1
|
Dada D, Abu-Ba'are GR, Turner D, Mashoud IW, Owusu-Dampare F, Apreku A, Ni Z, Djiadeu P, Aidoo-Frimpong G, Zigah EY, Nyhan K, Nyblade L, Nelson LE. Scoping review of HIV-related intersectional stigma among sexual and gender minorities in sub-Saharan Africa. BMJ Open 2024; 14:e078794. [PMID: 38346887 PMCID: PMC10862343 DOI: 10.1136/bmjopen-2023-078794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 01/09/2024] [Indexed: 02/15/2024] Open
Abstract
OBJECTIVES Sexual and gender minority (SGM) populations in sub-Saharan Africa (SSA) are disproportionately impacted by HIV and often face multiple HIV-related stigmas. Addressing these stigmas could reduce SGM HIV vulnerability but little is known about how the stigmas operate and intersect. Intersectional stigma offers a lens for understanding the experiences of stigmatised populations and refers to the synergistic negative health effects of various systems of oppression on individuals with multiple stigmatised identities, behaviours or conditions. This review aims to (1) assess how often and in what ways an intersectional lens is applied in HIV-related stigma research on SGM populations in SSA and (2) understand how intersectional stigma impacts HIV risk in these populations. DESIGN Scoping review following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews. DATA SOURCES Public health and regional databases were searched in 2020 and 2022. ELIGIBILITY CRITERIA Articles in French and English on HIV-related stigma and HIV outcomes among men who have sex with men, women who have sex with women and/or transgender individuals in SSA. DATA EXTRACTION AND SYNTHESIS Articles were screened and extracted twice and categorised by use of an intersectional approach. Study designs and stigma types were described quantitatively and findings on intersectional stigma were thematically analysed. RESULTS Of 173 articles on HIV-related stigma among SGM in SSA included in this review, 21 articles (12%) applied an intersectional lens. The most common intersectional stigmas investigated were HIV and same-sex attraction/behaviour stigma and HIV, same-sex attraction/behaviour and gender non-conformity stigma. Intersectional stigma drivers, facilitators and manifestations were identified across individual, interpersonal, institutional and societal socioecological levels. Intersectional stigma impacts HIV vulnerability by reducing HIV prevention and treatment service uptake, worsening mental health and increasing exposure to HIV risk factors. CONCLUSION Intersectional approaches are gaining traction in stigma research among SGM in SSA. Future research should prioritise quantitative and mixed methods investigations, diverse populations and intervention evaluation.
Collapse
Affiliation(s)
- Debbie Dada
- School of Nursing, Yale University, New Haven, Connecticut, USA
- St Michael's Hospital Centre for Urban Health Solutions, Toronto, Ontario, Canada
| | - Gamji R Abu-Ba'are
- Center for Interdisciplinary Research on AIDS, School of Public Health, Yale University, New Haven, Connecticut, USA
- Behavioral, Sexual, and Global Health Lab, University of Rochester, Rochester, New York, USA
| | | | | | | | | | - Zhao Ni
- School of Medicine, Yale University, New Haven, Connecticut, USA
| | - Pascal Djiadeu
- St Michael's Hospital Centre for Urban Health Solutions, Toronto, Ontario, Canada
- School of Public Health, University of Toronto Dalla Lana, Toronto, Ontario, Canada
| | - Gloria Aidoo-Frimpong
- Center for Interdisciplinary Research on AIDS, School of Public Health, Yale University, New Haven, Connecticut, USA
| | - Edem Yaw Zigah
- Behavioral, Sexual, and Global Health Lab, University of Rochester, Rochester, New York, USA
| | - Kate Nyhan
- Harvey Cushing/John Hay Whitney Medical Library, Yale University, New Haven, Connecticut, USA
| | - Laura Nyblade
- Research Triangle Institute, Research Triangle Park, North Carolina, USA
| | - LaRon E Nelson
- School of Nursing, Yale University, New Haven, Connecticut, USA
- St Michael's Hospital Centre for Urban Health Solutions, Toronto, Ontario, Canada
| |
Collapse
|
2
|
Gupta N, Cookson SR. Double Disparity of Sexual Minority Status and Rurality in Cardiometabolic Hospitalization Risk: A Secondary Analysis Using Linked Population-Based Data. Healthcare (Basel) 2023; 11:2854. [PMID: 37957999 PMCID: PMC10650143 DOI: 10.3390/healthcare11212854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 10/24/2023] [Accepted: 10/28/2023] [Indexed: 11/15/2023] Open
Abstract
Studies have shown separately that sexual minority populations generally experience poorer chronic health outcomes compared with those who identify as heterosexual, as do rural populations compared with urban dwellers. This Canadian national observational study explored healthcare patterns at the little-understood intersections of lesbian, gay, or bisexual (LGB) identity with residence in rural and remote communities, beyond chronic disease status. The secondary analysis applied logistic regressions on multiple linked datasets from representative health surveys, administrative hospital records, and a geocoded index of community remoteness to examine differences in the risk of potentially avoidable cardiometabolic-related hospitalization among adults of working age. Among those with an underlying cardiometabolic condition and residing in more rural and remote communities, a significantly higher hospitalization risk was found for LGB-identified persons compared with their heterosexual peers (odds ratio: 4.2; 95% confidence interval: 1.5-11.7), adjusting for sociodemographic characteristics, behavioral risk factors, and primary healthcare access. In models stratified by sex, the association remained significant among gay and bisexual men (5.6; CI: 1.3-24.4) but not among lesbian and bisexual women (3.5; CI: 0.9-13.6). More research is needed leveraging linkable datasets to better understand the complex and multiplicative influences of sexual minority status and rurality on cardiometabolic health to inform equity-enhancing preventive healthcare interventions.
