Assessing the State of Published HIV Research Concerning Sexual Minority Women: A Global English Language Scoping Review

Abstract

Purpose:

We conducted a scoping review to map peer-reviewed literature on HIV research concerning sexual minority women (SMW).

Methods:

Following guidance from Arksey and O’Malley’s framework and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews, we searched PubMed, Embase, PsycInfo, Sociological Abstracts, and CINAHL from inception through May 2023. Eligible studies were English language, peer-reviewed studies, containing disaggregated HIV-related data on SMW. Studies were systematically screened, and relevant data were extracted and then summarized.

Results:

Our search identified 7615 studies; 187 met eligibility requirements. Most studies were quantitative (82%), cross-sectional (74%), used survey data (80%) obtained via convenience sampling (61%), and conducted in the United States (65%). Annual publications increased over time. Overwhelmingly, studies did not report engaging the community in the research process (93%). Demographic reporting in studies varied; about half reported age (52%) and race (52%), two-thirds reported sexual orientation (68%), and only 25% focused exclusively on SMW. Diverse HIV-related findings were addressed: sexual risk behaviors (64%), HIV testing, prevalence, and risk perception (47%), substance use (43%), sexually transmitted infections (29%), health care access (21%), intimate partner violence (17%), mental health (15%), stigma (10%), and incarceration (9%).

Conclusions:

Our review highlights key methodological and topical gaps. Future SMW HIV research guidance includes focusing on structural-level factors and biomedical interventions; researching understudied regions highly impacted by HIV; including qualitative and quantitative approaches; establishing standardized procedural and reporting guidelines; and increasing research and practice resources to focus on SMW’s unique HIV-related health strengths and vulnerabilities.

Keywords

global HIV scoping review sexual minority women

Introduction

Sexual minority women (SMW)—women with a minoritized sexual orientation or identity such as lesbian, gay, bisexual, or queer, as well as women who are sexually attracted to or romantically/sexually partner with other women—are an often-overlooked population in the extant human immunodeficiency virus (HIV) literature.^1–4 Although disparities in HIV outcomes among women by sexual orientation are largely unexplored, some have been found among (sub)groups of women. For example, among women who inject drugs, HIV rates are higher in SMW versus heterosexual women (13.3% vs. 3.9%).⁵

HIV transmission is influenced by the aggregation of multiple HIV vulnerabilities^6–10—that is, factors associated with HIV risk such as sex work engagement,^11–14 substance use,^15–17 housing instability,^18–20 and low health care service utilization.^21,22 The growing SMW health literature has documented greater HIV vulnerabilities among SMW compared with their heterosexual counterparts,^23,24 including sexual risk behaviors,^23,25 illicit drug use,^26,27 housing instability,²⁸ sex exchange,^23,29 incarceration status,³⁰ violence,²³ reduced health care access,³¹ stigma,³² and HIV comorbidity with other sexually transmitted infections (STIs).³³ These data indicate that SMW have unique and exacerbated HIV risk, warranting greater public health attention.

The paucity of research on SMW’s HIV risk and outcomes is due to both methodological limitations and research priority setting. Many large HIV-related studies do not collect or report data on sexual orientation among women.^34–36 Further, health and HIV studies among sexual minority populations have historically focused on cisgender men or multigender samples.^37–40 Among studies that include multigender samples, data disaggregation is often limited, thus obscuring potentially significant gender differences.^23,41,42

Research on HIV risks, prevalence reporting, and prevention programming has primarily focused on “key populations” considered to be at higher risk of HIV acquisition, such as gay, bisexual, and other men who have sex with men (GBMSM), transgender women, people who use drugs, and sometimes women who exchange sex.^23,41,42 The volume of published research on these populations is remarkable; from 1980 to 1999, GBMSM were included in 95% of published articles related to STI research (including HIV). In contrast, SMW were included in only 6% of articles in the same period.⁴³ Although the high impact of HIV on key populations is unrefuted, greater attention to other vulnerable (sub)groups remains warranted.

A common rationale for the de-prioritization of SMW in HIV research and prevention efforts is that rates of HIV transmission from woman-to-woman sex are low.^1,44 Although this may be true regarding oral/vaginal sex between cisgender women, concluding that SMW have low risk is a mistake, as it fails to consider other psychosocial and behavioral factors that influence HIV transmission risk. Such conclusions rest on a series of false assumptions. First, sex between women can happen in a range of ways and is not limited to oral/vaginal sex. Second, not all women have vaginas; transgender women can have various genitalia depending on their gender goals and journey. Third, SMW, even lesbian-identifying women, do not necessarily have sex with other women exclusively^{23,24,45–47}; assuming overlap between sexual identity and behavior is a common error. Finally, HIV transmission among SMW can occur not only via sex but also via injection drug use. The prevailing narrative of HIV invulnerability among SMW poses a significant threat to HIV research and prevention efforts and further reinforces the systematic neglect of SMW’s needs in sexual and reproductive health services.^2,48

Even less HIV research attention is paid to SMW with other minoritized or stigmatized social positions and identities, such as minoritized racial and ethnic populations. The concepts of intersectionality, coined by Kimberle Crenshaw⁴⁹ and applied to HIV research by numerous contemporary scholars,^1,50–53 and minority stress, detailed by Dr. Virginia Rae Brooks in her seminal work on sexual minority stress theory among SMW,^54,55 posit that intersecting forms of stigma and discrimination (e.g., sexism, homophobia, racism, transphobia) experienced by stigmatized groups result in deleterious physical and mental health outcomes.

Applied to the current topic, these theories suggest that SMW’s HIV risk is impacted by intersecting structural powers, which lead to disparate negative health outcomes among and between SMW (sub)groups. Applications of intersectionality theory to HIV research are still evolving,⁵⁶ and while measures of structural discrimination are becoming more available in published literature, much of the historic literature has used demographic categories as proxies for these structural forces, and even that work is limited in the field of SMW HIV research.⁵⁷ For example, little attention is paid to intersections of gender modality (i.e., cisgender and transgender) and sexual orientation (e.g., homosexual, heterosexual, bisexual) among women. Although there is now a sizable evidence base on HIV risk among transgender women, sexual orientation is rarely considered in that literature.⁵⁸ More work is needed to explore how structural-level power dynamics impact SMW HIV risk.

Minimal collated research describes HIV outcomes and the effect of syndemic HIV risk factors among SMW, despite a range of evidence suggesting the need for such insights. To address this gap, we conducted a scoping review to systematically map peer-reviewed literature concerning HIV among SMW globally. Knowledge gained from this endeavor can inform the future direction of HIV research and practice with SMW—including necessary descriptive research with understudied (sub)populations—and promote public health practice that is inclusive of SMW concerns and needs.

