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Sexual Orientation Disparities in Sexually Transmitted Infections: Examining the Intersection Between Sexual Identity and Sexual Behavior

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Abstract

The terms MSM (men who have sex with men) and WSW (women who have sex with women) have been used with increasing frequency in the public health literature to examine sexual orientation disparities in sexual health. These categories, however, do not allow researchers to examine potential differences in sexually transmitted infection (STI) risk by sexual orientation identity. Using data from the National Longitudinal Survey of Adolescent Health, this study investigated the relationship between self-reported STIs and both sexual orientation identity and sexual behaviors. Additionally, this study examined the mediating role of victimization and STI risk behaviors on the relationship between sexual orientation and self-reported STIs. STI risk was found to be elevated among heterosexual-WSW and bisexual women, whether they reported same-sex partners or not, whereas gay-identified WSW were less likely to report an STI compared to heterosexual women with opposite sex relationships only. Among males, heterosexual-identified MSM did not have a greater likelihood of reporting an STI diagnosis; rather, STI risk was concentrated among gay and bisexual identified men who reported both male and female sexual partners. STI risk behaviors mediated the STI disparities among both males and females, and victimization partially mediated STI disparities among female participants. These results suggest that relying solely on behavior-based categories, such as MSM and WSW, may mischaracterize STI disparities by sexual orientation.

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Notes

  1. Only one female participant reported never having had an opposite-sex sexual relationship, therefore, all women who reported a gay or mostly gay identity were categorized as one group Sensitivity analyses excluding this participant did not significantly alter the results; thus, this participant was included in this category.

  2. Sample size limitations required that some identity categories be collapsed. Preliminary analyses showed that STI risk among mostly heterosexual participants was statistically different from 100% heterosexual identified participants, but did not statistically differ from bisexual identified participants. Similarly, mostly gay and 100% gay-identified participants did not report statistically difference STI risk odds ratios and were also collapsed to provide more stable coefficient estimates. There were only 11 cases of 100% gay or mostly gay participants reporting opposite-sex only sexual relationships; therefore, these cases were excluded from the analysis.

  3. For clarity, mostly heterosexual and bisexual participants are referred to as “bisexual.” While in the case of this study these groups were not statistically different, it is important to note that these sexual identity labels are not perfect substitutes in all cases.

  4. All supplementary analyses are available upon request from the author.

  5. This question was not asked at Wave IV.

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Acknowledgements

This research has benefited from the NICHD-funded University of Colorado Population Center (grant R21 HD51146) through administrative and computing support. I gratefully acknowledge support from the Eunice Shriver National Institute of Child Health and Human Development (NICHD) grant R03 HD062597 and the American Psychological Foundation (APF) Wayne F. Placek award. The content is solely the responsibility of the author and does not necessarily represent the official views of NIH, NICHD, or the APF. And I thank Dr. S. Bryn Austin, Dr. Stefanie Mollborn, Dr. Stephen Russell, and three anonymous reviewers for their insightful comments and suggestions on an earlier draft of this article.

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  1. Institute of Behavioral Science, Population Program, University of Colorado, Campus Box 484, Boulder, CO, 80309-0484, USA

    Bethany G. Everett

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Everett, B.G. Sexual Orientation Disparities in Sexually Transmitted Infections: Examining the Intersection Between Sexual Identity and Sexual Behavior. Arch Sex Behav 42, 225–236 (2013). https://doi.org/10.1007/s10508-012-9902-1

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