Young women ages 16-29 years using reproductive health clinics report significantly higher rates of intimate partner violence (IPV) compared to general population prevalence estimates. Few studies have compared differences in exposure to IPV and poor sexual and reproductive health among sexual minority (SM) women - broadly defined as women with same-sex attraction, identity, and/or behavior - and heterosexual women seeking services at reproductive health clinics. Population based estimates suggest that SM women are significantly more likely than their heterosexual counterparts to experience IPV and sexual assault (SA) over their lifetime, but further research is needed to understand the context of SM women's abusive relationships and how this impacts their sexual and reproductive health. In the parent study from which this proposed study emerges (Miller, R01HD064407), 72% of women with a history of male and female sexual partners had experienced IPV compared to 44% of women with male partners exclusively. After accounting for their exposure to IPV, SM women were more likely to report recent unprotected anal sex, recent unprotected vaginal sex, and fear of refusing sex, lifetime sex trade and lifetime STI diagnosis. Despite the clear need for comprehensive sexual and reproductive health services for SM women, previous research indicates there is provider discomfort discussing same-sex behavior or lack of knowledge regarding the health care needs of SM women, which may hinder assessment for IPV and provision of appropriate sexual and reproductive health services for this vulnerable population. This R03 expands the impact of the original parent study, which did not include specific training on the sexual and reproductive health care needs of SM women. Interviews with SM women who participated in the parent study (Aims 1 and 2;n=40) will explore 1) histories of IPV/SA and how IPV impacts sexual and reproductive health;2) attitudes toward and perceived social norms regarding sexuality, gender, sexual orientation, and other risk behaviors with sex;3) feedback on IPV discussion they've had with their family planning providers;and 4) experiences receiving sexual and reproductive health care. Brief surveys (n=50) and interviews (n=15) with providers from clinics who participated in the parent study will explore: 1) perceptions regarding the sexual and reproductive health needs of SM women, 2) experiences with training on health care provision for SM clients, 3) level of comfort and strategies for assessing for IPV/SA among SM clients. Findings are expected to translate directly into novel enhancements to reproductive health interventions that embed safety and harm reduction strategies to reduce IPV risk for SM women without targeting or further marginalizing this population.
Despite a small number of quantitative studies that have found sexual minority (SM) women to be at higher risk for IPV and sexual violence compared to heterosexual women, little is known about the context surrounding SM women's exposure to violence (including perpetrator characteristics) and the impact on sexual and reproductive health. The proposed exploratory study will interview SM patients and providers in reproductive health clinics to elucidate mechanisms through which SM women may be at increased risk for IPV and suffer poor sexual and reproductive health. Findings will inform clinic-based interventions to increase safety and connection to appropriate services for SM female clients seeking sexual and reproductive health care.