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

LGBTQ+ Peer Advocates' Health Communication Praxis for College Student Health Outreach and Intersectional Needs

The following essay examines health communication outreach for LGBTQ+ college students through analyzing both the design and exit evaluation of a federally funded United States public health program. SHARE-Pride was a three-year health intervention program that served LGBTQ+ students ages 18-24 at Southern University (SU)-a Hispanic and Minority Serving Institution. Because of structural barriers creating sexual health and drug and alcohol consumption risks, SHARE-Pride (SP) used a peer advocate model for students to develop mentoring relationships with LGBTQ+ peers to increase health knowledge. We first present health literature that informed SP's design and then examine research that shaped our exit study to understand advocates' intersectional identities and experiences as impacting their health communication outreach. We share rich findings from our interviews with 12 students, including communication approaches for LGBTQ+ health, increasing health communication inclusive of the full LGBTQ+ spectrum, and the role of intersectionality in LGBTQ+ health communication. We conclude with health communication praxis for future LGBTQ+ health programs and research.

Gender Differences in the Association Between Sexual Orientation and Risky Sexual Behavior Among College Students With Sexual Experience in Sichuan Province, Chinese

Background

Limited information is available regarding risky sexual behavior among college students with different sexual orientations.

Aim

The aim of this study was to examine the gender differences in the association between sexual orientation and risky sexual behavior among Chinese college students with sexual experience.

Methods

With a self-assessment questionnaire, we conducted a cross-sectional survey among 73,800 students from 25 vocational colleges (3-year colleges) in the Sichuan province of China. Multivariate logistic regression models were used to examine the association between sexual orientation and risky sexual behavior among students with sexual experience.

Outcomes

The main outcome measures used regarding risky sexual behavior are the following: condom use in the last sexual intercourse, early sexual debut, and having multiple sexual partners.

Results

12,711 students with sexual experience were included. Sexual minority students were more likely to have an early sexual debut (For male students, homosexual: OR = 1.88, P < .001; bisexual: OR = 1.96, P < .001; unsure: OR = 1.68, P < .001. For female students, homosexual: OR = 1.87, P < .01; bisexual: OR = 2.07, P < .01; unsure: OR = 1.53, P < .05), and less likely to use condoms in their last sexual intercourse (except for homosexual male students) (For male students, bisexual: OR = 0.65, P < .01; unsure: OR = 0.60, P < .001. For female students, homosexual: OR = 0.21, P < .001; bisexual: OR = 0.54, P < .001; unsure: OR = 0.68, tP < .05). There are gender differences in the association between sexual orientation and having multiple sexual partners. Male sexual minorities were more likely to have multiple sexual partners than heterosexual students (homosexual: OR = 2.06, P < .001; bisexual: OR = 1.66, P < .001; unsure: OR = 1.31, P < .05), while the same result was only observed in bisexual female students (OR = 1.46, P < .01).

Clinical Implications

Sexual health education professionals should consider the sexual orientation of students when providing counseling services or educational intervention, especially for male students and LGBT ones.

Strengths & Limitations

We examined gender differences in the association between sexual orientation and risky sexual behavior among college students with sexual experience. However, the ability for the cross-sectional survey to address causality is limited, and will be further tested in cohort studies.

Conclusion

Gender and sexual orientation affect the likelihood of risky sexual behavior among China's college students, and gender differences in the association between sexual orientation and risky sexual behavior should be noticed.

Li Y, Zhou D, Dai Y, et al. Gender Differences of the Association Between Sexual Orientation and Risky Sexual Behavior Among College Students With Sexual Experience in Sichuan Province, Chinese. Sex Med 2022;10:100547.

Bisexual people's utilization of sexual health services at an LGBTQ Community Center in Chicago

Bisexual people are at increased risk for sexually transmitted infections (STIs), including HIV. In STI data collection, bisexual people are often miscategorized as or conflated with heterosexual or gay/lesbian people. Such poor data capture practices invisibilize bisexual people and prevent the tailoring of HIV and STI services to cater to bisexual populations. The Center on Halsted (COH) is an LGBTQ community center in Chicago. COH's HIV & STD Services Department provides HIV testing to people who present for HIV screening services age 12 and older. COH also administers the State of Illinois AIDS, HIV, & STD Hotline. This manuscript reports HIV-related service access patterns of COH clients by sexual identity, with an emphasis on reporting patterns among bisexual and other non-monosexual (e.g., "bi+") populations in comparison with other sexual minority populations. Among COH's HIV testing clients who were sexual minorities in fiscal years 2018 and 2019, 15.42% in 2018 and 16.71% in 2019 identified as bisexual, respectively. Among sexual minority hotline callers, approximately one quarter (25.1% in 2018 and 28.8% in 2019) identified as bisexual. Given that bisexual individuals comprise over half of sexual minority populations, these findings indicate that bi+ individuals may be underrepresented in accessing HIV and STI services at COH. These results provide previously unknown insight into the sexual identities of populations accessing HIV- and STD-related services within a LGBTQ community setting. Funders of HIV and STI surveillance services should change reporting requirements to make visible the HIV services access patterns and outcomes of bisexual populations.

