title: Correlates of a lifetime history of sexually transmitted infections among women who have sex with women in Toronto, Canada: results from a cross-sectional internet-based survey.
abstract: OBJECTIVE
  Structural drivers of sexually transmitted infections (STI) among women who have sex with women (WSW) have been underexplored. The study objective was to understand sociodemographic, individual, structural, and sexual health factors associated with a lifetime history of STI among WSW.
  
  
  METHODS
  A cross-sectional survey was conducted in 2012 to engage a peer-driven recruitment sample of WSW in Toronto, Canada. Data were collected among a convenience sample of 466 WSW using an online structured interview.
  
  
  RESULTS
  Approximately one-fifth (n=89, 19.1%) of participants reported an STI diagnosis history. Participants identifying as bisexual were more likely, and lesbians less likely, to report an STI history than those identifying as queer. In multivariate logistic regression analyses adjusted for sociodemographic variables, STI history was associated with intrapersonal (STI knowledge, HIV/STI risk perceptions), interpersonal (male sex partners in past 3 months, number of lifetime sexual partners) and structural (sexual stigma, history of forced sex, belief healthcare provider (HCP) uncomfortable addressing sexual orientation) factors as well as sexual healthcare uptake (ever had STI/HIV test, STI/Pap test in past 2 years). Gender-non-conforming participants were less likely to report an STI history.
  
  
  CONCLUSIONS
  This research is among the first to examine intrapersonal, interpersonal and structural factors correlated with an STI history among WSW. Findings highlight the importance of STI prevention strategies for WSW to be tailored to sexual identity, with particular attention to bisexual women's needs. Interventions should connect to sexual healthcare, address sexual stigma and train HCP to better meet the needs of WSW.
authors.affiliation: Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada Women's College Research Institute, Women's College Hospital, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Carmen H
authors.initials: CH
authors.lastname: Logie
authors.affiliation: Department of Anthropology, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Daniela
authors.initials: D
authors.lastname: Navia
authors.affiliation: Women's College Research Institute, Women's College Hospital, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Mona R
authors.initials: MR
authors.lastname: Loutfy
mesh_terms: D000328:Adult; D001727:Bisexuality / Q000523:psychology / Q000706:statistics & numerical data*; D002690:Chlamydia Infections / Q000453:epidemiology*; D003218:Condylomata Acuminata / Q000453:epidemiology*; D003430:Cross-Sectional Studies; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006558:Herpes Genitalis / Q000453:epidemiology*; D018452:Homosexuality, Female / Q000523:psychology / Q000706:statistics & numerical data*; D006801:Humans; D020407:Internet; D008297:Male; D009864:Ontario / Q000453:epidemiology; D010379:Peer Group; D012307:Risk Factors; D012494:Sampling Studies; D011477:Sex Work / Q000706:statistics & numerical data*; D012747:Sexual Partners / Q000523:psychology; D019966:Substance-Related Disorders / Q000453:epidemiology*; D011795:Surveys and Questionnaires
keywords: CHLAMYDIA INFECTION; HPV; LESBIANS; SEXUAL HEALTH; SOCIAL SCIENCE