Sexual Stigma and Safer Sex Practices Among Lesbian, Bisexual and Queer Women in Toronto, Canada
Sexual health issues among lesbian, bisexual and queer (LBQ) women have been described as invisible, ignored and understudied. While LBQ women are often perceived at low risk for sexually transmitted infections (STIs), including HIV infection, evidence demonstrates transmission of STIs such as trichomoniasis, human papillomavirus, bacterial vaginosis, herpes, and hepatitis B between women. A large body of evidence demonstrates that sexual stigma, the devaluing of sexual minority identities, relationships and communities, is a barrier to safer sex practices among men who have sex with men. Yet scant research has examined the influence of sexual stigma on safer sex practices among LBQ women. This study examined associations between sexual stigma and safer sex practices among LBQ women in Toronto, Canada.
Intersectionality, the interdependent and mutually constitutive relationship between social identities and structural inequities, was the study’s guiding theoretical approach. We implemented a cross-sectional internet-based survey to a peer-driven recruitment sample of LBQ women in Toronto. Survey items were pilot tested with diverse LBQ women and modified based on participant feedback to enhance content validity. We conducted hierarchical block multiple linear regression (MLR) analyses to examine associations between independent (block 1: perceived sexual stigma; enacted sexual stigma; sexually transmitted infections (STI) knowledge; block 2: resilient coping; social support subscales: family, friends, significant other) and dependent variables (safer sex practices).
One-fifth (20.0%) of participants (n=444) (mean age= 31.4, SD 8.12; median annual income=$26,000 USD; 34.3% racial/ethnic minority; 46.4% queer, 28.6% lesbian, 16.2% bisexual, 4.3% gay, 4.5% other) reported ever having an STI. The majority of participants experienced perceived (96.3%) and enacted (83.4%) sexual stigma. Bisexual women were significantly more likely to have had an STI, and experienced higher levels of enacted sexual stigma, than non-bisexual women. Women of color experienced higher enacted sexual stigma and lower social support than Caucasians. Approximately half of participants (46.8%) believed their health care provider (HCP) was not knowledgeable about issues facing LBQ women and one-third (32.2%) reported their HCP did not know they were LBQ. In MLR analyses, lower enacted sexual stigma and higher STI knowledge were associated with safer sex practices, adjusted R2=0.11, F(3,364)=15.35, p<0.001. Higher resilient coping and higher social support (family, friends) were significantly associated with increased safer sex practices after controlling for enacted/perceived sexual stigma and STI knowledge, adjusted R2=0.14, F(4,360)=8.95, p<0.01.
Conclusions and Implications:
Enacted sexual stigma was significantly associated with reduced safer sex practices among LBQ women; STI knowledge, resilient coping, and social support were associated with increased safer sex practices. Health promotion and HIV/STI prevention interventions should be tailored for LBQ women of diverse sexual identities and ethnicities and aim to increase STI knowledge, build protective factors such as resilient coping and social support, and challenge sexual stigma. Social workers based at community health centers, hospitals and sexual health clinics should incorporate sexual orientation into assessments and acquire knowledge regarding LBQ women’s health. Social workers can also advance HCP’s awareness and knowledge about LBQ women’s health issues and develop inclusive practice models for promoting LBQ women’s sexual health.