Methods

This scoping review followed the framework outlined by Arksey and O’Malley⁵⁹ and guidance from the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR).⁶⁰ Institutional review board approval was not required as this review employs a secondary data analysis of published literature. No protocol was registered for this study.

Eligibility criteria

Eligible studies included peer-reviewed health research that contained disaggregated data on SMW and reported any findings related to HIV (e.g., HIV testing, prevalence, or any risk factors defined by the study authors as HIV-related). Eligible studies were published in English and were not limited by time frame or geographic location. We defined SMW individuals as any woman, cisgender or transgender, identifying with any sexual minority identity (e.g., lesbian, bisexual, queer), reporting ever having sex with women, or reporting same-gender attraction. Exclusion criteria included: gray literature (e.g., conference abstracts, dissertations), risk factors that are commonly recognized as HIV-related but not discussed in the article in the context of HIV (e.g., substance use), and including SMW in the sample but not providing disaggregated findings for SMW participants.

Data sources and search strategy

The search strategy included terms for HIV and SMW (Supplementary Table S1). Five databases were searched to identify peer-reviewed literature: PubMed (PubMed.gov), Embase (Elsevier), PsycInfo (EBSCO), Sociological Abstracts (ProQuest), and CINAHL (EBSCO). The search was run from inception to May 8, 2023, and restricted to English language items.

Screening process

References were managed and deduplicated in Covidence, a systematic review production tool.⁶¹ During title and abstract screening and full-text review, each record was independently reviewed by two team members. Reviewers were blinded to each other’s decisions, and conflicts were resolved through discussion with the study’s principal investigator.

Data collection process

Data extraction was independently conducted for each record by two researchers; consensus was organized in Covidence, and conflicts were resolved by the research team in regular meetings. A template was designed to extract the following data: funding, study design, study location, sampling design, population demographics, sexual minority status measurement, gender measurement, data sources, community engagement, and key findings. Consistent with existing guidance on scoping reviews,^60,62 formal risk-of-bias appraisal was not conducted.

Analysis and synthesis of results

Systematic narrative synthesis⁶³ was used to summarize and present study data, both within and between included studies. Microsoft Excel was used to calculate counts and percentages, which are always presented relative to the full sample size.⁶⁴ Excel’s “Geography” and “Map Chart” functions were used to analyze and map geographic frequencies (Fig. 2).⁶⁴

We modified a three-dimensional sexual orientation model⁶⁵ to analyze sexual orientation data operationalization including (1) identity (e.g., lesbian and bisexual identities), (2) behavior (e.g., women who have sex with women [WSW], women who have sex with women and men [WSWM]), and (3) attraction (e.g., attraction to other women), and added a “another operationalization” category for all other approaches.

For the race/ethnicity analysis, we used a modified version of the “Combined Race/Ethnicity” measure presented by Howell and Emerson.⁶⁶ Our categorization structure included (1) White, Caucasian, or European American; (2) Black or African American; (3) Hispanic/Latinx; (4) Asian or South Asian; (5) Biracial/Multiracial; (6) American Indian, Alaska Native, Native American, Aboriginal, and Torres Strait Islander; (7) Native Hawaiian or Other Pacific Islander. For studies that included racial or ethnic groups outside of this framework, we categorized them as (8) “Another race/ethnicity” and provided detailed reporting on the specific classifications observed within this category. When discussing studies, we use “SMW” population language regardless of language used by study authors,* and we offer insights on (sub)populations when available.

Team positionality

The research team included a principal investigator, an informationist, and five research team members supporting data collection, management, analysis, and article development. Our study team includes a diversity of identities, experiences, and perspectives. Five identify as cisgender women, four as LGBTQ+ (lesbian, gay, bisexual, transgender, queer, intersex, and asexual), three as SMW, and two as transgender/nonbinary people (identities not mutually exclusive). Most of the authors identify as White, hold graduate degrees in public health, and are U.S.-based. Team members were motivated by personal and professional interest and identification with the research topic and sample population. All team members were invited to bring their unique perspectives and lived experiences into the research process, which most likely influenced our study procedures and literature interpretation.

Results

Search results

The search returned 11,834 references, which were imported for screening. After identifying and removing duplicates, 7615 studies remained and were then screened against the title and abstract. Of those, 6967 studies were excluded, and 648 studies were assessed for full-text eligibility. Subsequently, 461 studies were excluded. Figure 1 illustrates the flowchart of article selection.⁶⁷ Ultimately, this review included 187 records.^{2,4,5,19,23,25,30,33,34,46,47,68–242}

FIG. 1.

Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow chart.⁶⁰

Study locations

The geographic representation of included studies varied: 121 studies were conducted in the United States (65%), 11 studies in Canada (6%), and 9 studies in Australia (5%). Further, five studies were conducted in Brazil (3%), four in the United Kingdom (2%), and three in China (2%). One study (0.5%) was conducted across both the United States and Canada. Six studies (3%) were conducted across Southern African countries: two studies were conducted in Lesotho, two were conducted across Botswana, Namibia, South Africa, and Zimbabwe, and one study each was conducted in South Africa and in a multicountry combination of Namibia, South Africa, and Zimbabwe. One study (0.5%) was conducted in each of the following countries: Chile, Czech Republic, Germany, Israel, Italy, Kenya, New Zealand, Norway, Philippines, and Spain. Notably, nine studies (5%) did not state their study location (Fig. 2).

FIG. 2.

Map of number of studies by country.

Among the eight review studies included in our sample, three (2%) did not state a location of focus, three focused on a Southern African context (1: Botswana, Namibia, South Africa, and Zimbabwe; 2: South Africa; and 3: Southern Africa; 0.5% each), one (0.5%) on India, and one (0.5%) listed “Low- and Middle-Income Countries” as their location of focus. Study-level counts are reported in the text. In contrast, Figure 2 presents country-level data, in which studies conducted across multiple countries are counted in each applicable country.

Publications over time

The 187 included studies were published between 1990 and 2023. The annual volume of publications ranged between 0 (0%; 2004) and 13 (7%; 2022). Overall, there was an upward publication trend over time, as shown in Figure 3.

FIG. 3.

Chart of number of studies by year.

Methodological approach and study type

The included studies primarily employed quantitative methodology (n = 154, 82%). Most (n = 139, 74%) were cross-sectional, some (n = 14, 7%) were longitudinal cohort studies, and 1 (0.5%) was an ecological study. Twenty studies were qualitative (11%), eight were reviews (4%), and five were mixed- or multimethod studies (3%). Overwhelmingly, studies did not report community engagement in their studies (n = 173, 93%).

Most studies were observational (n = 175, 94%) followed by eight reviews (4%), three interventions (2%), and one (0.5%) that included both observational and intervention components.

