Background: After MSM, Black women infected through “heterosexual contact” report the most cases of HIV. Unlike men, however, STD surveillance does not consider women’s sexual identity or sex with female partners, despite evidence of their increased risk. This study compared HIV sexual risk-related factors (past year) among Black women by sexual orientation.
Methods: We conducted a secondary analysis of the National Survey of Family Growth, 2006-2013 data. We restricted the sample to include Black women, aged 18-44 years, who had any kind of sex with a man (past year) and responded to eight different HIV sexual risk-related items; lesbians were excluded (due to data sparseness) (n=6,878). Weighted multivariate logistic regression analyses were conducted to identify factors associated with having 2+ HIV sexual risk factors (past year) among Black women by sexual orientation.
Results: Most women identified as heterosexual and were only sexually attracted to men (86.7%), while 7.9% identified as heterosexual but had same-sex attractions, and 5.4% identified as bisexual. Overall, 13.2% of women had 2+ HIV sexual risk factors (past year). Heterosexual women with same-sex attractions and bisexual women had 2.2 and 3.9 times greater odds, respectively, of having 2+ HIV sexual risk factors (past year) than heterosexual women only attracted to men. This relationship remained significant after adjusting for demographic characteristics (age and poverty level) and other sexual factors (age at first sex, ever forced to have sex, and sex with female partner – past year). Having sex with a female (past year) partially mediated this relationship and accounted for 5 times greater odds of having 2+ HIV sexual risk factors among Black women.
Conclusions: “Heterosexual contact” is too broad a category for STD surveillance. Additional categories, such as “women who identify as bisexual or report both male and female sex partners (WSMW),” should be considered for inclusion.