Using A Sexual & Gender Minority Health Disparities Framework To Examine Multi-level Influences On Bisexual College Women’s Sexual Health Communication About HIV

Abstract

Prior studies have consistently revealed that bisexual+ women are at an increased risk for numerous mental and sexual health disparities compared to individuals with differing sexual orientations, in part due to bierasure and binegativity—yet less is known about bisexual+ women’s approaches to obtaining information about partner sexual health and HIV status. My dissertation employed a mixed-methods approach to investigate sexual health communication strategies (i.e., requesting partner sexual health history) as a means of HIV prevention, and the multi-level psychosocial factors that underlie sexual health communication related to HIV. Specifically, I assessed the individual, interpersonal, community, and societal factors—informed by the Sexual & Gender Minority (SGM) Health Disparities Research Framework and the Theory of Planned Behavior (TPB)—that guide sexual health communication in bisexual+ college women. A total of 258 bisexual+ college women completed an online survey that assessed for multi-level factors that affect HIV-related sexual health disparities and HIV prevention behaviors. Across levels of influence in the SGM ecological framework, community level influence in the form of LGBTQ community connectedness predicted bisexual women's individual level experience of sexual identity outness (i.e., more LGBTQ community connectedness predicted more sexual identity outness). Societal level influence in the form of bierasure predicted medical mistrust on the interpersonal level (i.e., less bierasure predicted less medical mistrust). When examining ecological influences on variables associated with the TPB, more LGBTQ community connectedness and less internalized heterosexism predicted more favorable attitudes around having a shared sexual conversation. More LGBTQ community connectedness also predicted more perceived social pressure around having a shared sexual conversation. Examining TPB variables more focally, the TPB intermediate variable of intention was not only influenced by upstream TPB variables (more attitudes, norms, and self-efficacy predicted greater intention) but also predictive of TPB outcome variables of sexual safety strategies and request for partner sexual health history. A qualitative analysis of HIV prevention behavior (request for partner sexual health history) yielded three themes across participants who reported requesting history: 1) Style, 2) Content, and 3) Timing, and one theme across participants who did not request history: 1) Barriers. The Barrier theme had seven subthemes: Discomfort, Unaware, Managing Partner Reactions, Perceived Minimal Risk, Partner Initiated, Social Norms, and Perceived Lack of Relevance. Qualitative responses provided context for upstream TPB variables and elucidated specific attitudes, norms, and efficacy factors that are involved in shared sexual health conversations. Future research should continue to take a multi-level approach in capturing the numerous factors that influence HIV-related sexual health outcomes for bisexual+ women. HIV prevention programs should consider how fostering positive attitudes, favorable social norms, and self-efficacy influences request for partner sexual health history.