Data sources and sampling

Most studies (n = 138, 74%) used only one data source, 44 (24%) used two, and five (3%) used three. Most data sources were surveys (n = 150, 80%), followed by study-related clinical examinations (n = 36, 19%), interviews (n = 20, 11%), focus groups (n = 12, 6%), and (electronic) medical records (n = 8, 4%). Other sources included ethnographic mapping (n = 2, 1%), surveillance data (n = 2, 1%), field notes (n = 1, 0.5%), and online posts (n = 1, 0.5%).

Forty-seven studies (25%) performed secondary analysis of previously collected survey data. These source studies include: National HIV Behavioral Surveillance (NHBS; n = 3, 2%), Women’s Interagency HIV Study (WIHS; n = 3, 2%), Youth Risk Behavior Survey (YRBS; n = 3, 2%), Protect and Respect study/Project (n = 2, 1%), National Health and Nutrition Examination Survey (n = 2, 1%), An Evaluation of Sex Workers’ Health Access (n = 2, 1%), and the Healthy Living Project (n = 2, 1%). In addition, in some cases, multiple articles were written about a single study; 26 (14%) articles included separate analyses coming from 12 distinct source studies. More specifically, for six source studies, two articles were written, and for one source study, three articles were written.

Most studies used only one type of sampling design (n = 141, 75%), whereas 27 studies (14%) used two. The majority of studies (n = 115, 61%) used nonprobability, non-population-based sampling designs, followed by probability sampling (n = 31, 17%), purposive or targeted sampling (n = 27, 14%), population sampling/census data (n = 16, 9%), and nonprobability, population-based sampling (n = 5, 3%). Eleven studies (6%) did not state their sampling design, eight (4%) were reviews, and one (0.5%) had varying samples across surveys (Table 1).

Table 1.

Summary of Study Characteristics

Characteristics	Studies, n (%)
Methodology
Quantitative	154 (82)
Cross-sectional	139 (74)
Longitudinal	14 (7)
Ecological	1 (0.5)
Qualitative	20 (11)
Reviews	8 (4)
Mixed or multimethods	5 (3)
Reported community involvement	14 (7)
Study type
Observational	175 (94)
Reviews	8 (4)
Intervention	3 (2)
Health education	1 (0.5)
Health education and peer educators	2 (1)
Observational and intervention	1 (0.5)
Health education, peer support, and peer education	1 (0.5)
Data sources
Number of data sources used
1	138 (74)
2	44 (24)
3	5 (3)
Type of data source
Surveys	150 (80)
Secondary data analysis	47 (25)
Clinical examinations	36 (19)
Interviews	20 (11)
Focus groups	12 (6)
(Electronic) Medical records	8 (4)
Ethnographic mapping	2 (1)
Surveillance data	2 (1)
Field notes	1 (0.5)
Online posts and social media	1 (0.5)
Sampling
Number of sampling designs used
1	141 (75)
2	27 (14)
Not stated	11 (6)
Not applicable (reviews)	8 (4)
Sampling design
Nonprobability, non-population-based	115 (61)
Probability	31 (17)
Purposive or targeted	27 (14)
Population sampling/census	16 (9)
Nonprobability, population-based	5 (3)
Not stated	11 (6)
Not applicable (reviews)	8 (4)
Varying samples across surveys	1 (0.5)

Frequencies and percentages are based on the 187 included records unless otherwise indicated. Totals may exceed 187, and percentages may exceed 100% because some study characteristics were not mutually exclusive, and some studies contributed to more than one category. Missing or unreported study characteristics were coded as “not stated” where applicable.

Language used to describe SMW

The included studies used a variety of words to describe SMW; “bisexual” was the most common (n = 130, 70%), followed by “lesbian” (n = 118, 63%). Further, 60 studies (32%) used “women who have sex with women,” and 32 (17%) used the word “gay” to describe SMW. Figure 4 visually illustrates the frequency of SMW words used.

FIG. 4.

Word cloud of language used to describe sexual minority women (sub)samples by frequency; larger words were used most often.

SMW (sub)sample: Sociodemographic characteristics

SMW sample sizes

SMW (sub)sample sizes were reported by 169 studies (90%). SMW participants comprised the entire sample in 46 studies (25%) and most of the sample (between 50% and 83%) in 10 studies (5%). For the remaining studies, SMW participants comprised the sample minority, with 44 studies (24%) having <10% of their total. Participant sample size was not applicable to nine studies (5%) as they were reviews (n = 8) or based on social media posts (n = 1). Further, nine studies (5%) did not report the SMW (sub)sample size. An analysis of studies that included 50% or more SMW in their sample showed no clear trends in terms of publication year, geography, methodological approach, or study focus.

Sexual orientation

Among included studies, 128 (68%) reported detailed sexual orientation data among their SMW (sub)sample. Seventy-nine studies (42%) measured identity to characterize and report sexual orientation data, 30 studies (16%) used both identity and behavior, and 19 studies (10%) used only behavior. Further, five (3%) also used attraction to characterize sexual orientation.

Studies that operationalized sexual orientation by identity included participants who were bisexual (n = 92, 49%), lesbian (n = 86, 46%), gay (n = 29, 16%), heterosexual/straight (n = 20, 11%; reported having sex with other women), homosexual (n = 18, 10%), queer (n = 13, 7%), and those of another sexual orientation (n = 41, 22%; e.g., unsure, unidentified, pansexual, Two Spirit, same-gender-loving, asexual, dyke).

SMW (sub)populations operationalized with behavior data include WSW (n = 29; 16%) and WSWM (n = 29; 16%). Four studies (2%) included women who have sex with men only (identified with an SMW identity). Further, 12 studies (6%) defined their population based on recency of same-sex behavior, three (2%) used a sexuality spectrum, and four (2%) described same-sex behavior using alternative terminology (e.g., “homosexually experienced heterosexual,” “same-sex partners”).

Race/Ethnicity

Only 98 (52%) studies reported the racial and/or ethnic characteristics of SMW (sub)samples. Eighty-one studies in our sample included Black or African American participants (43%), 73 included White, Caucasian, or European American participants (39%), 58 included Hispanic/Latinx participants (31%), 36 included Asian or South Asian participants (19%), 30 included American Indian, Alaska Native, Native American, Aboriginal, or Torres Strait Islander participants (16%), 18 included Biracial/Multiracial participants (10%), and 9 included Native Hawaiian or Pacific Islander participants (5%).

Further, 58 (31%) studies included participants of another race/ethnicity. In most of those cases (n = 42, 22%), studies just listed “Other” for participant race/ethnicity, with no further details. However, 16 studies (9%) in this category used categories that fell outside our framework. These included studies that reported having “non-White” participants without providing further information (n = 6; 3%), “non-Aboriginal” participants (n = 3; 2%; conducted in Australia), participants of Jewish descent (n = 2; 1%), “Colored” participants (n = 2; 1%; conducted in Botswana, Namibia, South Africa, and Zimbabwe), and participants classified as Middle Eastern (n = 1; 0.5%), African Caribbean (n = 1; 0.5%), and “Mulatto” (n = 1; 0.5%; conducted in Brazil).

