Sexual stigma and uptake of safer sex practices among lesbian, bisexual, and queer women in Toronto, Canada Presented by Dr. Dionne Gesink 1 Authors: Carmen Logie 2, Ashley Lacombe- Duncan 2, Rachel MacKenzie 1, Tonia Poteat 3, Dionne Gesink 1 1: Dalla Lana School of Public Health, University of Toronto; 2: Factor- Inwentash School of Social Work, University of Toronto; 3: Johns Hopkins Bloomberg School of Public Health

Background: LBQ STIs 20% of lesbian, bisexual and queer (LBQ) women have a lifetime history of STIs – Similar to heterosexual women’s rates of STIs Yet limited research exists on safer sex among LBQ women despite reported low use of barriers – Contributes to low risk perception

Background: Sexual Stigma Sexual stigma: social and institutional processes that devalue and limit opportunities based on sexual minority identity Sexual stigma includes distal processes: – Enacted stigma: acts of violence and unequal treatment (e.g. harassment) – Perceived stigma: concerns of rejection and negative treatment by others because of actual or perceived LGBQ identity

Background: Minority Stress Model Sexual stigma is a chronic stressor with harmful effects on health and wellbeing Coping and social support often mediate stress initiated social processes, such as stigma Few studies have looked at coping & sexual risk

Purpose This study assessed: – Frequency and types of safer sex practices – Associations between sexual stigma & safer sex practices – Interactions between safer sex practices and social support/resilient coping among WSW in Toronto, Canada

Methods Cross sectional internet based survey with WSW in Toronto – Adults over 18 years old – Identified as lesbian, bisexual, queer, same sex attracted, women who has sex with women (WSW)

Methods 10 peer recruiters (PR) who were WSW (service providers, community organizers, event planners, DJ, promoter) hired to recruit participants Modified peer driven recruitment: – Each PR aimed to recruit a minimum of 25 persons Convenience sampling: – Listserves and venue based sampling (HIV/STI clinics, LGBT agencies)

Survey Participants completed self administered online survey Used scales with established validity & reliability: – Safer Sex Practices Scale with Lesbian Women – Sexual Stigma Scale adapted for LBQ Women – Brief Resilient Coping Scale – Multidimensional Scale of Social Support

Analyses Multivariable linear regression: – Perceived and enacted sexual stigma as predictors (exposures) of safer sex (outcome) – Coping and social support as effect modifiers – Control for confounders Statistical analyses conducted in R

Results: Participant Characteristics Age ranged from (mean age of 31 years; SD: 8.0 years) Average number of lifetime sexual partners 14.2 (SD 11.7) 20% reported a previous STI (lifetime) Participants included in analyses (complete safer sex data) did not differ significantly in socio- demographic characteristics or main exposure scores from those excluded from analyses

Results: Sexual Practices Similar to other studies we found: – Most WSW know about, but do not use, barriers during sex – ~1/2 of participants do not share sex toys consistently – 2% of women always use a dental dam – Relationship status impacted safer sex: those with multiple partners practiced greater safer sex

Bivariate linear regression of enacted & perceived sexual stigma & safer sex practices Variable EffectP Minority stressors Enacted Sexual Stigma (per 5-point increase in enacted sexual stigma) Perceived Sexual Stigma (per 5-point increase in perceived sexual stigma) Protective factors Coping/Resiliency (per 5- point increase in coping score) Social Support (per 5- point increase in social support score)

Multivariable linear regression model of the associations between enacted and perceived sexual stigma, safer sex practices and interacting variables Variable BetaSEP Relationship status (Versus “Casual Dating”) No Current Partners Dating: Not living together Living together Married Multiple Partners/Polyamorous History of male partner (Yes versus No) Minority stressorsPerceived Sexual Stigma Enacted Sexual Stigma Protective factorsResilient Coping Social Support Interaction between minority stressors and protective factors Resilient Coping*Perceived Sexual Stigma Social Support*Enacted Sexual Stigma

Ho: minority stress model

Conclusions Findings congruent with minority stress model for low levels of coping & social support – As perceived and enacted sexual stigma increased, safe sex decreased Findings incongruent with minority stress model for high levels of coping and social support – As perceived and enacted sexual stigma increased, safe sex increased

Acknowledgments Canadian institutes of Health Research Participants and peer recruiters Contact: Thank You ✦ Merci!

Hypotheses 1.Higher sexual stigma (enacted, perceived) would be associated with lower uptake of safer sex practices 2.Social support & resilient coping would moderate the associations between sexual stigma & safer sex practices

Table 2. Participation in safer sex strategies (n=388 with copmplete safer sex data) Practice Always use or practice, n (%) Sometimes use or practice, n (%) Know about this but don’t use or practice, n (%) Don’t know about this, n (%) Use latex gloves 14 (4) 86 (22) 254 (65) 34 (9) Use dental dams 8 (2) 37 (10) 323 (83) 20 (5) Do not share sex toys 169 (44) 88 (23) 121 (31) 10 (3) Do not brush or floss teeth before oral sex 101 (26) 74 (19) 122 (31) 91 (23) Do not have sex during you or your partners menstruation 100 (26) 112 (29) 133 (34) 43 (11) Do not share razors for shaving 191 (49) 47 (12) 110 (28) 40 (10) Cut condoms open for oral sex 4 (1) 27 (7) 305 (79) 52 (13)

Table 3. Univariable linear regression of enacted & perceived sexual stigma & safer sex practices Variable EffectP Minority stressors Enacted Sexual Stigma (per 5-point increase in enacted sexual stigma) Perceived Sexual Stigma (per 5-point increase in perceived sexual stigma) Protective factors Coping/Resiliency (per 5- point increase in coping score) Social Support (per 5- point increase in social support score)

Multivariable linear regression model of the associations between enacted and perceived sexual stigma, safer sex practices and interacting variables Total Model < VariableEffect Lower Confidence Interval (0.95) Upper Confidence Interval (0.95) Enacted Sexual Stigma: High Social Support Perceived Sexual Stigma: High Coping : Based on increasing enacted sexual stigma by 5 points, social support score =60; 2: Based on increasing perceived sexual stigma by 5 points, coping score=20

Multivariable regression results No significant interactions between: – enacted sexual stigma & resilient coping – perceived sexual stigma & social support Significant interactions between: – enacted sexual stigma & social support – Perceived sexual stigma & resilient coping At lower social support, higher enacted stigma associated with less safer sex practices At lower coping, higher perceived stigma associated with less safer sex practices

Discussion Those with lower coping reported less safer sex practices when experiencing perceived stigma – Similar to studies with MSM that showed maladaptive coping mediated the association between stigma & condomless sex – Higher resilient coping—positive adaptations to stress—may moderate effects of perceived stigma that is rooted in perceptions & fears of mistreatment; – Both resilent coping & perceived stigma reflect intrapersonal processes

Discussion Social support resulted in different safer sex practices when experiencing enacted stigma Possible that high levels of support from family, friends & significant other can lead to support, community building & solidarity when experiencing acts of stigma and discrimination These reflect interpersonal processes