Source: Carol Goodenow, Laura A. Szalacha, Leah E. Robin, and Kim Westheimer, “Dimensions of Sexual Orientation and HIV-Related Risk Among Adolescent Females: Evidence From a Statewide Survey,” American Journal of Public Health (June 2008): 1051-1058.

Even though the risk of female-to-female HIV transmission is very low, research has found that women who identify as lesbian, gay, or bisexual, and those who engage in same-sex activity have equal or higher risk of HIV infection as women who identify as heterosexual or who engage in sexual activity exclusively with men. This study seeks to examine this phenomenon.

Very few studies have been conducted that focus on adolescent females’ HIV risk-taking behavior, especially in correlation with their sexual orientation. Even fewer studies examine the different dimensions of sexual orientation, such as self-defined sexual identity and actual behavior. This study, however, looks at both sexual identity and the sex of partners in order to identify key factors that may put adolescent females at risk of HIV infection. 

The study used data from Massachusetts public high school students in grades nine–12 collected as part of the Massachusetts Youth Risk Behavior Survey (MYRBS).

Respondents were asked questions about the sex of their partners (both in their lifetime and within the past 3 months), alcohol and drug use, whether they had received AIDS education, and whether they had ever had an STD, been pregnant, or experienced any coerced sexual contact. Sexual contact was also never defined for respondents in the MYRBS.   

In order to ensure a large enough sample size of females who identify as lesbian, gay, bisexual, or who had engaged in same-sex sexual contact, the study included survey responses from 1995, 1997, 1999, and 2001. As a result, the study included responses from 3,973 female students who reported sexual contact with males, females, or both. A limitation to the study, however, is that it fails to explain whether some young women’s responses may have been duplicates because the data comes from waves of the MYRBS that are only two years apart. 

The study uses the term “sexual-minority” young women to refer to young women who either identify as lesbian, gay, or bisexual, were not sure of their identity, and/or engaged in same-sex activity. 

• Of the 3,973 young women, 3,714 reported sexual contact only with males, 79 reported sexual contact only with females, and 180 reported sexual contact with both males and females.
• 3,666 self-identified as heterosexual, 21 as lesbian or gay, 163 as bisexual, and 113 as not sure of their sexual identity. 
• Among young women who reported only having female partners, 82% self-identified as heterosexual, 14% as lesbian or bisexual, and 4% as not sure of their sexual identity. 
• Among young women who reported having both male and female partners, 31% self-identified as heterosexual, 58% as lesbian or bisexual, and 11% as not sure.
• Sexual-minority young women were more likely to have multiple recent and lifetime sexual partners than young women who identified as heterosexual and only engaged in sex with male partners.
• Among sexual-minority young women, sexual behavior (having same-sex or both-sex partners) was a stronger predictor of having multiple recent and lifetime sexual partners than self-identification. 
• Sexual-minority young women were more likely to report illegal injection drug use than young women who identified as heterosexual and only engaged in sex with male partners. 
• Young women who indicated that they were not sure of their sexual identity were more likely not to use condoms with male sexual partners than young women who self-identified as heterosexual.
• Young women who had both male and female sexual partners were the most likely to have ever been sexually coerced when compared to young women who have only male or only female partners.
• Young women who have experienced coerced sexual contact were significantly more likely not to use condoms than young women who had no experience with sexual coercion. 
• Overall, young women who identified as lesbian, gay, or bisexual, were at higher risk for illegal injection drug use, preadolescent sexual intercourse, multiple lifetime or recent sexual partners, pregnancy, STD diagnosis, coerced sexual contact than young women unsure of their identity or who identified as heterosexual.
• Overall, young women who had both-sex partners were at higher risk for illegal injection drug use, preadolescent sexual intercourse, multiple lifetime or recent sexual partners, infrequent condom use, pregnancy, STD diagnosis, coerced sexual contact, dating violence, than young women who had sex exclusively with males or females. 
• All female respondents who reported receiving AIDS education in school were almost half as likely to have multiple recent or lifetime sexual partners, were one third less likely to report illegal injection drug use or ever having an STD diagnosis from a medical provider, and were less likely to have ever been pregnant or failed to use condoms during sexual intercourse.
• Young women with only female partners and those with both-sex partners were less than half as likely as young women with only male partners to report receiving AIDS education in school.

This study provides valuable new information on the HIV risk-taking behaviors of sexual-minority young women, a population that is extremely under-researched. In addition, this study offers a rare glimpse into the different dimensions of sexual orientation by distinguishing between sexual identity and behavior.

The results show that self-identified sexual identity is often inconsistent with behavior. Furthermore, sexual behavior is a better predictor of risk than sexual identity. Young women who have sex with both males and females were the most likely to engage in HIV risk-taking behavior when compared to young women who exclusively have sex with males or females. 

The researchers didn’t construct their study to examine why sexual-minority young women?and particularly young women who have sex with both males and females?are at such a high risk for HIV infection, but they did suggest an explanation for this correlation. They believe it is likely that inadequate HIV/AIDS education may have contributed to the increased risk. The results of the study show that young women who reported receiving HIV/AIDS education were much less likely to have multiple sexual partners or failed to use a condom and had fewer adverse outcomes like STD diagnoses or pregnancies. Unfortunately, sexual-minority young women were less likely than heterosexual young women to report receiving HIV/AIDS education and they subsequently had higher rates of these risk behaviors and outcomes. 

The authors believe this discrepancy may be due to the fact that many sexual-minority young women skip school, and therefore miss important HIV/AIDS lessons, because of fear of discrimination or even harassment. They also suggest that sexual-minority young women perceive HIV/AIDS education as irrelevant to their personal sexual experiences because most curricula exclude information about same-sex behavior or relationships. With this in mind, the researchers conclude that “school AIDS education that is sensitive to the needs of lesbian, gay, and bisexual adolescents and adolescents with same-sex partners may exert a positive influence on their behavior, but political constraints in many school districts may make open discussion of sexual orientation or same-sex behavior difficult.” SIECUS agrees that it is essential for all young people to receive comprehensive sexuality education, that includes HIV/AIDS education, and that represents and respects sexual minority youth. 

Abstinence-only-until-marriage programs certainly fall far short of this goal, as most of them refuse to acknowledge the existence of lesbian, gay, or bisexual individuals at all. Unfortunately, many teen pregnancy- and HIV-prevention programs that go beyond abstinence-only, spend little time addressing the specific risks sexual minority youth face.   This study proves that we can’t afford to make assumptions about what information young women need and don’t need when it comes to sexuality education, especially when sexual identity and actual behavior do not always coincide. The researchers of this study agree: “it would be valuable to investigate whether more-tolerant social environments – either in school or elsewhere – were linked to lower levels of HIV risk among sexual-minority adolescents, as they have been for other forms of risk.”