Age

Among the studies that reported SMW (sub)sample age (n = 98, 52%), reporting method varied, including: mean age (n = 60; 32%), age groups (n = 26; 14%), age range (n = 25; 13%), median age (n = 10; 5%), and another age measurement (n = 8; 4%). Further, 74 studies (40%) included only adults (>18), 20 (11%) included both youth and adults, and four (2%) included only youth (<18). Notably, 89 (48%) studies did not report age data for the SMW (sub)sample, of which eight were reviews with no focus or restriction on age.

Key findings

The included studies covered diverse HIV-related findings (Table 2). Across topics, most studies reported overall prevalence among SMW and frequently conducted comparative analyses between SMW and other groups (e.g., heterosexual women, men) and sometimes between SMW (sub)groups.

Table 2.

Summary of Findings Regarding HIV and Sexual Minority Women, Globally

Findings	Studies, n (%)
Number of findings covered
1	59 (32)
2	31 (17)
3	41 (22)
4	26 (14)
5	17 (9)
6	3 (2)
7	1 (0.5)
8	1 (0.5)
Reviews	8 (4)
Key finding topics
Sexual risk behavior	120 (64)
HIV testing, prevalence, and risk perception	88 (47)
Substance use	81 (43)
Sexually transmitted infections	54 (29)
Health care access and service utilization	39 (21)
Intimate partner violence	32 (17)
Mental health	28 (15)
Stigma	19 (10)
Incarceration	16 (9)
PrEP	1 (0.5)
Family support	1 (0.5)
National HIV policy	1 (0.5)
Risk discordance	1 (0.5)

Frequencies and percentages are based on the 187 included records. Totals may exceed 187 and percentages may exceed 100% because individual studies could contribute to more than one key finding domain.

PrEP, preexposure prophylaxis.

Most studies reported findings related to sexual risk behaviors (n = 120; 64%), consistently describing variation in partnership patterns among SMW, including partner gender, partner number, concurrency, relationship duration, and diverse barrier use practices.^{2,5,19,23,25,46,47,74,77,78,81,82,86,87,91,94–96,102,104–106,109–111,113–117,119,121–128,130–143,145,148–150,152,154–157,159,161–168,171–175,177,179,183,186–193,196,199–203,205–209,211–213,215–222,224–228,231–234,237,240} Compared with heterosexual women, SMW (particularly bisexual and WSWM) were often reported to have higher partner counts, greater exposure to partners with elevated HIV/STI vulnerability, higher rates of concurrency, and, in some studies, more casual or short-term partnerships. Barrier use was frequently inconsistent (and often absent), with wide variation across studies; qualitative findings indicated that trust, relationship context, and gaps in inclusive sexual health education shaped protection decisions more than formal risk assessment. Across studies, elevated risk behaviors frequently co-occurred with structural vulnerabilities such as stigma, violence, and substance use.

Eighty-eight studies addressed HIV testing, prevalence, and risk perception among SMW (47%).^{5,23,25,33,46,47,69–73,76,79,82,83,87,89,91,95,97,99,104–107,109,110,113,115,117,118,121,127–131,134–138,141–143,145,148,150,156–159,161,166–171,173,175,176,178,184,185,188,190,193,196–199,201,205–208,212–218,222,229,233,240} HIV testing was generally high; SMW, particularly bisexual and WSWM, often reported higher testing engagement than heterosexual women, although disparities persisted by race and geography. SMW perceived themselves at low or no risk for HIV; several studies documented a disconnect between behavioral exposure (e.g., high partner counts) and perceived vulnerability. A few studies discussed HIV fear-driven testing avoidance and unequal access to HIV education.

Eighty-one studies covered substance use (43%), consistently reporting elevated alcohol and drug use among SMW compared with heterosexual women, although patterns varied substantially by subgroup.^{5,23,25,74,75,77,78,81,82,85,87,89,94–96,98,99,104,105,110,111,115,118,120–123,125,126,128–130,132,135,137,140–143,145,148,152,156,157,163,164,171,173,175–177,181,183,184,186–188,190,196,197,199–202,205,208–210,212,213,215–217,219–221,224,227,229,231,238} Heavy drinking, injection drug use, and noninjection drug use were frequently concentrated among bisexual women, WSWM, and racially and economically marginalized SMW. Across substances, qualitative and quantitative findings linked substance use to intersecting vulnerabilities (e.g., violence exposure, incarceration, unstable housing) and to sexual risk contexts; drugs and alcohol shaped partner dynamics and protection decisions.

Fifty-four studies discussed STIs (29%), showing wide variation in prevalence across infections, and consistent disparities between SMW subgroups.^{5,25,46,71,72,76,79,81,82,106,111,115,116,121,126–128,130,135,136,142,143,149,150,157,158,163,164,168,171,173,176,177,180,182,184,190,193,199,200,204–206,208,212,214,215,222,229–231,233,234,240} Bisexual women and WSWM were more likely than lesbian women and WSW to report bacterial and viral STI experiences, and to have partners with known STI histories; SMW experiencing racial, economic, or violence-related marginalization were the most impacted. STI screening and vaccination uptake were reported across studies but varied widely, with subgroup comparisons producing mixed findings.

Thirty-nine studies addressed health care access (21%), showing inequities among SMW that were strongly shaped by stigma rather than insurance or provider availability.^{5,33,71,76–80,99,115,117,127,131,132,134,135,137,143,147,148,150,153,157,159,160,170,173,190,193,194,211,212,229,233,236,238,240–242} Although many studies reported high rates of insurance coverage and primary care access, utilization of routine preventive services varied widely, and lesbian women/WSW were often less likely to receive routine testing (e.g., STIs, Papanicolaou), mental health counseling, or contraceptive services than their bisexual and heterosexual counterparts. Across studies, fear of discrimination, provider heteronormativity, and confidentiality concerns consistently discouraged disclosure and health care engagement. The findings indicate that structural barriers, not just individual behavior, constrained where and how SMW received care.

Thirty-two studies discussed intimate partner violence (IPV; 17%), consistently showing elevated exposure to violence (e.g., sexual assault, physical abuse, childhood abuse) among SMW relative to heterosexual women.^{5,23,71,72,77,78,93,96,99,100,108,123,125,126,128,148,163,170,171,177,183,186,194,196,197,200,212,213,221,222,224,235} Reported prevalence frequently exceeded one-third of participants, with bisexual/WSWM participants often facing the highest burden. Violence also included coercive control, emotional abuse, and social isolation, underscoring the relational and structural nature of risk. The single intervention study suggested that SMW-specific programming improved engagement.