LGBTQ College Students' Experiences With University Health Services: An Exploratory Study

Access to inclusive, equitable health care is central to the wellbeing of all college students yet little is known about LGBTQ students' experiences with university health services. In this article, individual interviews with a convenience sample of 14 LGBTQ students at a large public university were analyzed to explore their perceptions of and experiences with the university's health center and its services. Our findings demonstrate that the university is not adequately meeting their health care needs. Participants' narratives offer insights into how to improve campus-based health services for LGBTQ students.

Sexual Minority Health Disparities in Adult Men and Women in the United States: National Health and Nutrition Examination Survey, 2001-2010

OBJECTIVES

We used nationally representative data to investigate health disparities associated with sexual minority status among adults in the United States.

METHODS

We analyzed data from 11,114 adults who participated in the 2001 to 2010 waves of the National Health and Nutrition Examination Survey. Using multiple logistic regressions, we examined the prevalence of HIV, sexually transmitted infections, mental health problems, cigarette smoking, and alcohol and illicit drug use in sexual minorities and heterosexual adults.

RESULTS

After adjusting for sociodemographic characteristics, sexual minority men had greater odds of mental health problems, testing positive for HIV and herpes simplex virus type 2 and self-reported gonorrhea and chlamydia. Sexual minority women had greater odds of mental health problems, testing positive for hepatitis C, smoking, heavy drinking, and illicit drug use.

CONCLUSIONS

Numerous health disparities continue to face sexual minority men and women in the United States. Notably, health disparities persisted beyond the role of sociodemographic factors, including access to insurance and primary care, suggesting that further research is warranted to identify the determinants of health inequity for sexual minorities.

An Examination of Health Inequities among College Students by Sexual Orientation Identity and Sex

Background

Lesbian, gay, and bisexual (LGB) college students may have an increased number of health inequities compared to their heterosexual counterparts. However, to date, no research has provided a comprehensive examination of health-related factors by sexual orientation identity and sex among a national sample of college students. Thus, the purpose of this study was to examine physical, sexual, interpersonal relations/safety, and mental health inequities by sexual orientation identity and sex among a national sample of college students.

Design and methods

Participants (n=39,767) completed the National College Health Assessment II during the fall 2008/spring 2009 academic year. Hierarchical binary logistic regression analyses were used to examine health inequities by sexual orientation identity and sex.

Results

LGB students compared to heterosexual students, experienced multiple health inequities including higher rates of being verbally threatened and lower rates of physical activity and condom use.

Conclusions

An understanding of health inequities experienced by LGB college students is critical as during these years of transition, students engage in protective (e.g., physical activity) and risky (e.g., lack of condom use) health behaviours, establishing habits that could last a lifetime. Future research should be used to design and implement targeted public health strategies and policies to reduce health inequities and improve health-related quality of life among LGB college students.

Misperceptions regarding protective barrier method use for safer sex among African-American women who have sex with women

BACKGROUND

Barrier methods for HIV and sexually transmissible infection (STI) prevention among women who have sex with women (WSW) are available, although their effectiveness has not been systematically investigated. These methods are infrequently used by WSW. As part of a larger study on STI risk perceptions and safer sex among African-American WSW, we discovered several misperceptions regarding barrier methods that may be associated with their limited use.

METHODS

Participants were recruited from the Jefferson County Health Department STI Clinic and through word of mouth in Birmingham, Alabama, for focus group discussions exploring perceptions of STI risk and safer sex.

RESULTS

Seven focus groups with 29 participants were conducted (age range: 19-43 years). Several misperceptions regarding barrier methods were identified, notably the conflation of dental dams and female condoms. Descriptions of the use of barrier methods were qualified with phrases suggesting their hypothetical, rather than actual, use. Additional evidence that barrier methods are not actually used came from beliefs that dental dams and female condoms are available in major grocery stores or department store chains.

CONCLUSIONS

Those providing sexual health services to WSW should be cautious in assuming that WSW have accurate information regarding barrier methods for safer sex. Sexual health services provided to WSW should include an accurate description of what barrier methods are, how to distinguish them from barrier methods more commonly used during heterosexual sex (female and male condoms), and how to use them correctly. Future studies are needed to address how effectively these measures reduce transmission of STIs among WSW.

Sexual risk behaviors and psychosocial health concerns of female-to-male transgender men screening for STDs at an urban community health center

The sexual health of female-to-male (FTM) transgender men remains understudied. De-identified electronic medical records of 23 FTMs (mean age = 32, 48% racial/ethnic minority) who screened for sexually transmitted diseases (STDs) between July and December 2007 at a Boston, Massachusetts area health center were analyzed. Almost half (48%) were on testosterone and 39% had undergone chest surgery; none had undergone genital reconstruction. The majority (57%) were bisexual, and 30% reported sex with nontransgender males only in the prior three months. One individual was HIV-infected (4.3%) and two (8.7%) had a history of STDs (all laboratory-confirmed). Overall, 26% engaged in sexual risk behavior in the prior three months (i.e., unprotected sex with a nontransgender male, condom breakage, or anonymous sex). The majority (61%) had a DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, 4th Edition) diagnosis (52% depression, 52% anxiety, and 26% adjustment disorder), and regular alcohol use was common (65%). Alcohol use, psychosocial distress histories, and sex with males only (versus with males and females) were associated with sexual risk in the past three months. Transgender men have concomitant psychosocial health vulnerabilities which may contribute to sexual risk behaviors. Future research is needed to understand the myriad social, behavioral, and biological factors that contribute to HIV and STD vulnerability for FTMs.

