Sexual Orientation Disparities in Sexually Transmitted Infections: Examining the Intersection Between Sexual Identity and Sexual Behavior

The terms MSM (men who have sex with men) and WSW (women who have sex with women) have been used with increasing frequency
in the public health literature to examine sexual orientation disparities in sexual health. These categories, however, do
not allow researchers to examine potential differences in sexually transmitted infection (STI) risk by sexual orientation
identity. Using data from the National Longitudinal Survey of Adolescent Health, this study investigated the relationship
between self-reported STIs and both sexual orientation identity and sexual behaviors. Additionally, this study examined the
mediating role of victimization and STI risk behaviors on the relationship between sexual orientation and self-reported STIs.
STI risk was found to be elevated among heterosexual-WSW and bisexual women, whether they reported same-sex partners or not,
whereas gay-identified WSW were less likely to report an STI compared to heterosexual women with opposite sex relationships
only. Among males, heterosexual-identified MSM did not have a greater likelihood of reporting an STI diagnosis; rather, STI
risk was concentrated among gay and bisexual identified men who reported both male and female sexual partners. STI risk behaviors
mediated the STI disparities among both males and females, and victimization partially mediated STI disparities among female
participants. These results suggest that relying solely on behavior-based categories, such as MSM and WSW, may mischaracterize
STI disparities by sexual orientation.