Sexual Orientation and Sexual and Reproductive Health among African American Sexual Minority Women in the U.S. South.

BACKGROUND: Research on the sexual and reproductive health of sexual minority women, especially those of color, is limited.

METHODS: Using multivariable Poisson regression, we estimated risk ratios for the association between two dimensions of sexual orientation (sexual identity and sexual behavior) and five sexual and reproductive health indicators (pregnancy, contraceptive use, human immunodeficiency virus [HIV] testing, Pap test use, and sexual assault) among African American sexual minority women in the U.S. South (n = 165).

RESULTS: Lesbians were less likely than bisexual women to have ever been pregnant (risk ratio [RR], 0.64; 95% confidence interval [CI], 0.48-0.85), ever received an HIV test (RR, 0.88; 95% CI, 0.80-0.96), obtained a Pap test in the last 3 years (RR, 0.75; 95% CI, 0.61-0.91), and had an abnormal Pap test result in their lifetime (RR, 0.42; 95% CI, 0.24-0.75). Women with only female past-year sexual partners were less likely than women with male and female past-year sexual partners to have ever been pregnant (RR, 0.58; 95% CI, 0.43-0.78), ever received an HIV test (RR, 0.87; 95% CI, 0.79-0.96), obtained a Pap test in the last 3 years (RR, 0.82; 95% CI, 0.67-0.99), and had an abnormal Pap test result in their lifetime (RR, 0.55; 95% CI, 0.32-0.94). Contraceptive use, receiving an abnormal Pap test result at the time of the study visit, and experiencing sexual assault did not differ by sexual identity or behavior.

CONCLUSIONS: Several sexual and reproductive health indicators varied in relation to sexual identity and sexual behavior among Southern African American sexual minority women. Interventions that facilitate access to sexual and reproductive health services and are tailored to the unique needs of sexual orientation subgroups of sexual minority women are needed.