Project Proposal
Sexual minority women, that is women who do not identify as exclusively heterosexual, have
been found to be at increased risk for certain mental and physical health problems.1,2 Within
sexual minority women, significant health disparities have been reported for women who have
sex with women and men (WSWM) as compared to women who exclusively have sex with
women (WSW).3,4 There is research finding greater substance use and poorer physical and
mental health outcomes for bisexual women as compared to lesbian and heterosexual women,5,6
including research which has found greater STI and incidence and sexual risk behaviors (more
sexual partners, less protected sex) in this population.7-10 There is also evidence that sexual
minority women may be underserved by current HIV prevention efforts.11
The methods used in ISIS identified a subsample of women with a sexual minority orientation
who have also had recent sex with a man, a population that has been found to be at greater risk
for health and mental health problems. Specifically, ISIS assessed sexual orientation with two
response options that indicated sexual minority status (lesbian and bisexual) while also requiring
that women had had recent sexual contact with a man to enroll. Although the ISIS dataset lacks
information about sexual contact with women, it assesses sexual behavior with male partners in
great detail. Hence, it would provide a unique opportunity to investigate the extent to which
sexual minority women who have sex with men practice behaviors that put them at increased risk
of sexually transmitted infections, including HIV, as compared to women who identify as
exclusively heterosexual.
There is evidence that women who identify as bisexual or lesbian, but have had sex with men,
may have more transactional sexual relationships which may in turn relate to riskier
sex.7,9,12 Some research has found that women who have sex with woman and men are more
likely to have sex with bisexual men,8,9,13,14 a demographic group which has also been found to
be at increased risk of HIV infection as compared to exclusively heterosexual men.15 Bisexual
women have also been found to have greater rates of childhood sexual abuse,16 greater
depression and suicidal ideation,4 and greater substance use5 as compared to lesbian and
heterosexual women.
Because the ISIS data were collected from a group of high-risk women, an investigation of
sexual minority women in ISIS can make a unique contribution. Although not representative of
all sexual minority women, these analyses may provide insights into potential intervention
targets for an underserved group of women. The dataset includes several variables that have
been found significant in recent research on risk in sexual minority women including unprotected
sexual intercourse, transactional sex, self-reported STIs, substance use, childhood abuse, and
traumatic stress symptoms. The longitudinal nature of the dataset allows for a prospective
investigation of relationships among these factors.
To address the issues outlined above using this dataset, in the proposed research, I aim to:
1, Assess the proportion of sexual minority women among a sample of low income women at
increased risk of HIV acquisition.
2. Assess whether women who report childhood abuse or current abuse, traumatic stress
symptoms, depressive symptoms and substance use are more likely to be sexual minority
women.
3. Assess whether women who identify as sexual minority are at increased risk for:
a. self-reported STIs
b. unprotected anal or vaginal sex
c. transactional sex
4. Assess whether substance use and depression either moderate or mediate the relationship
between sexual minority status and sexual risk behaviors.
5. Create a path model with good fit that captures the inter-relationships among the variables
associated with sexual risk behaviors in sexual minority women in this sample.
Reference List
1. Cochran SD, Mays VM. Physical health complaints among lesbians, gay men, and bisexual
and homosexually experience heterosexual individuals: Results from the California Quality of
Life Survey. Am J of Public Health. 2007; 97(11): 2048-55.
2. King M, Semlyen J, Tai SS, Killapsy H, Osborn D, Popelyuk D, Nazareth I. A systematic
review of mental disorder, suicide, and deliberate self harm in lesbian, gay and bisexual People,
BMC Psychiatry. 2008; 8:70
3. Fredriksen-Goldsen KI, Kim HJ, Barkan SE, Balsam KF, Mincer SL. Disparities in healthrelated quality of life: a comparison of lesbians and bisexual women. Am J of Public Health.
2010; 100(11): 2255-2261.
4. Lehavot, K. Coping strategies and health in a national sample of sexual minority women. Am J
Orthopsychiatry, 2012; 82(4): 484-504.
5. Green KE, Feinstein BA. Substance use in lesbian, gay, and bisexual populations: an update
on empirical research and implications for treatment. Psychology of Addict Behavior, 2012;
26(2): 265-278.
6. Rothblum ED, Factor, R. Lesbians and their sisters as a control group: Demographic and
mental health factors. Psychological Science, 2001; 12: 63-69.
7. Bevier PJ, Chaisson MA, Hefferman RT, Castro KG. Women at a sexually transmitted disease
clinic who reported same sex contact: Their HIV sero-prevalence and risk behaviors. Am J of
Public Health, 1995; 85(10): 1366-1371.
8. Koh AS, Gomez CA Shade S, Rowley W. Sexual risk factors among self-identified lesbians,
bisexual women, and heterosexual women accessing primary care settings. Sex Tran Dis. 2005;
32(9): 563-569.
9. Muzny CA, Sunesara IR, Martin DH, Mena LA. Sexually transmitted infections and risk
behaviors among African American women who have sex with women: Does sex with men
make a difference? Sex Tran Dis, 2011; 38(12), 1118-1125.
10. Evrette BG. Sexual orientation disparities in sexually transmitted infections: examining the
intersection between sexual identity and sexual behavior. Arch of Sex Beh. 2013; 42(2):225-36.
11. Bauer GR, Welles SL. Beyond assumptions of negligible risk: sexually transmitted diseases
and women who have sex with women. Am J Public Health. 2001;91(8):1282–6.
12. Bobashev GV, Zule WA, Osilla KC, Lkine TL, Wechsberg WM. Transactional sex among
mena and women in the south at high risk for HIV and other STIs. J of Urban Health, 2009; 86
Suppl: 32-47.
13. Dworkin SL. Who is epidemiologically fathomable in the HIV/AIDS epidemic? Gender,
sexuality, and intersectionality in public health. Culture, Health and Sexuality,2005; 7(6): 615623.
14. Hollander, D. Lesbians, too, can get HIV/AIDS. Family Planning Perspective. 1996; 28(5):
186.
15. Gorbach PM, Murphy R, Weiss RE, Hucks-Ortiz C,4 Shoptaw S. Bridging sexual
boundaries: Men who have sex with men and women in a street-based sample in Los Angeles. J
of Urban Health. 2009; 86: 63–76.
16. Sweet T, Welles, SL. (2012). Associations of sexual identity or same-sex behaviors with
history of childhood sexual abuse and HIV/STI risk in the United States. J Acquired Immune
Deficiency Syndrome, 59(4):400-8.