Sexual Violence, Stigma and Health Outcomes Among Sexual Minority Women in Toronto, Canada
Lesbian, bisexual, and queer (LBQ) women experience sexual violence at similar or higher rates than heterosexual women. Most research with LBQ women, however, has focused on measuring prevalence of sexual violence but not its association with health outcomes and stigma. The objective of this study was to contribute to understanding regarding associations between experiences of sexual violence and: health (depression, sexually transmitted infections [STI], self-rated health), sexual health service utilization (HIV and STI testing), intrapersonal factors (self-esteem, resilient coping), interpersonal factors (safer sex practices, social support) and community factors (sexual stigma) among sexual minority women in Toronto, Canada.
Our study was informed by the social ecological framework that examines how individual behavior and health outcomes are shaped by interpersonal, intrapersonal, and community factors. We implemented a cross-sectional internet-based survey to a peer-driven recruitment sample of LBQ women in Toronto, Canada. Survey items were pilot tested with a diverse group of LBQ women and modified based on participant feedback to enhance content validity. Multivariate logistic regression analyses were conducted to assess correlates of having experienced forced sex.
The majority 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) experienced perceived (96.3%) and enacted (83.4%) sexual stigma. Almost half (41.7%) reported experiencing forced sex. One-fifth of those with a history of forced sex reported being sexually assaulted because of their sexual orientation. Over 40% of participants reported depression symptoms, and over 20% reported ever being diagnosed with a STI. Participants with a lesbian identity were significantly less likely to have experienced forced sex than those with a queer identity (OR: 0.59 [CI: 0.37, 0.95], p<0.05). When controlling for socio-demographic characteristics, having experienced forced sex was associated with significantly higher rates of depression (OR 1.19 [CI: 1.03, 1.37], p<0.05), a history of STI (OR: 1.93 [CI: 1.10, 3.37], p<0.05), having received an STI test (OR: 2.76 [CI: 1.34, 5.69], p<0.05), higher rates of sexual stigma (overall) (OR: 1.12 [CI: 1.07, 1.17], p<0.001), enacted sexual stigma (OR: 3.53 [CI: 1.98, 6.29], p<0.001), perceived sexual stigma (OR: 1.77 [CI: 1.26, 2.48], p<0.001) and homophobic sexual assault (OR: 2.74 [CI: 1.35, 5.60], p<0.05). A history of forced sex was associated with lower: self-rated health (OR: 0.70 [CI: 0.54, 0.94], p<0.05), social support from family (OR: 0.94 [CI: 0.89, 0.99], p<0.05) and self-esteem (OR: 0.64 [CI: 0.50, 0.81], p<0.001).
Conclusions and Implications:
A substantial proportion of sexual minority women experienced forced sex, indicating the importance of addressing sexual violence targeting women as well as homophobic sexual violence. Experiencing forced sex was associated with deleterious health outcomes (lower self-rated health, increased depression, increased STI) as well as intrapersonal (lower self-esteem), interpersonal (reduced social support) and community-level factors (increased sexual stigma). Sexual minority women with a history of forced sex were more likely to utilize STI testing services. This research highlights the need for interventions targeting LBQ women to address depression, STI, and trauma associated with forced sex.