Sexual & Reproductive Health| Volume 26, ISSUE 6, P612-621, November 2016

Sexual Orientation and Sexual and Reproductive Health among African American Sexual Minority Women in the U.S. South

Published:August 18, 2016DOI:



      Research on the sexual and reproductive health of sexual minority women, especially those of color, is limited.


      Using multivariable Poisson regression, we estimated risk ratios for the association between two dimensions of sexual orientation (sexual identity and sexual behavior) and five sexual and reproductive health indicators (pregnancy, contraceptive use, human immunodeficiency virus [HIV] testing, Pap test use, and sexual assault) among African American sexual minority women in the U.S. South (n = 165).


      Lesbians were less likely than bisexual women to have ever been pregnant (risk ratio [RR], 0.64; 95% confidence interval [CI], 0.48–0.85), ever received an HIV test (RR, 0.88; 95% CI, 0.80–0.96), obtained a Pap test in the last 3 years (RR, 0.75; 95% CI, 0.61–0.91), and had an abnormal Pap test result in their lifetime (RR, 0.42; 95% CI, 0.24–0.75). Women with only female past-year sexual partners were less likely than women with male and female past-year sexual partners to have ever been pregnant (RR, 0.58; 95% CI, 0.43–0.78), ever received an HIV test (RR, 0.87; 95% CI, 0.79–0.96), obtained a Pap test in the last 3 years (RR, 0.82; 95% CI, 0.67–0.99), and had an abnormal Pap test result in their lifetime (RR, 0.55; 95% CI, 0.32–0.94). Contraceptive use, receiving an abnormal Pap test result at the time of the study visit, and experiencing sexual assault did not differ by sexual identity or behavior.


      Several sexual and reproductive health indicators varied in relation to sexual identity and sexual behavior among Southern African American sexual minority women. Interventions that facilitate access to sexual and reproductive health services and are tailored to the unique needs of sexual orientation subgroups of sexual minority women are needed.
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      Madina Agénor, ScD, MPH, is an Assistant Professor in the Department of Social and Behavioral Sciences at Harvard T.H. Chan School of Public Health. Her research pertains to social inequalities in sexual and reproductive health in relation to gender, sexual orientation, and race/ethnicity, especially among marginalized women and girls.


      S. Bryn Austin, ScD, is Professor of Pediatrics at Harvard Medical School and Professor of Social and Behavioral Sciences at Harvard T.H. Chan School of Public Health. Her research pertains to sexual and gender minority health and the prevention of eating disorders.


      Daniel Kort, BA, is a doctoral student in the Department of Psychology at the University of Washington. His research pertains to the effects of discrimination on health outcomes among marginalized social groups.


      Erika L. Austin, PhD, MPH, is an Assistant Professor in the Department of Biostatistics at the University of Alabama at Birmingham School of Public Health. Her research pertains to the health of disadvantaged populations, including sexual minority women and homeless veterans.


      Christina A. Muzny, MD, is an Assistant Professor in the Division of Infectious Diseases at the University of Alabama at Birmingham School of Medicine. Her clinical and research interests focus on sexually transmitted infections among underserved groups of women, including lesbians and bisexual women.