Collapse
Affiliation(s)
- Neeru Gupta
- Department of Sociology, University of New Brunswick, Fredericton, NB E3B 5A3, Canada
| | | |
Collapse
|
3
|
Wainipitapong S, Oon-arom A, Wiwattarangkul T, Vadhanavikkit P, Wiwattanaworaset P, Srifuengfung M, Chiddaycha M. Sexual Behaviors Among Lesbian, Gay, Bisexual, Transgender, and Other Sexual and Gender Diverse Medical Students: A National Study of Thai Medical Schools. INTERNATIONAL JOURNAL OF SEXUAL HEALTH : OFFICIAL JOURNAL OF THE WORLD ASSOCIATION FOR SEXUAL HEALTH 2023; 35:352-362. [PMID: 38601729 PMCID: PMC10903562 DOI: 10.1080/19317611.2023.2214801] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 05/05/2023] [Accepted: 05/12/2023] [Indexed: 04/12/2024]
Abstract
Objective This study aims to investigate sexual behaviors among gender diverse (LGBT and other sexual/gender minorities) and nongender-diverse medical students. Methods In 2021 academic year, medical students from five Thai medical schools completed questionnaires identifying demographic data, psychosexual factors, sexual experiences, and risks. Results Among 1,322 students, 32.1% were gender-diverse students who had lower age at first sexual intercourse and more experiences in solitary and partnered sexual activity. Conclusions Use of hookup applications was more frequent among gay and bisexual males. Risky sexual behaviors were significantly higher among bisexual females. Gender-diverse medical students showed higher involvement in sexual activities. Future studies should be addressing sexual health in Thai medical education.
Collapse
Affiliation(s)
- Sorawit Wainipitapong
- Department of Psychiatry, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
- Center of Excellence in Transgender Health, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Awirut Oon-arom
- Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Teeravut Wiwattarangkul
- Department of Psychiatry, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Papan Vadhanavikkit
- Department of Psychiatry, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | | | - Maytinee Srifuengfung
- Department of Psychiatry, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Mayteewat Chiddaycha
- Department of Psychiatry, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| |
Collapse
|
4
|
Wei TH, Jiang Y. Mapping the Scientific Literature on Health Needs of Women with Same-Sex Attraction in Mainland China: A Scoping Review. LGBT Health 2023; 10:263-277. [PMID: 36595507 DOI: 10.1089/lgbt.2022.0119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Purpose: This review study aimed to investigate how much and how well the unique health needs of women with same-sex attraction (WSSA) in mainland China have been studied. Methods: This review included published studies and gray reports between January 1, 1990, and March 31, 2022, regarding the health needs of Chinese WSSA. Chinese peer-reviewed journal articles, conference papers, theses, and dissertations were retrieved through the China National Knowledge Infrastructure. Studies with WSSA of mainland China as research participants were retrieved through PubMed, Embase, PsycInfo, LGBT Life, CINAHL, Web of Science, and International Bibliography of the Social Sciences. Gray reports were provided by two informaticists and eight Chinese WSSA who consented to be our stakeholders for consultation. Results: Of the 38 reviewed articles, unmet health needs of Chinese WSSA fell into three domains: mental health and substance abuse, sexual and reproductive health, and domestic, intimate partner, and dating violence, which were significantly associated with minority stress. Minority stigma was discovered to oppress Chinese WSSA by a covert and subtle pathway that makes Chinese WSSA culturally unintelligible and health care providers unprepared to provide them with respectful care. The barriers to the health care of Chinese WSSA were identified as health care providers' presumption of heterosexuality and Chinese WSSA's concealment of minority sexuality when discussing medical history. Conclusion: This scoping review is the first research effort to explore studies about the health needs of WSSA in mainland China. More research is needed with the guidance of minority stress theory to address the unique health needs of Chinese WSSA.
Collapse
Affiliation(s)
- Tao H Wei
- University of Oklahoma Health Science Center Hudson College of Public Health, Oklahoma City, Oklahoma, USA
| | - Yun Jiang
- Department of Systems, Populations, and Leadership, University of Michigan School of Nursing, Ann Arbor, Michigan, USA
| |
Collapse
|
5
|
Gil-Llario MD, Morell-Mengual V, García-Barba M, Nebot-García JE, Ballester-Arnal R. HIV and STI Prevention Among Spanish Women Who have Sex with Women: Factors Associated with Dental Dam and Condom Use. AIDS Behav 2023; 27:161-170. [PMID: 35788924 PMCID: PMC9852118 DOI: 10.1007/s10461-022-03752-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2022] [Indexed: 01/24/2023]
Abstract
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.