Mental health topics were reported by 28 studies (15%), showing consistently worse depression, distress, anxiety, suicidality, and psychiatric hospitalization outcomes among SMW compared with heterosexual women.^{25,87,89,90,94,96,97,99,100,118,121,123,138,140,141,148,149,169,176,184,195,197,200,212,227,229,231} Depression and distress studies showed that bisexual women experienced the greatest burden, whereas studies concerning suicidal ideation and suicide attempts showed that transgender SMW faced particularly elevated risk. Across studies, mental health disparities were connected with substance use, violence exposure, and structural marginalization.

Nineteen studies addressed stigma (10%), which shaped both risk and care access for SMW.^{2,70,77,78,88,139,146,147,149,150,156,170,191–193,212,234,238,242} Studies documented specific manifestations of sexuality-related stigma, including antibisexual discrimination, lesbian stigma, and SMW invisibility in sex education, with many SMW reporting direct discrimination experiences. HIV-related stigma was linked to avoidant coping and compounded vulnerability through intersecting marginalizations. One study emphasized resilience, arguing that prevention efforts should build on SMW strengths rather than focus solely on risk.

Sixteen studies reported SMW incarceration experiences (9%), with descriptive analyses indicating that a substantial proportion of SMW had prior arrests or jail.^{5,25,30,68,105,121,123,128,130,145,152,156,163,171,209,212} Comparative analyses consistently showed higher incarceration among SMW than heterosexual women; bisexual women were the most impacted. Qualitative findings described incarceration intersecting with relationship dynamics and sexual networks, including the maintenance of existing partnerships, the formation of new or concurrent relationships during incarceration, and, in some cases, the simultaneous incarceration of partners.

One study (0.5%) covered each of the following: preexposure prophylaxis (PrEP),¹³² family support,⁸⁴ national HIV policy,¹⁰³ and risk perception discordance.¹⁴⁴ Notably, no studies focused on antiretroviral therapy (ART), vaccine trials, or explicitly strengths-based factors.

Discussion

This is the first global scoping review, to our knowledge, to systematically identify and synthesize scientific literature regarding the state of HIV research, inclusive of SMW. Other reviews related to SMW and HIV have been broader in terms of population (e.g., LGBTQ+ people),²⁴³ restrictive in time period,⁴ focused on a specific location,^112,170 sexual health-related but not HIV-specific,³⁴ or have focused on specific health outcomes that may be HIV-related, but were not conducted in an HIV context.^239,244

Our review identified 187 studies, most of which were conducted in the United States and utilized quantitative methods, most commonly cross-sectional designs, using survey data obtained via nonprobability, non-population-based convenience sampling methods. Overwhelmingly, studies did not report community engagement in the research process. Only about a quarter of studies focused exclusively on SMW. Publications show an upward trend over time. Inclusion of demographic data on SMW (sub)samples varied; about half of the studies reported on age and race, and about two-thirds reported on sexual orientation, limiting the potential for disparity analyses. Study foci ranged, with most research centering on sexual risk behavior and HIV testing, prevalence, and risk perception. Our review offers insights on a range of key methodological and topical gaps in the current literature related to SMW HIV risk, which can inform future research and practice efforts to improve HIV-related outcomes among SMW.

Although our final sample of included studies (n = 187) can seem considerable, the breadth of HIV literature related to other populations puts this number into perspective. Our search included all studies, anywhere, since the beginning of the epidemic (40+ years), related to HIV and SMW. In contrast, a systematic review of HIV testing and incidence among men who have sex with men (MSM) in Africa included 152 studies, comparable with our final sample, despite their more restrictive inclusion criteria (e.g., 2005–2023; Africa only).²⁴⁵ An HIV prevalence systematic review among MSM in China included 355 studies, nearly double our sample, again despite restrictive inclusion criteria (e.g., 2001–2018; China only).²⁴⁶ Given the vastness of the HIV literature, the epidemic status of HIV globally, and the heightened yet invisibilized risk among SMW, our comprehensive review highlights a critical need for increased HIV research among SMW.

The included studies commonly focused on sexual risk behaviors, HIV epidemiology, and substance use; a minority of studies focused on structural factors (e.g., stigma, incarceration) despite known association with HIV vulnerability.^247,248 Findings across domains indicate consistently poorer outcomes among SMW when compared with heterosexual women, with disproportionate impacts on bisexual women and WSWM relative to lesbian women and WSW. Disparities also persisted for racially and economically marginalized SMW. Across domains, vulnerabilities commonly co-occurred and were shaped by sociostructural factors rather than isolated behaviors. Notably, no studies included SMW-inclusive research on ART or vaccine trials, only one focused on PrEP, and intervention studies were limited, despite the critical role of PrEP²⁴⁹ and ART in HIV prevention and treatment.²⁵⁰ Additional underrepresented topics include HIV prevention education, sociostructural interventions, living with HIV, resilience and strength-based factors, and social determinants of health. Our findings offer a research agenda roadmap.

The geographic representation of included studies shows a strong bias toward North American research. Few studies were conducted in Latin America, Africa (outside of Southern Africa), Europe, or Asia. However, global data highlight that HIV infection rates among women remain disproportionately high across contexts, with persistent disparities between (sub)groups of women. For instance, HIV incidence is decreasing slower for young women compared with men in Sub-Saharan Africa; HIV infections among transgender women are increasing in Latin America, Eastern Europe, and Central Asia; treatment coverage for HIV is especially low for women in the Middle East and Northern Africa; and overall acquired immunodeficiency syndrome (AIDS)-related deaths increased among women in Central America, whereas it decreased for the overall population.²⁵¹

The lack of diverse geographic research pertaining to (sub)groups of women is likely related to bias and stigma in both Western and non-Western countries. It can partially be accounted for by our neo-colonial global order and its associated socioeconomic power imbalances, which center the Global North²⁵²; research agenda setting in Western nations, where most of the work and funding currently originate, may insufficiently allocate resources to SMW research.²⁵³ This is especially salient in the current moment, when the U.S. federal government is systematically defunding LGBTQ+ research.²⁵⁴

Sexuality-related stigma, rooted in homophobia and misogyny, is also operating within the Global South and may contribute to limited geographic diversity within SMW research; agenda setters and gatekeeper biases may prevent this research.²⁵⁵ Further, in contexts where societal-level biases and stigmas persist, respondents may be reticent to participate in available studies or share sexual orientation data due to anti-LGBTQ+ policies and cultural norms.²⁵⁶ Funding limitations for LGBTQ+ research in these locations could explain this underrepresentation. The lack of SMW-focused research in these highly impacted regions highlights an important literature gap and urgent need for investigations that consider regional and cultural contexts.

HIV studies with SMW have increased over time, potentially reflecting growing recognition of the need for this research. However, there was a notable drop in publications in 2021, potentially due to the impact of the COVID-19 pandemic, which disrupted research activities and diverted funding away from HIV-related research.^257,258 Although an increase in studies over time suggests progress, the current body of literature remains insufficient to address the diverse needs of SMW globally.

