile-vaginal (61%) and anal sex (63%). However, only 4% used a condom or other barrier consistently during oral sex and 28% used a condom or other barrier during their last sexual encounter. Injection drug use and needle-sharing behavior was low (2.1% and 1.1%, respectively). Comparisons with heterosexual college students' HIV/STI associated risk behaviors are included. Results may be useful for HIV/STI prevention programs targeting LGBT college students.