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  • I’m planing to throw a lot of data at you and see what happens. The last quesiotn is for discusison – I’ve got some provicative ideas so let’s hope we get there...
  • Almost half (47.7%) of these women were also in a regular relationship. That is, 22.6% women in a regular relationship with a woman had had a casual sexual partner in the preceding 6 months (only half were in a new relationship, that is, they were with their regular partner for less than six months).
  • Over half reported having used a sex toy (an increase from previous years). Anal practices were less common but again appear to be increasing; 28% had given or received manual stimulation of the anus and 20.8% had practised rimming (oral–anal contact).Worth including anal practices in health advice about lesbian sex?
  • In 2010, 11% of queer or other women reported sex work (compared to 3.9% of lesbians and 5% of bisexuals).
  • 4.1% in past 6 months - 18% often had unprotected sex 9.5% in past 6 months - 15.2% often had unprotected sex International research - M ajority have a sexual history / currently sexually active with men ( Mercer 2007; Bailey 2003; Marrazzo 2001 ) Condom use low ( Fethers 2000; Mercer 2007; McNair 2009 ) More likely to report gay or bisexual men as sexual partners ( Fethers 2000 )
  • When we compared the pregnancy rate of the 15-18 year olds with the SSASH study (Smith et al, 2009) we found that double the percentage of SSAGQ young women had been pregnant (10%) compared with 5% of their heterosexual peers. A t a time when the teenage pregnancy rate in Australia has nearly halved (8% to 5%) Lower condom use and earlier debut
  • One hundred and thirty women (13.5%) had ever received an STI diagnosis.
  • Echoes international findings re WSW It is worth noting that 16% of women did not know that if a person experiencing a cold sore outbreak has oral sex they can give their partner genital herpes
  • More likely to start having sex (any) earlier and less likely to use a condom
  • When we compared the pregnancy rate of the 15-18 year olds with the SSASH study (Smith et al, 2009) we found that double the percentage of SSAGQ young women had been pregnant (10%) compared with 5% of their heterosexual peers. A t a time when the teenage pregnancy rate in Australia has nearly halved (8% to 5%) Lower condom use and earlier debut
  • 88% of women know that they need pap smears Seek breast self-examination, mammograms, pap smears less often and with less regularity (Fish 2005) HPV transmission only requires skin-to-skin contact (Marrazzo 1998), prevalence of genital warts similar to exclusively heterosexual women (Fethers 2000)
  • Latex barrier use is low (Diamant 2000; Morrow 2000; Lindley 2003; Dolan 2003; Fishman 2003; Cox 2009)
  •  
  • Interview studies
  • I’ve pulled out some data to show you some of these barriers to action BUT also want to make an argument about the damage done by heterosex oriented education
  • One of the things that stood out in the interviews was women trying to work out how vulnerable other SSA women might be. Many tried to translate the knowledge they had about risk and sex with men to sex with women:
  • One of the things that stood out in the interviews was women trying to work out how vulnerable other SSA women might be. Many tried to translate the knowledge they had about risk and sex with men to sex with women:
  • Women always made a comparison - sex with women is safer (than sex with men), women who have sex with women are less vulnerable (than women who have sex with men). I would argue that we are seeing an unexpected legacy of education around safer heterosex – how women understand risk and vulnerability in sex between women can only be made in relation to what they know about sex between men and women. The risk is less so there is nothing to worry about?