Collapse
Affiliation(s)
- María Dolores Gil-Llario
- grid.5338.d0000 0001 2173 938XDepartment of Developmental and Educational Psychology, University of Valencia, Valencia, Spain
| | - Vicente Morell-Mengual
- grid.5338.d0000 0001 2173 938XDepartment of Developmental and Educational Psychology, University of Valencia, Valencia, Spain
| | - Marta García-Barba
- grid.9612.c0000 0001 1957 9153Department of Basic and Clinical Psychology and Psychobiology, Jaume I University, Castelló de la Plana, Castellon Spain
| | - Juan E. Nebot-García
- grid.9612.c0000 0001 1957 9153Department of Basic and Clinical Psychology and Psychobiology, Jaume I University, Castelló de la Plana, Castellon Spain
| | - Rafael Ballester-Arnal
- grid.9612.c0000 0001 1957 9153Department of Basic and Clinical Psychology and Psychobiology, Jaume I University, Castelló de la Plana, Castellon Spain
| |
Collapse
|
6
|
Gaps in sexual health research about women who have sex with women. A scoping review. GACETA SANITARIA 2022; 36:439-445. [DOI: 10.1016/j.gaceta.2022.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 01/18/2022] [Accepted: 01/21/2022] [Indexed: 11/19/2022]
|
7
|
Surís JC, Stadelmann S, Auderset D, Barrense-Dias Y. Transactional sex among young people in Switzerland: a cross-sectional study. Sex Health 2021; 18:445-452. [PMID: 34823645 DOI: 10.1071/sh21104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 07/08/2021] [Indexed: 11/23/2022]
Abstract
Background The aim of this research was to determine the prevalence and characteristics of youths having ever exchanged sex and to assess if there were differences depending on whether they had done it once or several times. We also investigated what they exchanged sex for and their relationship with the last person they did it with. Methods A cross-sectional national survey was carried out in Switzerland in 2017 among young adults. The 5175 participants (51% males, mean age 26.3years) who answered the question 'Have you ever received something or obtained an advantage in exchange for a sexual act?' were divided into three groups: Never (96.8%), Once (1.5%) and Several (1.7%). Results In the multivariate analysis, compared to the Never group, those in the Once group were significantly more likely to be males, to have a poor mental health, to be non-exclusively heterosexual and to have had 10+ lifetime sexual partners. Those in the Several group reported the same characteristics, but were also more likely to be younger at first sexual contact, to have their parents not living together, to report a lower socioeconomic status and a history of sexual abuse, and to have ever sent sexual images/videos of themselves. They were also less satisfied with their financial situation. Conclusions Results indicate that transactional sex is a reality for some youths in Switzerland, and health professionals dealing with them should include this question in their sexual anamnesis. From a public health perspective, sexual education and prevention campaigns should include this phenomenon.
Collapse
Affiliation(s)
- Joan-Carles Surís
- Research Group on Adolescent Health, Department of Epidemiology and Health Services, Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Sophie Stadelmann
- Research Group on Adolescent Health, Department of Epidemiology and Health Services, Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Diane Auderset
- Research Group on Adolescent Health, Department of Epidemiology and Health Services, Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Yara Barrense-Dias
- Research Group on Adolescent Health, Department of Epidemiology and Health Services, Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| |
Collapse
|
8
|
Abubakari GM, Dada D, Nur J, Turner D, Otchere A, Tanis L, Ni Z, Mashoud IW, Nyhan K, Nyblade L, Nelson LE. Intersectional stigma and its impact on HIV prevention and care among MSM and WSW in sub-Saharan African countries: a protocol for a scoping review. BMJ Open 2021; 11:e047280. [PMID: 34362801 PMCID: PMC8351482 DOI: 10.1136/bmjopen-2020-047280] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
INTRODUCTION Research has established that various forms of stigma (HIV stigma, gender non-conforming stigma and same-gender sex stigma) exist across Sub-Saharan Africa and have consequences for the utilisation of HIV prevention and care services. Stigmas are typically investigated in HIV literature individually or through investigating individual populations and the various stigmas they may face. The concept of intersectionality highlights the interconnected nature of social categorisations and their ability to create interdependent systems of discrimination based on gender, race, sexuality and so on. Drawing from perspectives on intersectionality, intersectional stigma denotes the convergence of multiple marginalised identities within an individual or a group, the experiences of stigma associated with these identities as well as the synergistic impact of these experiences on health and well-being. With respect to HIV, public health scholars can examine the impacts of intersectional stigmas on HIV prevention and care utilisation. METHODS AND ANALYSIS Reviewers will search systematically through MEDLINE, Global Health, Embase, Scopus, Web of Science Core Collection and Africa Index Medicus and citations for quantitative studies, qualitative studies and grey literature that include data on stigma and HIV among men who have sex with men and women who have sex with women in Sub-Saharan Africa. Eligible studies will include primary or secondary data on stigma related to HIV risk factors experienced by this population. Studies will be written in French or English and be published between January 1991 and November 2020. All screening and data extraction will be performed in duplicate, and if discrepancies arise, they will be settled by GM'RA, LEN, DD or AO. Findings from this study will be reported according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews. ETHICS AND DISSEMINATION Ethics approval is not required as there will be no human participants and no protected data will be used in this study. We will disseminate findings through peer-reviewed manuscripts, conferences and webinars.