A quarter of the studies included in this review focused exclusively on SMW populations. Among studies inclusive of but not focused on SMW, SMW participants comprised a minority of the sample. Demographic data of SMW (sub)samples were also lacking, making cross-study analyses difficult, especially in terms of examining (sub)group nuances, and limiting the possibility for intersectional analyses, even if using individual-level factors as proxies for structural forces. Although this review uses SMW as an umbrella term, we emphasize the importance of future research to disaggregate findings by SMW (sub)groups (e.g., lesbian women, bisexual women, WSW, WSWM) and to clearly define the populations under study. Additional health disparity analyses between SMW (sub)groups (e.g., defined by race, gender, or sexual orientation) are needed to better understand intersectional dimensions of HIV vulnerabilities and to inform responsive interventions.

Our review highlighted key methodological gaps in the existing literature. The overwhelming use of cross-sectional survey-based designs with convenience sampling provides an important orientation to relevant issues but limits finding generalizability. Future quantitative research should prioritize more complex designs, including longitudinal studies to investigate SMW HIV risk and outcome evolution over time, as well as more sophisticated sampling strategies to facilitate greater generalizability. In addition, future research could utilize pooled data or meta-analyses to derive insights across studies.

Although quantitative studies provide important prevalence and incidence data, qualitative approaches can offer deeper insights into barriers to care, stigma experiences, and structural factors influencing HIV risk. Qualitative research is underrepresented in this review, yet is essential for capturing the lived HIV risk, prevention, and care experiences of SMW. Further, there is a need for intervention studies to provide HIV-related and other support to SMW. Finally, SMW community-engaged research approaches are necessary to ensure relevant, accurate, and meaningful findings are generated.

In many instances, studies did not report important methodological factors (i.e., level of community engagement, sexual orientation operationalization). Although relevant data to describe study results and journal reporting requirements vary, this information is critical to contextualize the field and move toward better public health research practices. Taken together, the findings highlight the need for the establishment and adoption of transparent research implementation and reporting guidelines for SMW studies, similar to those developed for specific populations (e.g., transgender populations²⁵⁹), study designs (e.g., PRISMA-ScR for scoping reviews,⁶⁰ Consolidated Standards of Reporting Trials for randomized controlled trials²⁶⁰), and specific fields (e.g., Strengthening the Reporting of Observational Studies in Epidemiology for epidemiology²⁶¹).

Limitations

Our scoping review has some limitations. First, all searches potentially miss eligible articles; relevant articles may have been excluded because they were published in a language other than English. Further, we focused on peer-reviewed empirical publications, which omitted “gray literature” (e.g., doctoral dissertations, practice guidelines, government reports). Second, our choice to summarize the literature under the umbrella SMW term limits nuanced takeaways concerning (sub)group nuances. However, given the range of ways in which authors label and define SMW (sub)groups, and the goal of this scoping review, this choice still provided high-level summary data on the existing literature.

Conclusion

This scoping review of 187 studies provides insights into the current body of peer-reviewed, English language global research concerning SMW and HIV. We include an overview of study characteristics and research foci, offering rich insight into existing knowledge and highlighting key methodological and topical gaps. Specifically, further research on structural, level factors and biomedical interventions among SMW is needed. Expanding research efforts beyond North America should be prioritized, particularly in regions highly impacted by HIV, where SMW remain understudied. This research should include qualitative and quantitative approaches, with strengths-based lenses. Finally, the establishment of transparent and standardized procedural and reporting guidelines for SMW studies would enhance the comparability and utility of future research. Our study supports a need for increased resources for research and practice that focus on the unique HIV-related health strengths and vulnerabilities of SMW. These findings can inform future research agendas, policy development, and targeted public health interventions to help improve HIV-related outcomes for SMW globally.

Authors’ Contributions

J.L.G.: Conceptualization, data curation, formal analysis, funding acquisition, investigation, methodology, project administration, resources, supervision, validation, and writing—original draft. M.S.: Data curation, formal analysis, investigation, project administration, visualization, and writing—review and editing. F.M.W.: Data curation, formal analysis, investigation, visualization, and writing—review and editing. M.N.: Data curation, formal analysis, investigation, visualization, and writing—review and editing.

Ethical Considerations

This study was a scoping review of published literature and did not involve human participants or primary data collection. As such, ethics approval was not required.

Consent to Participate

Not applicable.

Consent for Publication

Not applicable.

Disclaimer

The content is solely the responsibility of the authors and does not necessarily represent the official views of the funders.

Data Availability

All data in this article are available on request to the corresponding author. No restrictions will be applied.

Footnotes

Acknowledgments

The authors thank Rebecca Fowler for her support in the early stages of this project, Lori Rosman for her technical support in developing and running the search, Katherine Banchoff for her support with data abstraction, Sara Malley for her support on early drafts of , Leanne Zhang for her academic editing, and Matthew Folse for expert support with reference formatting and citation review. The authors also thank the authors of the included studies and the women who participated in them.

Declaration of Conflicting Interest

The authors declare no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding Statement

This publication resulted, in part, from research supported by the NIH/NIDA (K01DA059328) and the Johns Hopkins University Center for AIDS Research, an NIH-funded program (1P30AI094189).

Supplemental Material

References

Logie

. (Where) do queer women belong? Theorizing intersectional and compulsory heterosexism in HIV research. Crit Public Health 2015; 25: 527–538; doi: 10.1080/09581596.2014.938612

2. Teti

and Bowleg

. Shattering the myth of invulnerability: Exploring the prevention needs of sexual minority women living with HIV/AIDS. J Gay Lesbian Soc Serv 2011; 23: 69–88; doi: 10.1080/10538720.2010.538009

3. Palma

and Orcasita

. Considerations for the design of human immunodeficiency virus (HIV) prevention programs for lesbian and bisexual women. Interface (Botucatu) 2017; 21: 1031–1038; doi: 10.1590/1807-57622016.0790

Andrade

CAA

, Aquino

, Souza

KRF

et al. Vulnerability of lesbian and bisexual women to HIV: A qualitative meta-synthesis. Rev Assoc Med Bras (1992) 2023; 69: e20220988; doi: 10.1590/1806-9282.20220988

Ompad

, Friedman

, Hwahng

et al. HIV risk behaviors among young drug using women who have sex with women (WSWs) in New York City. Subst Use Misuse 2011; 46: 274–284; doi: 10.3109/10826084.2011.523284

6. Garcia-Moreno

and Watts

. Violence against women: An urgent public health priority. Bull World Health Organ 2011; 89: 2; doi: 10.2471/BLT.10.085217

Milloy

, Marshall

, Kerr

et al. Social and structural factors associated with HIV disease progression among illicit drug users: A systematic review. AIDS 2012; 26: 1049–1063; doi: 10.1097/QAD.0b013e32835221cc

Shannon

, Kerr

, Allinott

et al. Social and structural violence and power relations in mitigating HIV risk of drug-using women in survival sex work. Soc Sci Med 2008; 66: 911–921; doi: 10.1016/j.socscimed.2007.11.008

Gupta

, Parkhurst

, Ogden

et al. Structural approaches to HIV prevention. Lancet 2008; 372: 764–775; doi: 10.1016/S0140-6736(08)60887-9

10.