  • Change paradigms but still the reference point
  • Even if perceived a risk of contracting an STI in sex with women, they don’t know what to do to prevent it
  • Embarrassed? I’d speculate that in Pandora's case it’s about not knowing how to introduce this into her relationship
  • Or, they don’t use things like condoms, dams or gloves because don’t know how, have no faith, or are embarrassed:
  • While other women talked about a kind of fairness, hinting at a perceived risk of suggesting to a partner that you or they might have an STI  
  • Earlier sexual debut

lesbian sexual health_ACON_Dec 2011_JulieMooneySomers lesbian sexual health_ACON_Dec 2011_JulieMooneySomers Presentation Transcript

  • Why LBQ women don’t use dental dams: Australian research on LBQ women’s sexual health Julie Mooney-Somers Presented at ACON’s Big Day In 9/12/2011This work is licensed under aCreative Commons Attribution-NonCommercial-NoDerivs 3.0 Unpor. The Centre for Values, Ethics & the Law in Medicine The University of Sydney, Australia
  • Questions1. What do we know about sexual behaviour and sexual health in LBQ women?3. What are women’s perceptions of STI risk?5. What do these research findings mean for health promotion? The Centre for Values, Ethics & the Law in Medicine The University of Sydney, Australia
  • What do we know about sexual behaviour and sexual health in LBQ women? The Centre for Values, Ethics & the Law in Medicine The University of Sydney, Australia
  • Sydney Women and Sexual Health Survey• SWASH run biannually since 1996• Data collected during the Sydney Gay and Lesbian Mardi Gras season• Women in contact with LGBTQ communities• Originally sexual health now general health and wellbeing The Centre for Values, Ethics & the Law in Medicine The University of Sydney, Australia
  • SWASH: sexual behaviour• 94% ever had sex with a woman – 82% in last 6 months• If had sex with a woman in past 6 months, 71% had one partner and 22% had 2-5 partners• 63% in regular relationship with a woman• 22% reported casual female partner in past 6 months The Centre for Values, Ethics & the Law in Medicine The University of Sydney, Australia
  • SWASH: sexual practices 2006 2008 2010 n (%) n (%) n (%)Fingers/hand on external genitals 723 (96) 751 (95) 753 (96)Fingers/hand inside vagina 704 (94) 746 (94) 741 (94)Fingers/hand inside anus 230 (31) 246 (31) 223 (28)Oral sex (mouth on partner’s genitals) 640 (85) 686 (87) 693 (88)Oral sex (mouth on respondent’s genitals) 611 (81) 668 (84) 663 (84)Rimming (mouth on partner’s anus) 112 (15) 145 (18) 119 (15)Rimming (mouth on respondent’s anus) 118 (16) 146 (18) 128 (16)Sex toy used on external genitals 421 (56) 474 (60) 470 (60)Sex toy used inside vagina 427 (57) 485 (61) 482 (61)Sex toy used inside anus 108 (14) 138 (17) 110 (14) The Centre for Values, Ethics & the Law in Medicine The University of Sydney, Australia
  • SWASH: N sex in past 4 wks 2008 2010 n (%) n (%) 0 100 (13) 129 (16) 1 73 (9) 82 (10) 2–5 223 (28) 244 (31) 6–10 136 (17) 139 (18) 11+ 127 (16) 107 (14) “A few” 6 (1) 9 (1) “Many”, “Lots” 41 (5) 31 (4) “Too many to count” 14 (2) 2 (0.3) “Not enough” 3 (0.4) 3 (0.4) “Don’t know”, “Forget” 19 (2) 4 (1) Not answered 50 (6) 38 (5) Total 792 (100) 788 (100) The Centre for Values, Ethics & the Law in Medicine The University of Sydney, Australia
  • SWASH: sexual practices• 16% involved in S&M without (15%) or with blood (4%)• 10% engaged in any group sex in past 6 months; 83% of this sex involved a woman • 5% had ever done sex work. Significantly more likely among women identifying as queer or other (11%). The Centre for Values, Ethics & the Law in Medicine The University of Sydney, Australia
  • SWASH: sex with men• 59% ever had sex with a man• Bisexual (82%), queer/other (79%) women more likely than lesbians (53%)• 18% of women ever had sex with a man they believed to be gay or bisexual• More likely to often have unprotected sex if sex with gay or bi man (last 6 months) The Centre for Values, Ethics & the Law in Medicine The University of Sydney, Australia
  • Research on young SSA women• “Writing themselves in” is a 6-yearly survey of same-sex attracted young (14 - 21 yo) people (Hillier 1998, 2005, 2010)• As likely to have had sex with both men and women, as women only, and sig % sex with men only (very different to men)• Less likely than men to use condom at last penetrative sex The Centre for Values, Ethics & the Law in Medicine The University of Sydney, Australia
  • SWASH: STI diagnosis 2010 n (%)Genital warts 35 (4)Chlamydia 30 (3)Bacterial vaginosis 26 (3)Genital herpes 25 (3)HPV 22 (2)Gonorrhoea 15 (2)Lice/crabs 10 (1)Hepatitis B 6 (1)Syphilis 0 (0.0) The Centre for Values, Ethics & the Law in Medicine The University of Sydney, Australia
  • STI rates higher in WSW• Self-identified lesbian (23%), bisexuals (38%) more likely to report STI diagnosis than heterosexuals (17%) (ASHR 2003)• WSW, regardless of sexual identity, more likely to self-report ever receiving an STI diagnosis (ASHR 2003; Mercer 2007; Tao 2008)• Especially bacterial vaginosis (BV) (Fethers 2000) and herpes simplex virus type 2 infection (HSV-2) (Xu 2010) The Centre for Values, Ethics & the Law in Medicine The University of Sydney, Australia
