A group-based HIV and sexually transmitted infections prevention intervention for lesbian, bisexual, queer and other women who have sex with women in Calgary and Toronto, Canada: study protocol for a non-randomised cohort pilot study

Carmen H Logie, Daniela Navia, Marie-Jolie Rwigema, Wangari Tharao, David Este, Mona R Loutfy, Carmen H Logie, Daniela Navia, Marie-Jolie Rwigema, Wangari Tharao, David Este, Mona R Loutfy

Abstract

Introduction: The limited research that exists suggests that lesbian, bisexual queer (LBQ) and other women who have sex with women are at similar risk for sexually transmitted infections (STI) as heterosexual women. However, scant research has evaluated HIV and STI prevention strategies for LBQ women. The authors present the rationale and study protocol for developing and pilot testing a psychoeducational group-based HIV and STI prevention intervention with LBQ women in Calgary and Toronto, Canada.

Methods and analysis: This is a multicentre non-randomised cohort pilot study. The target population is LBQ women in Calgary and Toronto, Canada. The authors aim to recruit 40 participants using purposive peer-driven recruitment methods. Participants will conduct a pretest followed by a 2-day group programme of six 2 h sessions addressing stigma, STI and HIV prevention, healthy relationships, safer sex self-efficacy, self-worth, social support and LBQ community engagement. Participants will conduct a post-test directly following the intervention and 6 weeks after the intervention. The primary outcome is safer sex practices; our prespecified index of clinically significant change is an effect size of 0.50. Secondary outcomes include: safer sex self-efficacy, STI testing frequency, STI knowledge, resilient coping, social support, sexual stigma, access to care, depression and self-esteem. We will conduct mixed-effects regression to calculate mean outcome pre-post test score change.

Ethics and dissemination: Research ethics approval was attained from the Office of Research Ethics (REB: 29291), University of Toronto, Toronto, Ontario, Canada. Trial results will be published according to the Transparent Reporting of Evaluations with Non-randomised Designs (TREND) statement, regardless of the outcomes.

Trial registration number: This study is registered at https://ichgcp.net/clinical-trials-registry/NCT02067845" title="See in ClinicalTrials.gov">NCT02067845.

Keywords: Education & Training (see Medical Education & Training); Public Health.