El-Bassel

, Shaw

, Dasgupta

et al. Drug use as a driver of HIV risks: Re-emerging and emerging issues. Curr Opin HIV AIDS 2014; 9: 150–155; doi: 10.1097/COH.0000000000000035

11.

Sherman

, Schneider

, Park

et al. PrEP awareness, eligibility, and interest among people who inject drugs in Baltimore, MD. Drug Alcohol Depend 2019; 195: 148–155; doi: 10.1016/j.drugalcdep.2018.08.014

12.

Paz-Bailey

, Noble

, Salo

et al. Prevalence of HIV among U.S. female sex workers: Systematic review and meta-analysis. AIDS Behav 2016; 20: 2318–2331; doi: 10.1007/s10461-016-1332-y

13.

13. Nerlander

, Handanagic

, Hess

, NHBS High Risk Women Study Group. et al.; HIV prevalence among women who exchange sex for money or drugs-4 U.S. Cities. J Acquir Immune Defic Syndr 2020; 84: 345–354; doi: 10.1097/QAI.0000000000002362

14.

Bole

, Khosropour

, Glick

et al. Characterization of patients seeking care at a sexual health clinic who report engaging in exchange sex. Sex Transm Dis 2022; 49: 719–725; doi: 10.1097/OLQ.0000000000001666

15.

Carey

, Guthrie

, Rich

et al. Alcohol use and sexual risk behavior in young women: A qualitative study. AIDS Behav 2019; 23: 1647–1655; doi: 10.1007/s10461-018-2310-3

16.

Mitchell

, Kelly

, O’Grady

et al. HIV-risk behavior among adults with opioid use disorder during 12 months following pre-trial detention: Results from a randomized trial of methadone treatment. AIDS Behav 2021; 25: 1247–1256; doi: 10.1007/s10461-020-03090-y

17.

Leddy

, Zakaras

, Shieh

et al. Intersections of food insecurity, violence, poor mental health and substance use among US women living with and at risk for HIV: Evidence of a syndemic in need of attention. PLoS One 2021; 16: e0252338; doi: 10.1371/journal.pone.0252338

18.

18. German

, Davey

and Latkin

. Residential transience and HIV risk behaviors among injection drug users. AIDS Behav 2007; 11: 21–30; doi: 10.1007/s10461-007-9238-3

19.

Gangamma

, Slesnick

, Toviessi

et al. Comparison of HIV risks among gay, lesbian, bisexual and heterosexual homeless youth. J Youth Adolesc 2008; 37: 456–464; doi: 10.1007/s10964-007-9171-9

20.

20. Ebner

and Laviage

. The parallel universe of homeless and HIV-positive youth. Semin Pediatr Infect Dis 2003; 14: 32–37; doi: 10.1053/spid.2003.127215

21.

Ogden

, Harris

, Childs

et al. “You need money to get high, and that’s the easiest and fastest way: ” A typology of sex work and health behaviours among people who inject drugs. Int J Drug Policy 2021; 96: 103285; doi: 10.1016/j.drugpo.2021.103285

22.

Trost

, Onwubiko

, Wilson

et al. Health care-seeking behaviors and perceptions of provider-initiated discussion of pre-exposure prophylaxis among PrEP-naive HIV-negative men who have sex with men in Atlanta, GA. Open Forum Infect Dis 2020; 7: ofaa165; doi: 10.1093/ofid/ofaa165

23.

Glick

, Lim

, Beckham

et al. Structural vulnerabilities and HIV risk among sexual minority female sex workers (SM-FSW) by identity and behavior in Baltimore, MD. Harm Reduct J 2020; 17: 43; doi: 10.1186/s12954-020-00383-2

24.

24. Glick

, Baugher

, Morris

, NHBS Study Group. et al.; Exploring HIV risk among sexual minority women by identity and behavior in a population-based sample of low-income heterosexually active women. LGBT Health 2025; 12: 350–362; doi: 10.1089/lgbt.2024.0098

25.

25. German

and Latkin

. HIV risk, health, and social characteristics of sexual minority female injection drug users in baltimore. AIDS Behav 2015; 19: 1361–1365; doi: 10.1007/s10461-014-0972-z

26.

McCabe

, Hughes

, Bostwick

et al. Sexual orientation, substance use behaviors and substance dependence in the United States. Addiction 2009; 104: 1333–1345; doi: 10.1111/j.1360-0443.2009.02596.x

27.

27. Schuler

, Dick

and Stein

. Sexual minority disparities in opioid misuse, perceived heroin risk and heroin access among a national sample of US adults. Drug Alcohol Depend 2019; 201: 78–84; doi: 10.1016/j.drugalcdep.2019.04.014

28.

28. Downing

and Rosenthal

. Prevalence of social determinants of health among sexual minority women and men in 2017. Am J Prev Med 2020; 59: 118–122; doi: 10.1016/j.amepre.2020.01.007

29.

29. Tyler

and Schmitz

. A comparison of risk factors for various forms of trauma in the lives of lesbian, gay, bisexual and heterosexual homeless youth. J Trauma Dissociation 2018; 19: 431–443; doi: 10.1080/15299732.2018.1451971

30.

Cohen

, Weber

, Lancki

et al. History of incarceration among women with HIV: Impact on prognosis and mortality. J Womens Health (Larchmt) 2019; 28: 1083–1093; doi: 10.1089/jwh.2018.7454

31.

Huang

, Nguyen

, German

et al. Health care utilization and care-seeking behavior among vulnerabilized sexual minority women: A social-ecological approach. J Health Care Poor Underserved 2024; 35: 583–604; doi: 10.1353/hpu.2024.a928634

32.

Perrin

, Shannon

, Lowik

et al. Access to and quality of care for sexual and gender minority women living with HIV in Metro Vancouver, Canada: Results from a longitudinal cohort study. Womens Health (Lond) 2023; 19: 17455057231205677; doi: 10.1177/17455057231205677

33.

Makrides

, Matson

, Arrington-Sanders

et al. Disparities in sexually transmitted infection/HIV testing, contraception, and emergency contraception care among adolescent sexual minority women who are racial/ethnic minorities. J Adolesc Health 2023; 72: 214–221; doi: 10.1016/j.jadohealth.2022.08.030

34.