  • Research on younger WSW/SSA• Likelihood of reporting an STI diagnosis higher than exclusively heterosexual women (Hillier 2008; Hillier 2005; Goodenow 2008; Smith 2002)• 2008 Australian Secondary School Students Survey reported 3% of sexually active young women reported an STI diagnosis (Smith, 2009)VS• 9% of same-sex attracted young women in 2005 and 4% in 2010 (Hillier 2005; Hillier 2010) The Centre for Values, Ethics & the Law in Medicine The University of Sydney, Australia
  • Young SSA women and pregnancy• 15% reported ever being pregnant – twice as many as hetero peers (Hillier 2010)• 37% of ever pregnant SSA were exclusively attracted to women (Hillier 2010)• Findings reflected internationally (Goodenow 2008; Saewyc 2004) The Centre for Values, Ethics & the Law in Medicine The University of Sydney, Australia
  • SWASH: STI screening• 54% ever had diagnostic or screening test for STI other than HIV; 16% in past six months• Queer and other women (66.), followed by bisexual women (54%) and lesbian women (52%)• Ever had sex with a man more likely (63%) compared never had sex with a man (42%) The Centre for Values, Ethics & the Law in Medicine The University of Sydney, Australia
  • SWASH: pap smears• 26% over due or never had pap smear• Rates improving but:• Never had sex with a man, three times more likely to have never been screened• Ever had sex with a man, 30% of bisexual women never screened The Centre for Values, Ethics & the Law in Medicine The University of Sydney, Australia
  • Perceptions of STI risk in sex between women? The Centre for Values, Ethics & the Law in Medicine The University of Sydney, Australia
  • SWASH: using latex barriers• 2002 data• Most women used latex barriers once or never (94% dental dam; 88% gloves; 83% condoms) (Richters 2004)• Women do not use barriers when having sex with menstruating (Richters 2005; Dolan 2003) The Centre for Values, Ethics & the Law in Medicine The University of Sydney, Australia
  • Using toys• 52-60 % do not use condoms with sex toys (Bailey 2003; Fishman 2003)• 12-22% don’t wash sex toys when sharing (Diamant 2000; Bailey 2003) The Centre for Values, Ethics & the Law in Medicine The University of Sydney, Australia
  • Barriers to risk reduction strategies• Uncertainty about when and how to introduce safer sex• Reticence about using dental dams and gloves due to a lack of experience• Embarrassment at buying dental dams or condoms• Stigmatising effects of disclosing STI diagnosis or the shame associated with their own past sexual behaviours The Centre for Values, Ethics & the Law in Medicine The University of Sydney, Australia
  • Perception of risk• Perceive the risk of STI transmission between women to be very low (Fishman 2003)• Lesbian = protection from STI (Dolan 2003)• “inherent invulnerability” - lesbians don’t have sex with men, or with women who have sex with men The Centre for Values, Ethics & the Law in Medicine The University of Sydney, Australia
  • Perception of risk• “lesbian immunity” - socially inoculated because they can detect and avoid the ‘infected’ (Stevens 2001)• Relies on ability to select “safe” partner, sharing of sexual histories, trust• But, may not know own status and hard to talk about sexual histories and safer sex The Centre for Values, Ethics & the Law in Medicine The University of Sydney, Australia
  • Perception of risk• Assessing the prevalence of a disease in the community is part of the risk assessment• “optimistic bias” – perceive prevalence of HPV as low compared to other communities and their own risk as lower than other women (Eaton 2008)• Low risk and low prevalence = low benefit of safer sex (Fishman 2003) The Centre for Values, Ethics & the Law in Medicine The University of Sydney, Australia
  • SSA younger women and risk• Julie’s pilot study with 9 young SSA in Sydney (2009-2010)• To explore the understandings and practices related to safer sex in same- sex attracted young women, and identify practical opportunities for intervention and education around STI prevention The Centre for Values, Ethics & the Law in Medicine The University of Sydney, Australia
  • Translating knowledge• I just hesitate to say just as vulnerable as women having sex with men [pause] I suppose ‘cause I’m just thinking of the physiology of it all and [...] well does semen actually carry these things? That is something that I think it might [long pause]. Like with AIDS for instance whereas with a woman having sex with a woman there is obviously no semen involved. (Pandora)• I would have thought less because there’s less transfer of bodily fluids. (Sarah) The Centre for Values, Ethics & the Law in Medicine The University of Sydney, Australia
  • Translating knowledge• I would be, I would be surprised if I managed to catch something like Chlamydia. But then, I think it would be, for example like you know if you’re using toys, then that would transfer it more than if you were touching yourself and then you touch your partner or the other way around. But if you’re only doing one direction, then I think it would less. (Sarah) The Centre for Values, Ethics & the Law in Medicine The University of Sydney, Australia
  • Relative risk• maybe if you only have sex with other women, you might be less likely to get some things (Georgia)• If you’ve only ever been with girls, and the girls who you slept with have only been with girls, that you’re at lower risk in general (Sarah)• because in a lot of those instances there are actually not penises involved, it will be fine. (Ange)• maybe I do feel a bit of security because I am not sleeping with a man (Pandora) The Centre for Values, Ethics & the Law in Medicine The University of Sydney, Australia