Collapse
Affiliation(s)
- Gamji M'Rabiu Abubakari
- Center for Interdisciplinary Research on AIDS, Yale University School of Public Health, New Haven, Connecticut, USA
| | - Debbie Dada
- Yale University School of Nursing, New Haven, Connecticut, USA
- St Michael's Hospital Centre for Urban Health Solutions, Toronto, Ontario, Canada
| | - Jemal Nur
- St Michael's Hospital Centre for Urban Health Solutions, Toronto, Ontario, Canada
| | - DeAnne Turner
- Center for Interdisciplinary Research on AIDS, New Haven, Connecticut, USA
| | - Amma Otchere
- Yale University School of Nursing, New Haven, Connecticut, USA
| | - Leonne Tanis
- Yale University School of Nursing, New Haven, Connecticut, USA
| | - Zhao Ni
- Yale University School of Medicine, New Haven, Connecticut, USA
| | | | - Kate Nyhan
- Harvey Cushing/John Hay Whitney Medical Library, Yale University, New Haven, Connecticut, USA
| | - Laura Nyblade
- Global Health Division, International Development Group RTI, Internation, New York, New York, USA
| | - LaRon E Nelson
- Yale University School of Nursing, New Haven, Connecticut, USA
- St Michael's Hospital Centre for Urban Health Solutions, Toronto, Ontario, Canada
| |
Collapse
|
9
|
Rahman N, Ghanem KG, Gilliams E, Page KR, Tuddenham S. Factors associated with sexually transmitted infection diagnosis in women who have sex with women, women who have sex with men and women who have sex with both. Sex Transm Infect 2020; 97:423-428. [PMID: 33122425 DOI: 10.1136/sextrans-2020-054561] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 08/27/2020] [Accepted: 09/27/2020] [Indexed: 01/16/2023] Open
Abstract
INTRODUCTION Many US women report same sex behaviour, yet data on risk factors and STIs in women who have sex with women (WSW), women who have sex with both men and women (WSB) and how these compare to women who have sex with men only (WSM) remain limited. Here we compared self-identified WSW, WSB and WSM attending two STI clinics in Baltimore, Maryland. METHODS This was a retrospective analysis using a database of first clinic visits 2005-2016. WSW and WSB were compared with an age-matched random sample of WSM. Proportions were compared using the χ2 test. Acute STI (aSTI) was defined as gonorrhoea (Neisseria gonorrhoeae, GC), chlamydia (Chlamydia trachomatis, CT), trichomonas (Trichomonas vaginalis, TV) or early syphilis. Logistic regression was used to assess aSTI predictors. CT testing was not uniformly done, so a sensitivity analysis removing CT from the aSTI definition was conducted. RESULTS Visits from 1095 WSW, 1678 WSB and 2773 WSM were analysed. WSB had equal or higher test positivity for all STIs except urogenital chlamydia, had more sexual partners, were more likely to engage in transactional sex and were more likely to report drug use and binge drinking than WSM (p≤0.01). WSW had lower test positivity for urogenital GC and CT than WSM or WSB, but comparable test positivity for TV, higher reported binge drinking and comparable reported substance use as WSM. Younger age and cocaine use predicted STI diagnosis only in WSM. CONCLUSIONS WSB in these clinics bear an equal or higher burden of most STIs, have more partners and report more substance use than WSM. WSW carry a lower, but still substantial burden of STIs, and many report substance use. Factors predicting STI diagnosis differ between WSW, WSB and WSM suggesting that tailored STI prevention and testing approaches are needed in these groups.
Collapse
Affiliation(s)
- Nazia Rahman
- Henry M Jackson Foundation for the Advancement of Military Medicine, USU Preventive Medicine and Biostatistics, Bethesda, Maryland, USA.,Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Khalil G Ghanem
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Elizabeth Gilliams
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Baltimore City Health Department, Division of Population Health and Disease Prevention, Sexual Health Clinics, Baltimore, Maryland, USA
| | - Kathleen R Page
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Susan Tuddenham
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| |
Collapse
|
10
|
Wikramanayake RM, Paschen-Wolff MM, Matebeni Z, Reddy V, Southey-Swartz I, Sandfort TGM. Southern African Lesbian and Bisexual Women Responses to Symptoms of Sexually Transmitted Infections. ARCHIVES OF SEXUAL BEHAVIOR 2020; 49:1887-1902. [PMID: 31950379 PMCID: PMC7321908 DOI: 10.1007/s10508-019-01581-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 10/11/2019] [Accepted: 10/31/2019] [Indexed: 06/10/2023]
Abstract
Sexually transmitted infection (STI) in lesbian and bisexual women is a relatively unexplored topic, particularly for women from low- and middle-income countries. Despite perceptions that women who have sex with women (WSW) are at negligible risk of contracting STI, existing research demonstrates that WSW do become infected with STI. Given the opposition between assumptions of invulnerability and the observed risks, we explored how WSW would respond to symptoms of STI (i.e., wait until symptoms passed, see a medical doctor, and inform sexual partners). We used data collected as part of a collaboration between academic researchers and community-based LGBTQ organizations in Botswana, Namibia, South Africa, and Zimbabwe. Chi-squared tests were used to test whether participants' responses to hypothetical STI symptoms varied in relation to several intrapersonal, interpersonal, and structural factors. Multivariable logistic regression (backward) was used to assess whether these variables were independently associated with women's responses. Most women would be proactive in response to potential STI symptoms and would see a medical doctor. However, most women would not inform their sexual partner of symptoms of STI. Findings demonstrate several intrapersonal, interpersonal, and structural factors that influence WSW's health agency, and show a clustering of high-risk factors among women who would not be proactive about their health. Our findings suggest the need for improved health and health care of WSW in Southern Africa.
