| Background Previous researches showed that sexual health including HIV/sexually transmitted infection (STI) related risk behaviors like sex with men, multiple bisexual partners, and drug use existed among women who have sex with women (WSW). Further, they avoided routine physical examination, and concealed their homosexual behaviors when seeing a gynecologist or practitioner specializing in STIs which may cause inaccurate diagnosis and treatment. No research about WSW had been done in China before. In this study characteristics of Chinese WSW will be described, and factors for STI will be explored.Objectives To assess sexually transmitted infections and their risk behaviors among women who have sex with women, and obtain knowledge of background of the behaviors as well. To explore the recruiting methods of the sensitive population.Methods A cross-sectional study of women recruited from venues and internet outreach was conducted and analyzed using interviews and laboratory tests. From September2010-April2011, recruitment was announced over the internet through lesbian activist groups, LGBT (lesbian, gay, bisexual, transgender) websites, lesbian and gay bars, lesbian forums; also, the study was reviewed and leaflets were distributed in Beijing--area WSW venues, which included two bars, a salon, and two non-governmental organization sites. In both video and radio programs, the research and related lesbian sexual health issues were discussed through internet resources focused on lesbians. Some WSW who had attended the quantitative survey were chosen to qualitative study according to the study objectives. In the cross-sectional study we mainly collected the information of social demography, women-women sexual behavior, heterosexual behavior, commercial sex behavior, alcohol consumption, drug use, contract marriage (gay man and lesbian marriage), HIV/STI knowledge, reproductive health, health seeking behavior, etc. Blood sample of WSW was collected for diagnosis of syphilis, HIV, hepatitis B virus (HBV), hepatitis C virus (HCV), herpes simplex virus type2(HSV-2). A gynecological examination was conducted by trained physicians and cervical samples were collected for evaluation of Neisseria gonorrhoeae, Chlamydia trachomatis; vaginal secretions were tested for candidiasis and bacterial vaginosis (BV). Univariable analyses, multivariable analyses and odds ratios calculations were performed as appropriate. The topics of qualitative study were background, sexuality (including sexual behavior), factors of infecting STI.Results We recruited224WSW. They were mainly recruited from internet and friends promotion, which accounted for47.3%(106/224) and35.3%(79/224), respectively. Significantly more WSW recruited from internet experienced vaginal bleeding during or after sex compared with those recruited from other ways (P=0.003). Their average age was25.6years and83.9%were between20-29years.93.7%had a university-level education. Homosexual self-identification was cited by67.4%(151/224). In the year preceding their participation in the study, sexual relations with men were reported by10.7%(24/224) of participants;92%(206/224) of them reported sexual relations with women,26.8%(60/224) of whom had had sex with two women or more. Internet, accounting for50.9%(14/224), was the main way of approaching female sex partners for the participants. Digital and clitoral/vaginal contacts were most common among women-women sexual behavior, which accounted for91.5%and90.2%, respectively. The concept of the G-spot (the Grafenberg spot) was known to90.6%(184/203) of participants,65.2%(120/184) of whom mentioned having had their G-spot stimulated by their partner during sex. More than one-third (36.4%(67/184)) of those noticed the G-spot experienced vaginal bleeding during or after sex. A positive association was noted between the frequency of seeking the G-spot and vaginal bleeding (P<0.001). A total of47.8%(107/224) of participants had ever gone to see a gynecologist or practitioner specializing in STIs,37.4%(40/107) of whom reported having been diagnosed with one or more sexually transmitted infections. However, only10.3%(11/107) of those who had seen a specialist had told their doctors about their women-women sexual behavior.The STI rates were:gonorrhea (15.8%), Chlamydia (3.5%), syphilis (0.5%), bacterial vaginosis (BV)(14.4%), hepatitis B virus (HBV)(0.9%), hepatitis C virus (HCV)(0.5%), and candidiasis (6.9%). No HIV or herpes simplex virus (HSV) positive cases were detected. Factors associated with gonorrhea infection were non-Beijing local residency (odds ratio (OR)=2.2,95%confidence interval (CI):1.23to3.78), genital-genital contact (OR=2.5,95%CI:1.09to5.71), internet-based recruitment (OR=3.3,95%CI:1.39to7.61) and bleeding during or after sex (OR:11.9;95%CI:3.39,42.39); factors associated with gonorrhea, Chlamydia, or syphilis were non-Beijing local residency (OR=1.9;95%CI:1.22to3.0) and bleeding during or after sex (OR=19.2;95%CI:5.57to66.42); and the factor associated with any STI was bleeding during or after sex (OR=37.8,95%CI:11.22to127.4).The awareness rate of AIDS knowledge was92.0%(206/224). There were4.5%(10/224) of WSW who had received HIV testing in the previous year, all of whom knew the testing results. HIV prevention service covered56.7%(127/224) of the participants. The most common service was HIV/STI promotional materials which accounted for48.7%(109/224). The major origin from which the participants received HIV knowledge and information was internet which accounted for73.2%(164/224).Conclusion WSW in Beijing engaged in high-risk sexual behaviors and were at substantial risk of being infected with STI. The population needs targeted prevention and intervention. To implement STI prevention and intervention among women, women-women sexual behavior should be considered when doing research and intervention programs. Internet will be very promising and play an important role in sensitive population recruitment, survey, study and intervention. |
