Original article
Why Girls Choose Not to Use Barriers to Prevent Sexually Transmitted Infection During Female-to-Female Sex

https://doi.org/10.1016/j.jadohealth.2017.10.005Get rights and content

Abstract

Purpose

Using data from a national qualitative study of lesbian, bisexual, and other sexual minority adolescent girls in the U.S., this study examined their awareness of the risk of sexually transmitted infection (STI) and opportunities for barrier use.

Methods

Online asynchronous focus groups were conducted with lesbian and bisexual (LB) girls ages 14–18 years. Girls were assigned to online groups based on their self-identified sexual identity and whether they were sexually experienced or not. Two moderators posed questions and facilitated online discussions. Interpretive description analysis conducted by multiple members of the research team was used to categorize the results.

Results

Key factors in girls' decisions not to use barriers with female partners concerned pleasure, sex of sexual partner, lack of knowledge of sexual risk or of barrier use for female-to-female sexual activities, and use of STI testing as a prevention tool.

Conclusions

Addressing knowledge and access gaps is an important first step for improving sexual health. Prevention priorities should focus on helping LB girls understand their risk of STI transmission in both opposite and same-sex relationships. Tailoring messaging to move beyond heteronormative scripts is critical to engaging LB girls and equipping them with the skills and knowledge to have safer sex regardless of the sex of their partner.

Section snippets

Methods

LB girls, ages 14–18 years (see Table 1 for more descriptive information), were recruited primarily through Facebook using standardized protocols [26], [27], [28]. The 160 girls participated in asynchronous, online focus groups as part of a larger project. Online focus groups were chosen as a convenient way to interact with LB girls from all over the U.S. while protecting their identities [29]. The University of British Columbia's Behavioral Research Ethics Board and the Chesapeake

Results

Four main themes emerged as part of participant's reasons for why they would not use barriers. The themes, as discussed in greater detail below, concerned pleasure, risk linked to sex of partner, lack of knowledge of barriers, and STI testing as a prevention measure. Results also noted that once the topic of barriers was introduced in the focus groups, some participants did share reasons and scenarios in which they might use barriers, particularly among inexperienced girls.

Discussion

Despite the increased risk of STIs and adolescent pregnancy among LB girls [1], [2], [3], participants in this study had limited knowledge of their STI risk or interest in using barriers for protection. Some girls highlighted lack of access as key reasons why they did not use them. Consistent with other literature [32], [33], participants also had limited knowledge of the risk for STI transmission during female-to-female sex and limited knowledge of female specific barriers. Prevention programs

Limitations

Our results confirm the findings of similar studies with adult bisexual and lesbian women and offers further insight about an overall lack of knowledge and awareness among younger populations, but limitations exist. Although the online medium allowed us to interact with a large number of girls across the U.S., the asynchronous format made asking follow-up questions a challenge. The medium did not always encourage cross talk and conversation that may have helped the girls elaborate on their

Funding Sources

This work was supported by the Office of Adolescent Health, Award No. TP2AH000035.

References (42)

  • E. Saewyc

    Adolescent pregnancy among lesbian, gay and bisexual teens

  • A. Ferenczy et al.

    Human papillomavirus DNA in fomites on objects used for the management of patients with genital human papillomavirus infections

    Obstet Gynecol

    (1989)
  • J.M. Marrazzo et al.

    Emerging sexual health issues among women who have sex with women

    Curr Infect Dis Rep

    (2012)
  • J.V. Bailey et al.

    Sexually transmitted infections in women who have sex with women

    Sex Transm Infect

    (2004)
  • H.A. Kwakwa et al.

    Female-to-female transmission of human immunodeficiency virus

    Clin Infect Dis

    (2003)
  • S.K. Chan et al.

    Likely female-to-female sexual transmission of HIV, Texas, 2012

    MMWR

    (2014)
  • L.M. Gorgos et al.

    Sexually transmitted infections among women who have sex with women

    Clin Infect Dis

    (2011)
  • J.M. Marrazzo

    Barriers to infectious disease care among lesbians

    Emerg Infect Dis

    (2004)
  • C.E. Kaestle et al.

    Bacterial STDs and perceived risk among sexual minority young adults

    Perspect Sex Reprod Health

    (2011)
  • M. Mullinax et al.

    Screening for sexually transmitted infections (STIs) among a heterogeneous group of WSW(M)

    Int J Sexual health

    (2016)
  • K. Hodson et al.

    Lesbian and bisexual women's likelihood of becoming pregnant: A systematic review and meta-analysis

    BJOG

    (2017)
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    Conflicts of Interest: The authors have no conflict of interest.

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