Health and social inequalities among young drug-using women who have sex with women

Lesbian and bisexual women experience health inequalities compared to heterosexual women. We explored potential health and social inequalities among heroin, crack and/or cocaine users, comparing women who have sex with women (WSWs, n=133) and women who have sex with men only (WSMOs, n=242). Data were collected as part of a cross-sectional study of NYC neighborhoods. Participants were predominantly Hispanic (44.3%) or Black (40.0%); most had not completed high school (58.7%). WSWs were more likely to be homeless, have an illegal income source and incarceration history as compared to WSMOs. WSWs were significantly less likely to have public assistance and health insurance. There were no significant differences in HIV, HBV or HCV seroprevalence. WSWs were more likely to be cocaine (p=0.002) and crack dependent (p=0.06) and were younger at first sexual intercourse, had a greater number of recent sex partners, and were more likely to have traded sex and to report a recent MSM sexual partner. WSWs were also more likely to report having been shot as compared to WSMOs. Our findings suggest that drug-using WSWs experience multiple stressors (i.e., fewer resources and more violence). Multiple jeopardy and multiple minority stress may be salient concepts here; drug-using WSWs are members of multiple communities (i.e., women, LGBTQ, ethnic, drug-using, and/or poor communities) which may experience stress related to social position, discrimination, lack of cultural competency, etc. Research is needed to understand if/how these stressors work to produce health inequalities. Targeted, culturally-competent interventions are warranted to address the complex needs of this population.