Collapse
Affiliation(s)
- Radhika M Wikramanayake
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY, 10032, USA
| | - Margaret M Paschen-Wolff
- Department of Psychiatry, Division on Substance Use Disorders, New York State Psychiatric Institute, Columbia University Irving Medical Center, New York, USA
| | - Zethu Matebeni
- Department of Sociology, University of the Western Cape, Cape Town, South Africa
| | - Vasu Reddy
- Faculty of the Humanities, University of Pretoria, Pretoria, South Africa
| | | | - Theo G M Sandfort
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY, 10032, USA.
- Department of Psychology, University of Pretoria, Pretoria, South Africa.
| |
Collapse
|
11
|
Paschen-Wolff MM, Reddy V, Matebeni Z, Southey-Swartz I, Sandfort T. HIV and sexually transmitted infection knowledge among women who have sex with women in four Southern African countries. CULTURE, HEALTH & SEXUALITY 2020; 22:705-721. [PMID: 31345116 PMCID: PMC6982583 DOI: 10.1080/13691058.2019.1629627] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 06/05/2019] [Indexed: 06/10/2023]
Abstract
Women who have sex with women in Southern Africa, where HIV prevalence is high, are often presumed to have minimal risk for sexually transmitted infections (STI) and HIV despite research documenting female-to-female transmission. This study examined the demographic and social factors contributing to female-to-female STI/HIV transmission knowledge among Southern African women who have sex with women using an integrated model of health literacy. In collaboration with community-based organisations in Botswana, Namibia, South Africa and Zimbabwe, data were collected through anonymous surveys (N = 591). Multivariable stepwise forward logistic regression assessed independent associations between participant characteristics and high vs. low knowledge using five items. Overall, 64.4% (n = 362) of women had high knowledge; 35.6% (n = 200) had low knowledge. Higher education (adjusted odds ratio [aOR]: 2.24, 95% confidence interval [CI]: 1.48, 3.40), regular income (aOR: 2.14, 95% CI: 1.43, 3.21), residence in Botswana (aOR: 3.12, 95% CI: 1.15, 8.48) and having ever received tailored STI/HIV information (aOR: 2.17, 95% CI: 1.41, 3.32) predicted significantly higher odds of high knowledge in the final multivariable model. Results suggest opportunities for peer-led sexual health programming and expanded HIV prevention campaigns addressing women who have sex with women.
Collapse
Affiliation(s)
- Margaret M. Paschen-Wolff
- HIV Center for Clinical and Behavioral Studies at the NY State Psychiatric Institute and Columbia University, Department of Psychiatry, Division of Gender, Sexuality, and Health, New York, NY, USA
| | - Vasu Reddy
- Faculty of Humanities, University of Pretoria, Hatfield, South Africa
| | - Zethu Matebeni
- Department of Anthropology and Sociology, University of the Western Cape, Bellville, South Africa
| | | | - Theodorus Sandfort
- HIV Center for Clinical and Behavioral Studies at the NY State Psychiatric Institute and Columbia University, Department of Psychiatry, Division of Gender, Sexuality, and Health, New York, NY, USA
- Department of Psychology, University of Pretoria, Hatfield, South Africa
| |
Collapse
|
12
|
Rodríguez-Otero LM. [Literature review on studies of women who have sex with women]. Medwave 2020; 20:e7884. [PMID: 32343685 DOI: 10.5867/medwave.2020.03.7884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 03/27/2020] [Indexed: 11/27/2022] Open
Abstract
Women who have sex with other women are a group that has been mostly invisible from public health policies. This category includes the group of lesbians, bisexual women, heterosexual behaviour, and homosexual practices, who have sexual relations with transsexual and transgender (trans) women and trans men who have sex with women. In the absence of a Spanish literature review of a study that addresses women who have sex with other women, a narrative bibliographic review was done using the PubMed/MEDLINE, Scopus, Dialnet, and Taylor and Francis databases. From a universe of 679 articles and after applying the inclusion criteria, 40 documents were analysed, from 1998 to 2019. Three meta-categories were identified (sexual education, the incidence of certain sexually transmitted infections, and aspects related to sexual practices), concerning prevention and risky behaviours. Women who have sex with other women are a particularly vulnerable group when it comes to sexually transmitted infections. These may include bacterial vaginitis, human papillomavirus and acquired immunodeficiency virus. Likewise, there is a lack of specific training and information in health and education professionals, as well as in women who have sex with other women.