References

    1. Bauer GR, Welles SL. Beyond assumptions of negligible risk: sexually transmitted diseases and women who have sex with women. Am J Public Health 2001;91:1282–6
    1. Logie CH, Gibson MF. A mark that is no mark? Queer women and violence in HIV discourse. Cult Health Sex 2013;15:29–43
    1. Marrazzo JM. Sexually transmitted infections in women who have sex with women: who cares? Sex Transm Infect 2000;76:330–2
    1. Marrazo JM, Gorgos LM. Emerging sexual health issues among women who have sex with women. Curr Infect Dis Rep 2012;14:204–11
    1. Peel E, Thomson M. Editorial introduction: lesbian, gay, bisexual, trans and queer health psychology: historical development and future possibilities. Fem Psychol 2009;19:427–36
    1. Pinto VM, Tancredi MV, Neto A, et al. Sexually transmitted disease/HIV risk behaviour among women who have sex with women. AIDS 2005;19:S64–9
    1. Fethers K, Marks C, Mindel A, et al. Sexually transmitted infections and risk behaviours in women who have sex with women. Sex Transm Infect 2000;76:345–9
    1. Steele LS, Ross LE, Dobinson C, et al. Women's Sexual Orientation and Health: results from a Canadian Population-Based Survey. Women Health 2009;5:353–67
    1. Logie C, Rwigema MJ. Associations between sexual stigma and safer sex practices among lesbian, bisexual and queer women in Toronto, Canada Poster presentation for XIX International AIDS Conference 2012, July, Washington, DC
    1. Bevier PJ, Chiasson MA, Heffernan RT, et al. Women at a sexually transmitted disease clinic who reported same-sex contact: their HIV seroprevalence and risk behaviors. Am J Public Health 1995;10:1366–71
    1. Goodenow C, Szalacha LA, Robin LE, et al. Dimensions of sexual orientation and HIV-related risk among adolescent females: evidence from a statewide survey. Am J Public Health 2008;6:1051–8
    1. Logie C, James L, Tharao W, et al. ‘We don't exist’: a qualitative study of marginalization experienced by HIV-positive lesbian, bisexual, queer and transgender women in Toronto, Canada. J Int AIDS Soc 2012;15:17392.
    1. Logie C, James L, Tharao W, et al. Race, gender, sexual orientation, HIV and sex work: intersectional stigma experienced by women living with HIV in Ontario, Canada. PLoS Med 2011;11:e1001124.
    1. Herek GM. Beyond “homophobia”: thinking about sexual prejudice and stigma in the twenty-first century. Sex Res Soc Policy 2004;1:6–24
    1. Alvy LM, McKirnan DJ, Mansergh G, et al. Depression is associated with sexual risk among men who have sex with men, but is mediated by cognitive escape and self-efficacy. AIDS Behav 2010;15:1171–9
    1. Yi H, Sandfort TGM, Shidlo A. Effects of disengagement coping with HIV risk on unprotected sex among HIV-negative gay men in New York City. Health Psychol 2010;2:205–14
    1. Diaz RM, Ayala G, Bein E, et al. The impact of homophobia, poverty and racism on the mental health of gay and bisexual Latino men: findings from 3 US cities. Am J Public Health 2001;91:927–32
    1. Tjepkema M. Health care use among gay, lesbian and bisexual Canadians. Health Rep 2008;19:52–64
    1. Charnley H, Langley J. Developing cultural competence as a framework for antiheterosexist social work practice. J Soc Work 2007;7:307–21
    1. Pugh S. Assessing the cultural needs of older lesbians and gay men: implications for practice. Practice 2005;17:207–18
    1. Fish J. Far from mundane: theorising heterosexism for social work education. Soc Work Educ 2008;27:182–93
    1. McNair RP, Anderson S, Mitchell A. Addressing health inequalities in Victorian lesbian, gay, bisexual and transgender communities. Health Promot J Austr 2001;11:305–11
    1. Manthorpe J. Nearest and dearest? The neglect of lesbians in caring relationships. Br J Soc Work 2003;33:753–68
    1. Wilton T, Herbst JH, Coury-Doniger P, et al. Efficacy of an HIV/STI prevention intervention for black men who have sex with men: findings from the Many Men, Many Voices (3MV) project. AIDS Behav 2009;13:532–44.
    1. Bayliss K. Social work values, anti-discriminatory practice and working with older lesbian service users. Soc Work Educ 2000;19:45–53
    1. Donovan C, Hester M, Holmes J, et al. Comparing domestic abuse in same sex and heterosexual relationships. Swindon: ESRC award no. RES-000-23-0650, 2006
    1. Hardman KLJ. Social workers’ attitudes to lesbian clients. Br J Soc Work 1997;27:545–63
    1. Hunt R, Fish J. Prescription for change: lesbian and bisexual women's health check. London: Stonewall, 2008. . [accessed 29 Nov 2012]
    1. Sale A. Back in the closet: confronting the needs of ageing gay and lesbian people. Community Care 2002;1424:30–1
    1. Spectrum. Count me in: health and social care needs assessment of LGBT communities in Brighton and Hove 2003. [accessed 28 Nov 2012]
    1. Davis TS, Saltzburg S, Locke CR. Supporting the emotional and psychological well being of sexual minority youth: youth ideas for action. Child Youth Serv Rev 2009;31:1030–41
