Barriers to infectious disease care among lesbians.(International Conference On Women And Infectious Diseases)

United States who identify as lesbian, few data exist that address lesbians' health needs. The Institute of Medicine emphasized that data on sexually transmitted infections, Pap smear screening, and cervical dysplasia among lesbians were needed to guide clinical practice, policy development , and patient education. Use of surveillance data for this purpose is limited because risk classifications exclude same-gender sex among women or subsume it under behavior considered as higher risk. However, sexual transmission of human papillomavirus, HIV, Treponema pal-lidum, and Trichomonas vaginalis between women has been reported. Data indicate that lesbians receive routine Pap smear screening less frequently than is optimal. Moreover, lesbians commonly report previous pregnancy, induced abortion, and hormonal contraceptive use. Education of lesbians and their care providers should counter assumptions that sex between women confers no risk for transmission of sexually transmitted infections, and lesbians should receive Pap smears according to current guidelines. A causative link between a patient's sexual orientation and access to healthcare is not evident. Why should identification as a lesbian or practice of same-sex behavior affect a patient's access to infectious diseases–related care? We discuss data to support this connection and make appropriate recommendations. Because this article discusses a subset of women defined by their practice of sex with other women, it will focus primarily on sexually transmitted infections (STIs) and their consequences. For the sake of simplicity, we will use the term " lesbian " to refer to a woman who engages in sex with another woman, and thus represents the axis of sexual behavior, which may not necessarily be congruent with self-defined sexual identity (1). In the United States, estimates of lifetime same-gender sexual behavior among women are 8% to 20%, and 1.4%–4.3% of all women may currently be sexually active with other women (1,2). An estimated 2.3 million women specifically describe themselves as lesbian (3). Despite these considerable numbers, relatively little data are available on important health outcomes for these women, including prevalence of STI, HIV, and cervical cancer. Until recently, the major national women's health studies did not collect information on same-sex behavior or sexual identity (4). In its 1999 report, Lesbian Health: Current Assessment and Directions for the Future, the Institute of Medicine emphasized that more data were needed on STIs, Pap smear screening, and risk for cervical cancer in lesbians (3). Sexual Behavior and STIs Attempts to use national or local surveillance data to estimate the …