Use of barrier protection for sexual activity among women who have sex with women

OBJECTIVE

To assess the frequency and associations of barrier protection use during sexual activity in a population of women who have sex with women (WSW).

METHODS

WSW were invited to participate in an international internet-based survey. Information regarding ethnodemographics, sexual health, and barrier use during sexual activities was collected.

RESULTS

The study cohort comprised 1557 participants. Barrier use was least prevalent during digital genital stimulation (11.3% ever used barriers) and most prevalent during stimulation with a sex toy (34.4% ever used barriers). Univariate analysis revealed that women in non-monogamous relationships were more likely than monogamous women to always use barrier protection for sexual activity (14.3% vs 3.5%). On multivariate analysis, there was no association between barrier use and frequency of casual sexual activity or history of sexually transmitted infection. Small associations were noted between barrier use and certain sexual activities, age, race, and number of partners.

CONCLUSION

Many WSW do not use barrier protection during sexual activity, even in the context of potentially risky sexual behaviors. Safer-sex practices among WSW merit increased attention from healthcare providers and public health researchers.

Attitudes and beliefs about anti-retroviral therapy are associated with high risk sexual behaviors among the general population of Kisumu, Kenya

Attitudes and beliefs about antiretroviral therapy (ART) may affect sexual risk behaviors among the general population in sub-Saharan Africa. We performed a cross-sectional population-based study in Kisumu, Kenya to test this hypothesis in October 2006. A total of 1655 participants were interviewed regarding attitudes and beliefs about ART and their sexual risk behaviors. The majority of participants, (71%) men and (70%) women, had heard of ART. Of these, 20% of men and 29% of women believed ART cures HIV. Among women, an attitude that "HIV is more controllable now that ART is available" was associated with sex with a non-spousal partner, increased lifetime number of sexual partners as well as a younger age at sexual debut. No significant associations with this factor were found among men. The belief that "ART cures HIV" was associated with younger age of sexual debut among women. The same belief was associated with an increased likelihood of exchanging sex for money/gifts and decreased likelihood of condom use at last sex among men. These findings were most significant for people aged 15-29 years. In high HIV seroprevalence populations with expanding access to ART, prevention programs must ensure their content counteracts misconceptions of ART in order to reduce high risk sexual behaviors, especially among youth.

Sexually transmitted disease (STD) diagnoses and mental health disparities among women who have sex with women screened at an urban community health center, Boston, MA, 2007

BACKGROUND

A growing body of research documents mental health disparities among women who have sex with women (WSW) compared with women who have sex with men only (WSM). However, there remains a dearth of research exploring these indicators alongside sexually transmitted diseases (STDs) and WSW sexual health.

METHODS

A retrospective chart review was conducted of all female patients (n = 368) screened for STDs between July 2007 and December 2007 at an urban community health center in Boston, MA. Deidentified electronic medical record data (e.g., demographics, psychosocial, sexual health) were analyzed and linked to STD positivity. Women who did not have sexual behavior documented in their medical chart (n = 58) were excluded from this analysis. Bivariate and multivariable logistic regression procedures examined sexual and psychosocial health indicators, including sexual preference.

RESULTS

Twenty-seven percent of participants were WSW (17% WSW only and 10% WSW/M). Overall, 5% of WSW were diagnosed with a new STD (human papillomavirus, anogenital warts, genital herpes, pelvic inflammatory disease) and 17% had a history of a prior STD. In multivariable models adjusting for demographics, WSW were disproportionately more likely to have mental health and psychosocial issues noted in their medical records, including: a clinical diagnosis of depression, anxiety, and posttraumatic stress disorder, history of suicide attempts, and inpatient psychiatric/mental health treatment. However, WSW were significantly less likely than WSM to engage in "high risk" HIV/STD sexual behavior. In a final multivariable model, same sex behavior was not associated with a different likelihood of being diagnosed with an STD, compared with opposite sex behavior. However, WSW diagnosed with STDs were at increased odds of having bipolar disorder and utilizing outpatient mental health counseling services compared with WSW without STDs. WSW with a history of STDs were at increased odds of having attempted suicide in the past, utilizing both outpatient and inpatient mental health treatment services, and having a history of injection drug use compared with WSW without a history of STDs.

CONCLUSIONS

WSW with STDs may have presenting psychosocial problems. Further research is warranted to better understand the relationship between sexual behavior and health, as well as to guide the development of interventions to ameliorate health disparities among WSW, particularly in the psychosocial domain.