    1. Fish J. Invisible no more? Including lesbian, gay and bisexual people in social work and social care. Practice 2009;21:47–64
    1. Davies M, Addis S, MacBride-Stewart S, et al. The health, social care and housing needs of lesbian, gay, bisexual and transgender older people: literature review. Cardiff University, Centre for Health Sciences Research, 2006
    1. Greaves B, Fish J, Graham D, et al. The health and social care needs of lesbian, gay and bisexual people in Leicester. Unpublished report submitted to the Leicester Public Health Partnership, 2007
    1. Caceres CF. HIV among gay and other men who have sex with men in Latin America and the Caribbean: a hidden epidemic? AIDS 2002;16:S23–33
    1. Johnson WD, Diaz RM, Flanders WD, et al. Behavioral interventions to reduce risk for sexual transmission of HIV among men who have sex with men. Cochrane Database Syst Rev 2008;3:CD001230 (accessed 2 Dec 2012)
    1. Marrazzo J, Thomas KK, Ringwood K. A behavioral intervention to reduce persistence of bacterial vaginosis among women who report sex with women: results of a randomized trial. Sex Transm Infect 2011;87:399–405
    1. Marrazzo JM, Coffey P, Bingham A. Sexual practices, risk perception and knowledge of sexually transmitted disease risk among lesbian and bisexual women. Perspect Sex Reprod Health 2005;37:6–12
    1. Herbst JH, Beeker C, Matthew A, et al. The effectiveness of individual, group and community-level HIV behavioral risk-reduction interventions for adult men who have sex with men: a systematic review. Am J Prev Med 2007;32:S38–67
    1. Herrick AL, Lim SH, Wei C, et al. Resilience as an untapped resource in behavioural intervention design for gay men. AIDS Behav 2011;15:S25–9
    1. Campbell C, Deacon H. Unravelling the contexts of stigma: from internalization to resistance to change. J Community Appl Soc 2006;16:411–17
    1. Link BG, Phelan JC. Conceptualizing stigma. Annu Rev Sociol 2001;27:363–85
    1. Meyer IH. Minority stress and mental health in gay men. J Health Soc Behav 1995;36:38–56
    1. Mayer KH, Bekker LG, Grulich A, et al. Comprehensive clinical care for men who have sex with men: an integrated approach. Lancet 2012;12:40–51
    1. Nyamathi A, Stein JA. Assessing the impact of HIV risk reduction counseling in impoverished African American women: a structural equations approach. AIDS Educ Prev 1997;9:253–73
    1. Teva I, Bermudez MP, Buela-Casal G. Sexual sensation seeking, social stress, and coping styles as predictors of HIV/STD risk behaviors in adolescents. Youth Soc 2010;42:255–77
    1. Baral S, Logie CH, Grosso A, et al. Modified social ecological model: a tool to guide the assessment of the risks and risk contexts of HIV epidemics. BMC Public Health 2013;13:482.
    1. Hayes R, Kapiga S, Padian N, et al. HIV prevention research: taking stock and the way forward. AIDS 2010;24:S81–92
    1. Rogers SM, Willis G, Al-Tayyib A, et al. Audio computer assisted interviewing to measure HIV risk behaviours in a clinic population. Sex Transm Infect 2005;81:501–7
    1. Fishman SJ, Anderson EH. Perception of HIV and safer sexual behaviors among lesbians. J Assoc Nurses AIDS Care 2003;14:48–55
    1. Kalichman SC, Rompa D, DiFonzo K, et al. Initial development of scales to assess self-efficacy for disclosing HIV status and negotiating safer sex in HIV-positive persons. AIDS Behav 2001;5:291–6
    1. Redding CA, Rossi JS. Testing a model of situational self-efficacy for safer sex among college students: stage and gender-based differences. Psychol Health 1999;14:467–86
    1. Jaworski BC, Carey MP. Development and psychometric evaluation of a self-administered questionnaire to measure knowledge of sexually transmitted diseases. AIDS Behav 2007;11:557–74
    1. Sinclair VG, Wallston KA. The development and psychometric evaluation of the Brief Resilient Coping Scale. Assessment 2004;11:94–101
    1. Russell DW, Cutrona CE. Social provisions scale. Iowa State University, 1984
    1. Frost DM, Meyer IH. Measuring community connectedness among diverse sexual minority populations. J Sex Res 2012;49:36–49
    1. Currie MR, Cunningham EG, Findlay BM. The Short Internalized Homonegativity Scale: examination of the factorial structure of a new measure of internalized homophobia. Educ Psychol Meas 2004;64:1053–67
    1. Diamant AL, Schuster MA, Lever J. Receipt of preventive health care services by lesbians. Am J Prev Med 2000;19:141–8
    1. Kroenke K, Spitzer RL, Williams JB. The Patient Health Questionnaire-2: validity of a two-item depression screener. Med Care 2003;41:1284–92
    1. Rosenberg M. Society and the adolescent self-image. Princeton, NJ: Princeton University Press, 1965
    1. Thabane L, Ma J, Chu R. et al. A tutorial on pilot studies: the what, why and how. BMC Med Res Methodol 2010;10:1.

Source: PubMed

3
Abonneren