This study analyzed data from a national survey of over 5,500 adolescents to compare sexual behaviors and HIV risk factors among heterosexual, lesbian, and bisexual females. The results showed that lesbian and bisexual females were more likely than heterosexual females to have engaged in various sexual activities. They also exhibited riskier behaviors like inconsistent condom use and failure to discuss condoms with partners. However, lesbian and bisexual females were more likely to use the internet to search for health information on topics like HIV/AIDS. The study concludes that tailored HIV prevention programs are needed for lesbian and bisexual youth, and technology could be effective for delivering sexual education.

1. 11th International AIDS Impact Conference
Barcelona, Spain
Tuesday, October 1, 2013
The research justification for HIV
prevention programming for lesbian and
bisexual females
Michele L. Ybarra MPH PhD, Center for Innovative Public Health
Research
Kimberly J. Mitchell PhD, Crimes against Children Research
Center, University of New Hampshire
* Thank you for your interest in this presentation. Please note that analyses
included herein are preliminary. More recent, finalized analyses may be available
by contacting CiPHR for further information.

2. Acknowledgements
The project described was supported by Award Number
R01 HD057191 from the National Institute of Child
Health and Human Development. The content is solely
the responsibility of the authors and does not necessarily
represent the official views of the National Institute of Child
Health and Human Development or the National Institutes
of Health.
We would like to thank the entire Study team from the
Center for Innovative Public Health Research, the
University of New Hampshire, the Gay Lesbian Straight
Education Network (GLSEN), Latrobe University, and
Harris Interactive, who contributed to the planning and
implementation of the study. We thank the study
participants for their time and willingness to participate in
this study.

3. Study motivation
HIV prevention programming that is
tailored to lesbian (as well as bisexual)
adolescents is practically non-existent.
This may be because there we assume
that lesbian females are at low risk for HIV
and STIs…
Image from: http://www.afterellen.com/sugar-rushcomes-to-the-states/01/2009/

4. Study motivation
Data from regional studies suggest,
however, that adolescent females who
self-identify as lesbian (or queer) are
more likely to:
Get pregnant,
 Engage in anal sex, and
 Engage in inconsistent condom use

compared to heterosexual adolescent
females.
Saewyc EM, Bearinger LH, Blum RW, Resnick MD. Sexual intercourse, abuse and pregnancy among
adolescent women: does sexual orientation make a difference? Fam Plann Perspect. 1999 MayJun;31(3):127-31.
Herrick AL, Matthews AK, Garofalo R. Health risk behaviors in an urban sample of young women who have
sex with women. J Lesbian Stud. 2010;14(1):80-92. doi: 10.1080/10894160903060440.
Stevens PE, Hall JM. Sexuality and safer sex: the issues for lesbians and bisexual women. J Obstet

5. Study motivation
How these data translate to national
samples (as local samples may not
necessarily be representative of the larger
population) is not well understood…
Image from: http://www.drwendyschwartz.com/Los-Angeles-Marriage-and-Family-Counseling/category/teens/page/2/

6. Teen Health and Technology
survey methodology





A national survey of 5,542 13-18 year olds (3,011 of
whom were female) was conducted in August 2010 –
January 2011
Included an oversample of LGBT youth
Data were conducted online.
Data were weighted to approximate a representative
national sample of U.S. adolescents.
Measurements of sexual activity:
◦ Consensual vaginal sex was asked with the following
question: “Have you ever, when you wanted to, had sex where
a penis went into a vagina?”
◦ Receptive anal sex was queried: “Have you ever, when you
wanted to, had sex where someone's penis went into your
anus?”
◦ Penetrative sex was queried: Have you ever, when you
wanted to, had sex with another person that involved a finger
or sex toy?”

7. Ever sexual experience
(n=3,011)
80%
70%
Bisexual
Heterosexual
Lesbian
60%
51%
48%
50%
38%
40%
30%
15%
20%
10%
17%15%
14%
4% 2%
0%
Penetrative sex***
*** P<0.001
Anal sex***
Vaginal sex***

8. HIV risk behavior among females who
have ever had sex
80%
Lesbian
Heterosexual
Bisexual
70%
60%
67%
48%
50%
39%
40%
25%
30%
30%
29%
20%
10%
0%
Inconsistent condom use
*** P<0.001
Did not talk to parter about
condoms***

9. HIV protective behavior: Using
technology to search for health
information (n=3011)
80%
70%
Lesbian
Heterosexual
Bisexual
60%
50%
40%
31%
30%
18%
20%
12%
11%
10%
11%
5%
0%
Information about HIV/AIDS*** Information about condoms /
birth control***
*** P<0.001

10. Limitations



As with all self-report measures, some youth
respondents may not have accurately disclosed
sensitive topics.
The representativeness of the sample is based
upon the weighting. Findings should be replicated.
Sexual identity is fluid in adolescence. It is
possible that lifetime rates of sexual activity include
some youth who first self-identified as and
engaged in sexual behavior consistent with a
heterosexual identity; and subsequently identified
as lesbian.

11. Conclusions



The current findings add to the negligible
literature documenting HIV risk and protective
behavior among lesbian and bisexual females.
More needs to be done to ensure that lesbian
and bisexual youth have the
specific, necessary information they need to
make healthy sexual choices.
Given their use of the Internet to access sexual
health information, technology-based HIV
prevention programs (i.e., those delivered
online, via text messaging, or a combination of
the two) seem likely feasible and acceptable to
deliver healthy sexual education to lesbian and
bisexual females.