Sexually Transmitted Disease (STD) Diagnoses and Mental Health Disparities Among Women Who Have Sex With Women Screened at an Urban Community Health Center, Boston, MA, 2007

Reisner, Sari L. MA*; Mimiaga, Matthew J. ScD, MPH*†; Case, Patricia ScD, MPH*‡; Grasso, Chris MPH*; O'Brien, Casey T. BS*§; Harigopal, Padmini MD*; Skeer, Margie ScD, MPH, MSW*¶; Mayer, Kenneth H. MD*∥

Sexually Transmitted Diseases:
doi: 10.1097/OLQ.0b013e3181b41314
Articles
Abstract

Background: A growing body of research documents mental health disparities among women who have sex with women (WSW) compared with women who have sex with men only (WSM). However, there remains a dearth of research exploring these indicators alongside sexually transmitted diseases (STDs) and WSW sexual health.

Methods: A retrospective chart review was conducted of all female patients (n = 368) screened for STDs between July 2007 and December 2007 at an urban community health center in Boston, MA. Deidentified electronic medical record data (e.g., demographics, psychosocial, sexual health) were analyzed and linked to STD positivity. Women who did not have sexual behavior documented in their medical chart (n = 58) were excluded from this analysis. Bivariate and multivariable logistic regression procedures examined sexual and psychosocial health indicators, including sexual preference.

Results: Twenty-seven percent of participants were WSW (17% WSW only and 10% WSW/M). Overall, 5% of WSW were diagnosed with a new STD (human papillomavirus, anogenital warts, genital herpes, pelvic inflammatory disease) and 17% had a history of a prior STD. In multivariable models adjusting for demographics, WSW were disproportionately more likely to have mental health and psychosocial issues noted in their medical records, including: a clinical diagnosis of depression, anxiety, and posttraumatic stress disorder, history of suicide attempts, and inpatient psychiatric/mental health treatment. However, WSW were significantly less likely than WSM to engage in “high risk” HIV/STD sexual behavior. In a final multivariable model, same sex behavior was not associated with a different likelihood of being diagnosed with an STD, compared with opposite sex behavior. However, WSW diagnosed with STDs were at increased odds of having bipolar disorder and utilizing outpatient mental health counseling services compared with WSW without STDs. WSW with a history of STDs were at increased odds of having attempted suicide in the past, utilizing both outpatient and inpatient mental health treatment services, and having a history of injection drug use compared with WSW without a history of STDs.

Conclusions: WSW with STDs may have presenting psychosocial problems. Further research is warranted to better understand the relationship between sexual behavior and health, as well as to guide the development of interventions to ameliorate health disparities among WSW, particularly in the psychosocial domain.

In Brief

A study of female patients screened for STDs at an urban community health center in Boston, MA found multiple health disparities when compared by sexual behavior.

Author Information

From the *The Fenway Institute, Fenway Health, Boston, MA; †Harvard Medical School/Massachusetts General Hospital, Boston, MA; ‡School of Public Health, Boston University, Boston, MA; §Tufts University, Medford/Somerville MA; ¶Harvard School of Public Health, Boston, MA; and ∥Brown Medical School/Miriam Hospital, Providence, RI

The authors thank the Medical and Mental Health Departments at Fenway, and D'hana Perry and Benny Vega who assisted with medical record extraction.

Supported by the Center for Population Research in LGBT Health at The Fenway Institute and by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) under Award Number R21HD051178; and The National Institute on Drug Abuse (NIDA) grant number R03DA023393 (to M.M.: PI).

The content is solely the responsibility of the authors and does not necessarily represent the official views of the NICHD, NIDA, or the National Institutes of Health.

Correspondence: Sari Reisner, MA, The Fenway Institute, Fenway Health, 1340 Boylston Street, 8th Floor, Boston, MA 02215. E-mail: sreisner@fenwayhealth.org.

Received for publication March 2, 2009, and accepted June 18, 2009.

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