Advancing sexually transmitted infections prevention among women who have sex with women in urban Canada: A multi-centre cohort pilot study

Background: Lesbian, bisexual, and queer (LBQ) women and other women who have sex with women (WSW) are vulnerable to sexually transmitted infections (STIs), with estimated lifetime history of STI rates of 20%--similar to heterosexual women. The limited research examining LBQ women’s sexual practices has revealed inconsistent uptake of safer sex strategies. Scant research has evaluated interventions to reduce HIV and STI vulnerability among lesbian, bisexual, and queer (LBQ) women, and other WSW. This study examined the effectiveness of a group-based psycho-educational HIV/STI intervention with LBQ women in 2 urban Canadian centers.

Methods: We conducted a nonrandomized cohort pilot study of a group-based psycho-educational HIV/STI prevention intervention for LBQ women and other WSW developed and delivered in collaboration with community-based agencies. The intervention was informed by evidence-based group HIV/STI prevention strategies with men who have sex with men, including the Many Men, Many Voices (3MV) intervention. Participants completed a pre-test, post-test, and 6-week follow-up. The primary outcome was sexual risk practices, while secondary objectives included intrapersonal (self-esteem, STI knowledge, resilient coping, depression), interpersonal (safer sex self-efficacy), community (community connectedness, social support), and structural (sexual stigma, access to healthcare) factors. We used mixed-effects regression to model each continuous outcome measure as a function of two time dummy variables, one for post-intervention interview time point and one for week 6 follow-up.

Results: Forty-four women (mean age 28.7 years) participated in a weekend retreat consisting of six consecutive sessions tailored for LBQ women. Sessions covered a range of topics addressing behavioral and social-structural determinants of HIV/STI risk, including STI information, safer sex negotiation skills, and addressing sexual stigma. Adjusted for socio-demographic characteristics, sexual risk practices (b2= -2.96, 95% CI - 4.43, - 1.50), barrier use self-efficacy (b2 = 1.52, 95%CI 0.51, 2.53), STI knowledge (b2 = 4.41, 95% CI 3.52, 5.30), and sexual stigma (b2= -2.62, 95% CI - 3.48, - 1.75) scores showed statistically significant changes 6 weeks post-intervention.

Discussion: A group-based, psycho-educational HIV and STI prevention intervention was effective in reducing sexual risk practices and sexual stigma, and increasing barrier use self-efficacy and STI knowledge, among LBQ women and other WSW. Initial increases in safer sex self-efficacy, social support, and community connectedness were not sustained at 6-week follow up, highlighting the need for booster sessions or alternative approaches to address social factors. Study results may inform HIV/STI prevention interventions, sexual health care provision, and support services tailored for LBQ women.