Collapse
Affiliation(s)
- Luis Manuel Rodríguez-Otero
- Facultad de Trabajo Social y Desarrollo Humano, Universidad Autónoma de Nuevo León, Nuevo León, México. . ORCID: 0000-0002-1748-9303
| |
Collapse
|
13
|
Tseng YH, Cheng CP, Kuo SH, Hou WL, Chan TF, Chou FH. Safe sexual behaviors intention among female youth: The construction on extended theory of planned behavior. J Adv Nurs 2019; 76:814-823. [PMID: 31774190 DOI: 10.1111/jan.14277] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 11/07/2019] [Accepted: 11/19/2019] [Indexed: 01/02/2023]
Abstract
AIM To examine female youth's intentions for safe sex with the relationship partners based on the extended theory of planned behaviour (TPB) model and explore the direct and indirect impact of parent-child communication about sex, peer interaction related to sexual issues, and exposure to sexually explicit materials on female youth's safe sexual behaviour intentions. DESIGN A non-experimental, cross-sectional research design. METHODS A convenience sampling was employed for data collection and 731 female youth aged 15-24 years old were recruited in 2013-2014. An anonymous, self-report structured questionnaire was used as a research instrument to collect participants' basic information and measure the internal and additional variables in the extended TPB model. RESULTS The extended TPB model explained 42-45% of the total variance. Perceived behavioural control (PBC) and subjective norms had a positive effect on female youth's intentions for contraceptive use, condom use, and dual use with relationship partner; PBC was found to have the greatest influence. Among the additional variables in the extended TPB model, more parent-child communication about sex was found to lead to more positive dual use intentions. More peer interaction related to sexual issues was found to lead to less dual use intentions. CONCLUSIONS To improve female youth's sexual health, the priorities are to reinforce their PBC and subjective norms and enhance parent-child communication about sex. Future efforts should strengthen sex education in families and schools and shape a social environment that facilitates safe sex. IMPACT The extended TPB model can successfully predict female youth's safe sexual behaviour intentions. Empowering female youth to establish a sense of subjectivity and awareness of being a mature individual with physical autonomy, is importance for their sexual health.
Collapse
Affiliation(s)
- Ying-Hua Tseng
- College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chung-Ping Cheng
- Department of Psychology, National Cheng Kung University, Tainan, Taiwan
| | - Shih-Hsien Kuo
- College of Medical and Health Science, Fooyin University, Kaohsiung, Taiwan
| | - Wen-Li Hou
- College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Te-Fu Chan
- Department of Obstetrics and Gynecology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Fan-Hao Chou
- College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan
| |
Collapse
|
14
|
Logie CH, Wang Y, Marcus N, Levermore K, Jones N, Ellis T, Bryan N. Syndemic Experiences, Protective Factors, and HIV Vulnerabilities Among Lesbian, Gay, Bisexual and Transgender Persons in Jamaica. AIDS Behav 2019; 23:1530-1540. [PMID: 30600454 DOI: 10.1007/s10461-018-2377-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Syndemics approaches explore the convergence of psychosocial factors that elevate HIV vulnerabilities. Less research has explored syndemics among lesbian, gay, bisexual and transgender (LGBT) persons in contexts where criminalization has downstream impacts on LGBT discrimination, such as Jamaica. We implemented a cross-sectional survey with LGBT persons (n = 911) in Jamaica. We conducted structural equation modeling to examine direct and indirect effects of a latent syndemics construct (binge drinking, depressive symptoms, childhood/adult abuse) on HIV vulnerabilities (lifetime sex partners, perceived HIV risk, condom self-efficacy) and the mediating role of protective factors (social support, resilient coping). Direct paths from syndemics to lifetime sex partners, perceived HIV risk, and condom self-efficacy were significant. Resilient coping and social support partially mediated the association between syndemics and condom use self-efficacy. Resilient coping partially mediated the relationship between syndemics and lifetime sex partners. Interventions can target syndemic issues to reduce HIV vulnerabilities among Jamaican LGBT persons.
Collapse
Affiliation(s)
- Carmen H Logie
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street, Toronto, ON, M5S 1V4, Canada.
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada.
