Factors Associated with STD Testing Among Self-Identified Lesbian and Bisexual Women in the US and UK

Background:  Limited research has explored STD testing among sexual minority (non-heterosexual) women despite documented STD transmission between women.  The purpose of this study was to determine individual and behavioral factors associated with an STD test (past year) among a sample of self-identified lesbian and bisexual women living in the US and UK.

Methods: More than 4,500 English-speaking women from 67 countries completed an internet-based survey. The sample was restricted to females who identified as gay/lesbian or bisexual, were aged 18 years or older, resided in the US or UK, and responded to all items of relevance (n=2,713). Individual factors included age, race/ethnicity, education, relationship status, country of residence, sexual identity, and self-described femininity/masculinity. Sexual behaviors included age of first sex with a woman, past year history of performing oral sex on a woman or man, and lifetime history of vaginal or anal intercourse with a man. Multivariate logistic regression analyses were conducted to identify factors associated with recent STD testing.

Results: Most respondents were White (89.1%), self-identified as gay/lesbian (79.1%), and feminine/femme (70.6%). Participants ranged in age from 18-69 years (M=29.62, SD=9.26). Nearly one-third (31.3%) of respondents (n=848) said they had received a STD test in the past year.  In unadjusted models, women who identified as bisexual were nearly twice as likely as gay/lesbian identified women to have had an STD test in the past year; while masculine/butch identified women were 30% less likely to have had an STD test than feminine/femme identified women. This relationship remained significant after adjusting for other individual factors.  However, after adjusting for sexual behaviors, associations between sexual identity, femininity/masculinity and STD testing became non-significant, suggesting that sexual behaviors may mediate this relationship.

Conclusions: Results can be used to inform STD testing and prevention efforts targeting sexual minority women in the US and UK.