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Sexual Risk Factors Among Self-Identified Lesbians, Bisexual Women, and Heterosexual Women Accessing Primary Care Settings

Koh, Audrey S. MD*; Gómez, Cynthia A. PhD; Shade, Starley MPH; Rowley, Erin

doi: 10.1097/01.olq.0000175417.17078.21

Objectives: There is scant data on the sexual behaviors of women of diverse sexual orientations in a low-risk population.

Goals: The goals of this study were to sample women of all sexual orientations in primary care settings and to evaluate sexual behaviors and risk for HIV and other sexually transmitted diseases (STDs).

Study: A total of 1,304 women (self-identified as 49% heterosexual, 11% bisexual, and 40% lesbian) were surveyed by anonymous questionnaire at 33 healthcare sites.

Results: Among women who recently had sex with men (N = 600), 51% reported ever using condoms. Heterosexual women were at highest risk for acquiring HIV as a result of lack of condom use (P <0.001), particularly in higher-risk situations. Bisexual women reported substance use with sex at a higher rate than lesbians or heterosexual women (P <0.001). Lesbians had higher rates of sex with bisexual men (P <0.001) and injection drug users (P <0.02), but also a higher rate of condom use (P <0.001) compared with bisexual or heterosexual women.

Conclusion: Women of all sexual orientations, and particularly heterosexual women, engaged in behaviors that put them at risk for HIV and STD.

Women of all sexual orientations engaged in risky behaviors for HIV and sexually transmitted disease acquisition. Lesbian and bisexual women used condoms with male partners more often than did the heterosexual women.

From the * Department of Obstetrics and Gynecology, California Pacific Medical Center, San Francisco, California; and the † Center for AIDS Prevention Studies, University of California, San Francisco, San Francisco, California

Partial funding for the original study was provided by the Lesbian Health Fund, a project of the Gay and Lesbian Medical Association. Assistance in the preparation of this manuscript was provided by Stacey Carter and the Lesbian Health Research Center at University of California, San Francisco.

Correspondence: Audrey S. Koh, MD, Department of Obstetrics and Gynecology, California Pacific Medical Center, 2100 Webster Street, Suite 427, San Francisco, CA 94115. E-mail:

Received for publication November 17, 2004, and accepted January 27, 2005.

© Copyright 2005 American Sexually Transmitted Diseases Association