| | - Ying Wang
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street, Toronto, ON, M5S 1V4, Canada
| | - Natania Marcus
- Department of Applied Psychology and Human Development, University of Toronto, Toronto, ON, Canada
| | | | | | - Tyrone Ellis
- Jamaica AIDS Support for Life, Kingston, Jamaica
| | | |
Collapse
|
15
|
Caceres BA, Jackman KB, Ferrer L, Cato KD, Hughes TL. A scoping review of sexual minority women's health in Latin America and the Caribbean. Int J Nurs Stud 2019; 94:85-97. [PMID: 30947062 PMCID: PMC6570531 DOI: 10.1016/j.ijnurstu.2019.01.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2018] [Revised: 01/20/2019] [Accepted: 01/25/2019] [Indexed: 12/29/2022]
Abstract
OBJECTIVES Despite research documenting significant health disparities among sexual minority women (lesbian, bisexual, and other non-heterosexual women) in high-income countries, few studies of sexual minority women's health have been conducted in low- and middle-income countries. The purpose of this scoping review was to examine the empirical literature related to the health disparities and health needs of sexual minority women in Latin America and the Caribbean (LAC), and to identify research gaps and priorities. DESIGN A scoping review methodology was used. DATA SOURCES We conducted a comprehensive search of seven electronic databases. The search strategy combined keywords in three areas: sexual minority women, health, and LAC. English, Spanish, and Portuguese language studies published through 2017 in peer-reviewed journals were included. REVIEW METHODS A total 1471 articles were retrieved. An additional 5 articles were identified following descendancy search; 3 of these met inclusion criteria. After removal of duplicates and title and abstract screening, we screened the full text of 37 articles, of which 22 (representing 18 distinct studies) met inclusion criteria. At least two authors independently reviewed and abstracted data from all articles. RESULTS More than half of the studies were conducted in Brazil (n = 9) and Mexico (n = 5). Sexual health was the most studied health issue (n = 11). Sexual minority women were at elevated risk for sexually transmitted infections related to low use of barrier contraceptive methods during sexual encounters with men. Findings suggest that sexual minority women are generally distrustful of healthcare providers and view the healthcare system as heteronormative. Providers are believed to lack the knowledge and skills to provide culturally competent care to sexual minority women. Sexual minority women generally reported low levels of sexual health education and reluctance in seeking preventive screenings due to fear of mistreatment from healthcare providers. Sexual minority women also reported higher rates of poor mental health, disordered eating, and substance use (current tobacco and alcohol use) than heterosexual women. Gender-based violence was identified as a significant concern for sexual minority women in LAC. CONCLUSIONS Significant knowledge gaps regarding sexual minority women's health in LAC were identified. Additional investigation of understudied areas where health disparities have been observed in other global regions is needed. Future research should explore how the unique social stressors sexual minority women experience impact their health. Nurses and other healthcare providers in the region need training in providing culturally appropriate care for this population.
Collapse
Affiliation(s)
| | | | - Lilian Ferrer
- Director of International Affairs, School of Nursing, Pontificia Universidad Catolica de Chile, Chile
| | - Kenrick D Cato
- Columbia University School of Nursing, New York-Presbyterian Hospital, United States
| | | |
Collapse
|
16
|
Paul Poteat V, Russell ST, Dewaele A. Sexual Health Risk Behavior Disparities Among Male and Female Adolescents Using Identity and Behavior Indicators of Sexual Orientation. ARCHIVES OF SEXUAL BEHAVIOR 2019; 48:1087-1097. [PMID: 29204816 PMCID: PMC10388691 DOI: 10.1007/s10508-017-1082-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 09/05/2017] [Accepted: 09/12/2017] [Indexed: 05/15/2023]
Abstract
Sexual minority adolescent sexual risk behavior studies often overlook young women, do not consider behavior- and identity-based sexual orientation indicators in combination, and focus mainly on condomless sex. We examined multiple risk behaviors in a large sample of adolescent young men and women using combined behavior- and identity-based indices. The 2015 Dane County Youth Assessment data included 4734 students in 22 high schools who had ever voluntarily engaged in sexual contact (51.7% male; 76.0% White, non-Hispanic). Items assessed having sex with unfamiliar partners, sex while using substances, using protection, and STI testing. Logistic regressions tested for disparities based on combined identity- and behavior-based sexual orientation indicators. For both young men and women, youth who reported heterosexual or questioning identities-but who had sex with same-sex partners-were at consistently greater risk than heterosexual youth with only different-sex partners. Also, for both young men and women, bisexuals with partners of both sexes more consistently reported higher risk than heterosexual youth than did bisexuals with only different-sex partners. Risk behavior for gay young men who had sex only with men mirrored those in extant literature. Risk levels differed for specific groups of sexual minority young women, thus deserving further attention. Findings underscore the need for sexual health research to consider sexual orientation in a more multidimensional manner.
Collapse
Affiliation(s)
- V Paul Poteat
- Department of Counseling, Developmental, and Educational Psychology, Boston College, Campion Hall 307, 140 Commonwealth Ave, Chestnut Hill, MA, 02467, USA.
| | - Stephen T Russell
- Department of Human Development and Family Sciences, University of Texas, Austin, TX, USA
| | - Alexis Dewaele
- Experimental-Clinical and Health Psychology, Ghent University, Ghent, Belgium
| |
Collapse
|
17
|
Kowalczyk R, Nowosielski K. Impact of social factors and sexual behaviors on the knowledge of sexually transmitted infections among women who have sex with women/women who have sex with women and men. Int J STD AIDS 2018; 30:163-172. [PMID: 30348067 DOI: 10.1177/0956462418802736] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Although heterosexual individuals' knowledge of sexually transmitted infections (STIs) has been examined, no studies have been conducted in Poland of the STI knowledge in women who have sex with women (WSW) and women who have sex with women and men (WSWM). We enrolled a group of 146 WSW and 113 WSWM and asked them to complete a study questionnaire that contained items about socioeconomic factors, sexual behaviors, and STI knowledge. The level of STI knowledge among the studied WSW was insufficient. The frequency of correct answers was higher in WSWM. A multivariate regression model revealed that only the higher importance of sex to the respondents ( F(1) = 4.31, p = 0.04) and a higher number of same-sex sexual partners within the last 12 months ( F(1) = 14.86, p = 0.0001) influenced the level of STI knowledge. The results of the study allowed us to conclude that WSW have insufficient STI knowledge, whereas WSWM have better knowledge, and this is influenced by awareness that STI risk is not associated with the partner's gender, age, importance of sex, sexual behaviors, and openness to discussing STIs with a sexual partner.