  • Changing paradigms• So I think, yeah definitely from a young girl who’s had sex with boys and then having sex with women, I think the likelihood to use condoms or sexual protection is definitely greatly reduced because you have reproduction taken out of the equation and you’re also, you may be using products like dildos and things that haven’t been used with other people. You might have bought something with your girlfriend, who you’re having a long term relationship with. The likelihood of you feeling the great need to use a condom in that situation is incredibly reduced because it’s not going through the whole community like a man’s [laughs] penis may be (Dani) The Centre for Values, Ethics & the Law in Medicine The University of Sydney, Australia
  • Don’t know what to do• Because there’s a broad range of sexual activities with lesbians, I think it can be unclear as to what is the appropriate protective measures I can take for this activity. So there’s the obvious, oral or digital sex, [laugh] I guess I don’t know how to term that, fingering, but there’s that obvious way of lesbian sex but then there’s other forms. Some women engage in anal sex. Some women use dildos. Some women are doing S and M activity that involves body fluids; all these kind of things. There’s no specific education given as to what to do in those situations. There’s only implied education or implied information “ (Dani) The Centre for Values, Ethics & the Law in Medicine The University of Sydney, Australia
  • Do know but don’t use• With my partner, it is a bit different because women cannot wear condoms so... I’ve read, I’ve got a book at home on lesbian sex, it’s a manual my friend gave me for my birthday, very embarrassingly, and [pause] every single thing is, “Put a latex glove on, step one,” and I [pause] have never done that. (Pandora) The Centre for Values, Ethics & the Law in Medicine The University of Sydney, Australia
  • Or lack faith in strategy• There’s a lack of stuff like condoms that accurately work for same-sex women like dams don’t. As far as I’m aware they don’t really work because they move around and get turned around and what’s the point? (Ange)• I was sleeping with women and we weren’t using gloves or dams or any of that stuff and I was, “I’m tested, are you tested?” and they would say, “Yep” but there wasn’t that trust there and they were people that I know to have been sleeping with a variety of other people much like myself (Ange) The Centre for Values, Ethics & the Law in Medicine The University of Sydney, Australia
  • Or confidence in self• I think it’s also hard to translate [...] your use of protection when you do go from having a long term relationship to infrequent casual relationships because, coming from personal experience, it’s hard to negotiate what you should do in that situation. Like, I didn’t do it for one person, so why should I do it in this situation? So I think that can be difficult. (Dani)• At the beginning of one’s relationship maybe you should go and get tested [pause]. When I was dating a boy that is what we were about to do [...] With my partner now, we did not discuss that that was not an option. It did occur to me at the beginning and I guess I felt rude [pause] to ask that (Pandora) The Centre for Values, Ethics & the Law in Medicine The University of Sydney, Australia
  • Main points from pilot study• Heterosex is reference point• Dont know if sex between women is risky• Don’t know how to tell if vulnerable• Don’t know what to do if they do• Don’t feel confident in strategies?? how do you assess and/or address risk is such a highly ambiguous situation? The Centre for Values, Ethics & the Law in Medicine The University of Sydney, Australia
  • What do these research findings mean for health promotion? The Centre for Values, Ethics & the Law in Medicine The University of Sydney, Australia
  • Provocations…1. LBQ women’s sexual health promotion should talk about condom use for hetero sex2. We’ve been too eager to jump on the STI bandwagon for LBQ women (equal opportunities & politics)3. If the hets are only told to use condoms, why do we have to use dams and gloves?4. Skin-to-skin (herpes, warts, HPV, BV) are most relevant but there’s no $ The Centre for Values, Ethics & the Law in Medicine The University of Sydney, Australia
  • Paradox?• Higher STI rates and unplanned pregnancy, and low screening rates• Sex with men?• Health promotion failing this population?• Consequences of messages about safer sex framed by heterosexuality?• History of same-sex-experience a marker of sexual adventurousness? The Centre for Values, Ethics & the Law in Medicine The University of Sydney, Australia
  • Contact me for references, discussion or if you have answers/ideas/provocations! Julie.MooneySomers@Sydney.edu.auThis work is licensed under aCreative Commons Attribution-NonCommercial-NoDerivs 3.0 Unpo. ATTRIBUTION: Mooney-Somers, J. Why LBQ women don’t use dental dams: Australian research on LBQ women’s sexual health. ACON Big Day In, Sydney, 9 December 2011 The Centre for Values, Ethics & the Law in Medicine The University of Sydney, Australia