Sexuality and safer sex: the issues for lesbians and bisexual women

Nursing interventions to help women reduce their risk of contracting HIV must be designed from an in-depth understanding of the complex sociocultural patterns of sexuality in particular communities and among specific subgroups.

In this data collection phase of a community-based HIV prevention project, the objective was to understand HIV risk-taking and HIV risk-reduction activities of lesbians and bisexual women.

Qualitative field study.

Data were collected in women's bars and dance clubs and at selected lesbian/bisexual community events in San Francisco.

Interviews were conducted with 1,189 racially diverse, socially and sexually active lesbians and bisexual women.

Inductive content analysis produced two themes: realities of sexual behavior and sexual expressions and their meanings. Realities of sexual behavior included an assumption that women who have sex with other women cannot get HIV, a lack of familiarity with HIV prevention strategies, inconsistent practice of safer sex with men and/or women, and the negative effect of alcohol or drug use on safer sex efforts. Sexual expressions and their meaning included trust in monogamy, a sense that safer sex practices detracted from intimacy and eroticism, the difficulty of negotiating sexual behaviors with men or women, and dealing with partner resistance to safer sex practices.

Specific recommendations for practice are the need for nurses to understand the range and diversity of women's sexual behaviors, to develop skills in conducting inclusive sexual histories, and to develop a comprehensive approach to sexual health.