Collapse
Affiliation(s)
- Robert Kowalczyk
- 1 Department of Sexology, Andrzej Frycz Modrzewski Cracow University, Kraków, Poland
| | - Krzysztof Nowosielski
- 2 Department of Sexology and Family Planning, Medical College in Sosnowiec, Sosnowiec, Poland
| |
Collapse
|
18
|
Gereige JD, Zhang L, Boehmer U. The Sexual Health of Women in Lebanon: Are There Differences by Sexual Orientation? LGBT Health 2017; 5:45-53. [PMID: 29130791 DOI: 10.1089/lgbt.2017.0031] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE From studies conducted in Western countries (United States, United Kingdom, and Australia), we know that the sexual health of sexual minority women (SMW) differs in key ways from that of heterosexual women (HSW). To date, the sexual health of SMW living in the Middle East and North Africa region has not been studied. The purpose of this study was to compare the sexual health of SMW and HSW living in Lebanon. METHODS SMW and HSW living in Lebanon (N = 95) completed an anonymous, self-administered survey. SMW's risk perceptions and health promoting and sexual behaviors were compared to those of HSW. We examined differences by sexual orientation by using t tests and Fisher's exact tests. RESULTS The 45 SMW and 50 HSW had similar demographic characteristics. Significantly more SMW had heard of human papillomavirus, but only 22% of women from both groups knew of its association with abnormal Papanicolaou tests. Cervical cancer screening rates were similar in SMW and HSW, although remarkably low (42%) compared with rates in Western countries. Significantly more SMW (18%) reported difficulty with access to care than HSW (0%). Forty-four percent of SMW reported discomfort in disclosing their sexual orientation to their healthcare provider and 61% reported that healthcare providers lacked sensitivity toward lesbian, gay, bisexual, and transgender needs. Unwanted sexual contact occurred more frequently in SMW (53%) than HSW (23%). CONCLUSION The sexual health of women is affected by sociocultural factors. SMW living in Lebanon have unique health needs that should be addressed within their sociocultural context.
Collapse
Affiliation(s)
- Jessica D Gereige
- 1 Department of Internal Medicine, Massachusetts General Hospital , Boston, Massachusetts.,2 Harvard Medical School , Boston, Massachusetts
| | - Li Zhang
- 3 Department of Biostatistics, Boston University School of Public Health , Boston, Massachusetts
| | - Ulrike Boehmer
- 4 Department of Community Health Sciences, Boston University School of Public Health , Boston, Massachusetts
| |
Collapse
|
19
|
Zaidi SS, Ocholla AM, Otieno RA, Sandfort TGM. Women Who Have Sex with Women in Kenya and Their Sexual and Reproductive Health. LGBT Health 2015; 3:139-45. [PMID: 26684690 DOI: 10.1089/lgbt.2014.0121] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE To describe sexual and reproductive health characteristics of women who have sex with women (WSW) in Kenya's three most populous cities: Kisumu, Mombasa, and Nairobi. Although the last decade has shown an upsurge of health-related research studies in African sexual minority populations, these studies have generally concentrated on the health status of men who have sex with men to the exclusion of WSW. This study presents the first findings on Kenyan WSW's sexual and reproductive health. METHODS A community-based, cross-sectional survey was conducted among 280 women who were at least 18 years old, had at least one female sexual partner in the past three years, and were Kenyan residents. RESULTS A significant proportion of participants reported that they had at least one male sexual partner in the past three years (38.9%), ever had an abortion (13.2%), been infected with at least one sexually transmitted infection (STI) in the past three years (33.9%), and been tested for HIV at least once (88.9%). Of the women who reported having been tested for HIV, 9.4% (7.5% of the total sample) received a positive test result. Some women noted that they were open with their doctors about their sexual orientation, and that their doctors had not reacted negatively to this information. CONCLUSION WSW in Kenya are at risk for negative sexual and reproductive health outcomes, including HIV, STIs, unplanned pregnancy, and unsafe abortion, positioning these women as a critical population for public health efforts. Some WSW actively exercise their agency in making important health decisions. Therefore, this study indicates a need to incorporate WSW's health concerns within Kenyan national health policy programming.
Collapse
Affiliation(s)
- Sidra S Zaidi
- 1 Division of Gender, Sexuality and Health, Department of Psychiatry, Columbia University , New York, New York.,2 New York State Psychiatric Institute , New York, New York
| | | | | | - Theo G M Sandfort
- 1 Division of Gender, Sexuality and Health, Department of Psychiatry, Columbia University , New York, New York.,2 New York State Psychiatric Institute , New York, New York
| |
Collapse
|