Logie Carmen H, Marcus Natania, Wang Ying, Lacombe-Duncan Ashley, Levermore Kandasi, Jones Nicolette, Bryan Nicolette, Back Robin, Marshall Annecka
a Associate Professor , Factor-Inwentash Faculty of Social Work, University of Toronto , Toronto , ON , Canada . Correspondence:
b Adjunct Scientist, Women's College Research Institute, Women's College Hospital , Toronto , ON , Canada.
Reprod Health Matters. 2018 Dec;26(52):1517543. doi: 10.1080/09688080.2018.1517543.
Limited research has examined lesbian and bisexual women's sexual health practices in the Caribbean, where lesbian and bisexual women experience sexual stigma that may reduce sexual healthcare utilisation. We conducted a sequential multi-method research study, including semi-structured individual interviews (n = 20) and a focus group (n = 5) followed by a cross-sectional survey (n = 205) with lesbian and bisexual women in Kingston, Montego Bay, and Ocho Rios, Jamaica. Binary logistic analyses and ordinal logistic regression were conducted to estimate the odds ratios for social-ecological factors associated with lifetime STI testing, sex work involvement, and the last time of STI testing. Over half of participants reported a lifetime STI test and of these, 6.1% reported an STI diagnosis. One-fifth of the sample reported ever selling sex. Directed content analysis of women's narratives highlighted that stigma and discrimination from healthcare providers, in combination with low perceived STI risk, limited STI testing access and safer sex practices. Participants described how safer sex self-efficacy increased their safer sex practices. Quantitative results revealed that a longer time since last STI test was positively associated with depression, sexual stigma, and forced sex, and negatively associated with residential location, perceived STI risk, safer sex self-efficacy, and LGBT connectedness. Selling sex was associated with perceived STI risk, relationship status, sexual stigma, food insecurity, and forced sex. Sexual health practices among lesbian and bisexual women in Jamaica are associated with intrapersonal, interpersonal, and structural factors, underscoring the urgent need for multi-level interventions to improve sexual health and advance sexual rights among lesbian and bisexual women in Jamaica.
在加勒比地区，针对女同性恋和双性恋女性性健康行为的研究有限，而在该地区，女同性恋和双性恋女性面临性污名，这可能会降低她们对性健康护理的利用率。我们开展了一项多方法序列研究，包括对牙买加金斯敦、蒙特哥贝和奥乔里奥斯的20名女同性恋和双性恋女性进行半结构化个人访谈以及一次有5人的焦点小组访谈，随后进行了一项有205名女同性恋和双性恋女性参与的横断面调查。我们进行了二元逻辑分析和有序逻辑回归，以估计与终身性传播感染检测、性工作参与情况以及上次性传播感染检测时间相关的社会生态因素的比值比。超过一半的参与者报告进行过终身性传播感染检测，其中6.1%报告被诊断患有性传播感染。五分之一的样本报告曾从事性交易。对女性叙述的定向内容分析突出表明，医疗服务提供者的污名和歧视，再加上对性传播感染风险的低认知，限制了性传播感染检测的机会和安全性行为。参与者描述了安全性行为自我效能感如何增加了她们的安全性行为。定量结果显示，距离上次性传播感染检测的时间越长，与抑郁、性污名和强迫性行为呈正相关，与居住地点、感知到的性传播感染风险、安全性行为自我效能感以及与 LGBT 群体的联系呈负相关。从事性交易与感知到的性传播感染风险、恋爱状况、性污名、粮食不安全和强迫性行为有关。牙买加女同性恋和双性恋女性的性健康行为与个人、人际和结构因素相关，这凸显了迫切需要采取多层次干预措施，以改善牙买加女同性恋和双性恋女性的性健康并推进她们的性权利。
