CLINICAL ISSUES
Sexuality and Safer Sex: The Issues for Lesbians and Bisexual Women

https://doi.org/10.1111/j.1552-6909.2001.tb01563.xGet rights and content

Nursing interventions to help women reduce their risk of contracting HIV must be designed from an in-depth understanding of the complex sociocultural patterns of sexuality in particular communities and among specific subgroups.

Objective

In this data collection phase of a community-based HIV prevention project, the objective was to understand HIV risk-taking and HIV risk-reduction activities of lesbians and bisexual women.

Design

Qualitative field study.

Setting

Data were collected in women's bars and dance clubs and at selected lesbian/bisexual community events in San Francisco.

Participants

Interviews were conducted with 1,189 racially diverse, socially and sexually active lesbians and bisexual women.

Results

Inductive content analysis produced two themes: realities of sexual behavior and sexual expressions and their meanings. Realities of sexual behavior included an assumption that women who have sex with other women cannot get HIV, a lack of familiarity with HIV prevention strategies, inconsistent practice of safer sex with men and/or women, and the negative effect of alcohol or drug use on safer sex efforts. Sexual expressions and their meaning included trust in monogamy, a sense that safer sex practices detracted from intimacy and eroticism, the difficulty of negotiating sexual behaviors with men or women, and dealing with partner resistance to safer sex practices.

Conclusions

Specific recommendations for practice are the need for nurses to understand the range and diversity of women's sexual behaviors, to develop skills in conducting inclusive sexual histories, and to develop a comprehensive approach to sexual health.

Section snippets

Method

Twenty female peer researchers, self-identified as lesbian or bisexual and trained in the conduct of qualitative field interviews, collected data from 626 women during Year 1 and 563 women during Year 2. Of the total 1,189 respondents, 41% were women of color. The sample comprised 59% whites, 17% African Americans, 13% Latinas, 9% Asians/Pacific Islanders, and 2% Native Americans. The sample was young; more than half were in their 20s. Because data collection and intervention occurred in

Realities of Sexual Behavior

In describing their understanding of HIV risk, women in this study articulated a common assumption, that women who have sex with other women cannot get HIV. Reinforced by this perception, women engaged in a number of behaviors that put them at risk for HIV, including unprotected sex with men, unprotected sex with women, and inconsistent practice of safer sex with men and women. Alcohol and drug use influenced sexual behavior despite intentions.

Limitations of the Study

Even though the sample was large and racially diverse, limitations on the depth and adequacy of the knowledge gained are posed by the brevity of interviews and the fact that they occurred in public places where privacy could not be guaranteed. The open-ended nature of peer researchers’ questions and the participant-driven content of interviews do not allow calculation of prevalence rates and statistical comparisons as in conventional epidemiologic investigations.

Findings represent experiences

Acknowledgments

This research was supported by an American Foundation for AIDS Research Targeted Education Grant #100399-15-EGR awarded to Lyon-Martin Women’s Health Services, 1748 Market Street, Suite 201, San Francisco, CA 94102. At the time of the study, Patricia E. Stevens was supported by a National Research Service Award Individual Postdoctoral Fellowship from the National Institute of Nursing Research, NIH #F32 NRO6833. Joanne M. Hall was supported by a National Research Service Award Individual

REFERENCES (30)

  • N.M. Carroll

    Optimal gynecologic and obstetric care for lesbians

    Obstetrics and Gynecology

    (1999)
  • S.D. Cochran et al.

    Prevalence of HIV-related sexual risk behaviors among young 18- to 24-year-old lesbian and bisexual women

    Women's Health: Research on Gender, Behavior, and Policy

    (1996)
  • A.L. Diamant et al.

    Receipt of preventive health care services by lesbians

    American Journal of Preventive Medicine

    (2000)
  • A.L. Diamant et al.

    Lesbians' sexual histories with men: Implications for taking a sexual history

    Archives of Internal Medicine

    (1999)
  • K.J. Igartua

    Therapy with lesbian couples: The issues and interventions

    Canadian Journal of Psychiatry

    (1998)
  • Institute of Medicine

    Lesbian health: Current assessment and directions for the future

    (1999)
  • C. Manodori

    This powerful opening of the heart: How ritual affirms lesbian identity

    Journal of Homosexuality

    (1998)
  • V.M. Mays

    Are lesbians at risk for HIV infection

    Women's Health: Research on Gender, Behavior, and Policy

    (1996)
  • C.A. Parks

    Lesbian parenthood: A review of the literature

    American Journal of Orthopsychiatry

    (1998)
  • M. Pope

    Sexual issues for older lesbians and gays

    Topics in Geriatric Rehabilitation

    (1997)
  • J.H. Price et al.

    Perceptions of cervical cancer and Pap smear screening behavior by women's sexual orientation

    Journal of Community Health

    (1996)
  • E.J. Rankow

    Lesbian health issues for the primary care provider

    Journal of Family Practice

    (1995)
  • E.M. Saewyc et al.

    Gender differences in health and risk behaviors among bisexual and homosexual adolescents

    Journal of Adolescent Health

    (1998)
  • E.M. Saewyc et al.

    Sexual orientation, sexual behaviors, and pregnancy among American Indian adolescents

    Journal of Adolescent Health

    (1998)
  • J.M. Saunders

    Health problems of lesbian women

    Nursing Clinics of North America

    (1999)

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    Copyright © 2001 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses. Published by Elsevier Inc. All rights reserved.