Background: Research suggests sexual minority women (SMW) face elevated HIV risk compared to their heterosexual counterparts. This study examines the association between sexual minority status– defined by identity and behavior– and HIV-related vulnerabilities among heterosexually-active low-income women.

Methods: Analysis used National HIV Behavioral Surveillance data (n=5,542) collected in 2019 from heterosexually-active low-income women in 23 U.S. urban areas. We compared sexual minority identity and behavior to a set of substance use, sexual behavior, health and healthcare, and social determinants of health indicators commonly associated with heightened HIV transmission risk. Log-linked Poisson regression models generated adjusted prevalence ratios (aPRs) and 95% confidence intervals.

Results: Among women who reported sexual minority identity (22.2%; n=1231), 34.6% (n=426) reported past year sex with only men. Of women who reported past year sex with both women and men (17.8%; n=985), 18.3% (n=180) identified as heterosexual. In adjusted models, SMW had significantly higher prevalence of nearly every HIV-risk associated factor examined than their heterosexual counterparts. Risk profiles by identity and behavior were similar. Notably, SMW defined by behavior had similar or higher prevalence of nearly every risk factor than those defined by identity.

Conclusion: In this sample of low-income heterosexually-active women, we found disproportionate HIV-related vulnerabilities among SMW compared to their heterosexual counterparts. Findings underscore the importance of measuring multiple dimensions of sexual orientation (identity and behavior), as these populations and their associated risks show important nuances. Implications include tailoring HIV prevention and health promotion interventions to meet the needs of low-income SMW.

Background: Sexual and gender minorities (SGMs) have increased cervical cancer risk and are less likely to have completed cervical cancer screening (CCS). Current CCS is reported by 69.0% of lesbian women, 72.2% of bisexual women, 59.1% of female to male transgender individuals, and 50.3% of transgender gender nonconforming individuals compared to 82.5% of heterosexual cisgender women. This CCS disparity is influenced by socioecological factors, including, individual, sociocultural, and healthcare system barriers. No known studies have assessed factors affecting CCS and the acceptability of hrHPV self-sampling in a rural state after COVID-19.

Methods: We investigated socioecological factors influencing CCS, CCS experiences, and the feasibility and acceptability of at-home hrHPV self-sampling for primary CCS in a qualitative, phenomenological study. Semi-structured interview data were content analyzed by three team members using line-by-line coding to identify themes.

Results: Nineteen Kentucky SGMs completed at-home hrHPV self-sampling and participated in qualitative interviews in 2022-2023. Identified themes included CCS perceptions, prior negative experiences in healthcare settings, desirability of hrHPV self-sampling, at-home hrHPV self-sampling experiences, concerns related to hrHPV self-sampling, and reasons for participating in hrHPV self-sampling.

Discussion: At-home hrHPV self-sampling was acceptable and feasible in this SGM population. At-home hrHPV self-sampling removes identified SGM population barriers to CCS that include lack of affirming healthcare environments and healthcare providers as well as discrimination and stigma in the healthcare system. Increasing access to CCS through at-home hrHPV self-sampling is a viable option for this population and should be used to increase CCS screening in SGMs and other underscreened populations.

Background: Existing research indicates that health and well-being outcomes may vary significantly by specific sexual orientations that exist within the Lesbian, Gay, Bisexual, and Queer (LGBQ) community. However, analyses are frequently done by grouping the LGBQ populations together.

Objective: To identify health and well-being disparities within the LGBQ population in San Diego County.

Methods: Using data from the California Health Interview Survey (CHIS), 2018-2022, descriptive analysis of demographic and health and well-being outcomes by sexual orientation were completed. Statistically stable results were visualized via an interactive Tableau dashboard.

Results: From 2018-2022, 8.8% of adults in San Diego County identified as Lesbian, Gay, Bisexual, or some other sexual minority. Bisexual adults made up 5.4% of the adult population in San Diego County, making it the greatest proportion of the LGBQ population. The adult bisexual population reported the highest rates of poor mental health, with female bisexuals reporting the highest rates compared to all sexual orientation groups. Bisexuals also reported the highest rates of binge drinking (33.9%), current smoking (14%), experiencing 4 or more adverse childhood experiences (ACEs) (47.9%,) and experiencing intimate partner violence (26.6%). The lesbian population also reported higher rates of poor mental health compared to the gay and male and female heterosexual population.

Conclusion: The needs of the LGBQ population vary by sexual orientation. The bisexual population, and especially the female bisexual population, experiences poor health and well-being outcomes at disproportionate rates. Further research is needed to explore underlying factors contributing to health disparities.

Background
Patient reports of discrimination based on gender and sexual orientation in a health care setting are important for health equity for women, particularly lesbian and bisexual/pansexual populations. Among cisgender adult women, we examined 1) rates of discrimination; and 2) characteristics and health outcomes associated with discrimination.

Methods We pooled 2021 and 2023 data from the Minnesota Health Access Survey (MNHA) (n=10,364). Discrimination was defined as reports of unfair treatment by a health care provider due to gender, sexual orientation, gender identity, or gender expression (SOGI). Physical and mental health were measured as frequent mental distress: reporting 14 or more physically or mentally unhealthy days of the past 30 days. We used adjusted logistic regression to examine correlates of discrimination and its association with physical and mental health.

Results
Discrimination was high among women with minoritized sexual identities, reported by 35.8% of bisexual/pansexual women and 25.1% of lesbian women, compared with 8.4% for straight women. These results were consistent in multivariate analysis. Further, discrimination was associated with worse mental health (aOR 2.0, 95%CI 1.4-2.9) and physical health (aOR 2.6, 95%CI 1.8-3.8). Bisexual/pansexual women also saw increased odds of frequent mental distress (aOR 2.4, 95%CI 1.5-4.0), relative to straight women.

Conclusions

These results show that monitoring and addressing SOGI-based discrimination is important for health equity for lesbian and bisexual/pansexual women. Provider training, system-level interventions such as improving mental health care access, and recruitment of diverse future providers could help alleviate some of the disparities we are seeing.