34. Tat

, Marrazzo

and Graham

. Women who have sex with women living in low- and middle-income countries: A systematic review of sexual health and risk behaviors. LGBT Health 2015; 2: 91–104; doi: 10.1089/lgbt.2014.0124

35.

Obón-Azuara

, Vergara-Maldonado

, Gutiérrez-Cía

et al. Gaps in sexual health research about women who have sex with women. A scoping review. Gac Sanit 2022; 36: 439–445; doi: 10.1016/j.gaceta.2022.01.008

36.

Chaudhry

, Hebert-Beirne

, Hanneke

et al. The health needs of sexual and gender minority migrant women in the United States: A scoping review. LGBT Health 2024; 11: 1–19; doi: 10.1089/lgbt.2022.0392

37.

Coulter

, Kenst

, Bowen

et al. Research funded by the National Institutes of Health on the health of lesbian, gay, bisexual, and transgender populations. Am J Public Health 2014; 104: e105–e112; doi: 10.2105/AJPH.2013.301501

38.

Mijas

, Grabski

, Blukacz

et al. Sexual health studies in gay and lesbian people: A critical review of the literature. J Sex Med 2021; 18: 1012–1023; doi: 10.1016/j.jsxm.2021.02.013

39.

Blondeel

, Say

, Chou

et al. Evidence and knowledge gaps on the disease burden in sexual and gender minorities: A review of systematic reviews. Int J Equity Health 2016; 15: 16; doi: 10.1186/s12939-016-0304-1

40.

Lewis

, Milletich

, Kelley

et al. Minority stress, substance use, and intimate partner violence among sexual minority women. Aggress Violent Behav 2012; 17: 247–256; doi: 10.1016/j.avb.2012.02.004

41.

Chakrapani

, Loganathan

, Saha

et al. Engagement of vulnerable communities in HIV prevention research in India: A qualitative investigation. Res Involv Engagem 2024; 10: 12; doi: 10.1186/s40900-024-00542-w

42.

Arias Garcia

, Chen

, Calleja

et al. Availability and quality of surveillance and survey data on HIV prevalence among sex workers, men who have sex with men, people who inject drugs, and transgender women in low- and middle-income countries: Review of available data (2001-2017). JMIR Public Health Surveill 2020; 6: e21688; doi: 10.2196/21688

43.

Boehmer

. Twenty years of public health research: Inclusion of lesbian, gay, bisexual, and transgender populations. Am J Public Health 2002; 92: 1125–1130; doi: 10.2105/ajph.92.7.1125

44.

White

. HIV risk assessment and prevention in lesbians and women who have sex with women: Practical information for clinicians. Health Care Women Int 1997; 18: 127–138; doi: 10.1080/07399339709516268

45.

45. Bauer

and Jairam

. Are lesbians really women who have sex with women (WSW)? Methodological concerns in measuring sexual orientation in health research. Women Health 2008; 48: 383–408; doi: 10.1080/03630240802575120

46.

46. Diamant

, Lever

and Schuster

. Lesbians’ sexual activities and efforts to reduce risks for sexually transmitted diseases. J Gay Lesbian Med Assoc 2000; 4: 41–48; doi: 10.1023/a:1009513623365

47.

47. Montcalm

and Myer

. Lesbian Immunity from HIV/AIDS: Fact or fiction? J Lesbian Stud 2000; 4: 131–147; doi: 10.1300/J155v04n02_09

48.

Thorpe

, Hargons

, Tanner

et al. Perceived HIV invulnerability and PrEP knowledge and attitudes among Black sexual minority women. Am J Sex Educ 2022; 17: 400–413; doi: 10.1080/15546128.2022.2035291

49.

Crenshaw

. Demarginalizing the intersection of race and sex: A Black feminist critique of antidiscrimination doctrine, feminist theory and antiracist politics. Univ Chic Leg Forum 1989; 8: 139–168.

50.

Bauer

, Churchill

, Mahendran

et al. Intersectionality in quantitative research: A systematic review of its emergence and applications of theory and methods. SSM Popul Health 2021; 14: 100798; doi: 10.1016/j.ssmph.2021.100798

51.

Bowleg

. The problem with intersectional stigma and HIV equity research. Am J Public Health 2022; 112: S344–S346; doi: 10.2105/AJPH.2022.306729

52.

Earnshaw

, Jonathon Rendina

, Bauer

et al. Methods in HIV-related intersectional stigma research: Core elements and opportunities. Am J Public Health 2022; 112: S413–S419; doi: 10.2105/AJPH.2021.306710

53.

53. Poteat

and Logie

. A case for strengths-based approaches to addressing intersectional stigma in HIV research. Am J Public Health 2022; 112: S347–S349; doi: 10.2105/AJPH.2021.306659

54.

Brooks

. Minority stress and lesbian women. New York, NY: Free Press, 1981.

55.

Rich

, Salway

, Scheim

et al. Sexual minority stress theory: Remembering and honoring the work of Virginia Brooks. LGBT Health 2020; 7: 124–127; doi: 10.1089/lgbt.2019.0223

56.

Bowleg

. Evolving intersectionality within public health: From analysis to action. Am J Public Health 2021; 111: 88–90; doi: 10.2105/AJPH.2020.306031

57.

57. Zubizarreta

and Beccia

. Quantitative approaches to structural intersectionality research: Conceptual and methodologic considerations. Soc Sci Med 2025; 367: 117712; doi: 10.1016/j.socscimed.2025.117712

58.

Poteat

, Malik

, Scheim

et al. HIV prevention among transgender populations: Knowledge gaps and evidence for action. Curr HIV/AIDS Rep 2017; 14: 141–152; doi: 10.1007/s11904-017-0360-1

59.

59. Arksey

and O’Malley

. Scoping studies: Towards a methodological framework. Int J Soc Res Methodol 2005; 8: 19–32; doi: 10.1080/1364557032000119616

60.

Tricco

, Lillie

, Zarin

et al. PRISMA extension for scoping reviews (PRISMA-ScR): Checklist and Explanation. Ann Intern Med 2018; 169: 467–473; doi: 10.7326/M18-0850

61.

61.Veritas Health Innovation Ltd. Covidence systematic review software. Melbourne, Australia: Veritas Health Innovation Ltd, 2025.

62.

Peters

, Godfrey

, Khalil

et al. Guidance for conducting systematic scoping reviews. Int J Evid Based Healthc 2015; 13: 141–146; doi: 10.1097/XEB.0000000000000050

63.

Greenhalgh

, Robert

, Macfarlane

et al. Storylines of research in diffusion of innovation: A meta-narrative approach to systematic review. Soc Sci Med 2005; 61: 417–430; doi: 10.1016/j.socscimed.2004.12.001

64.

64.Microsoft Corporation. Microsoft Excel. Redmond, WA: Microsoft Corporation, 2018.

65.

Badgett

MVL

, Goldberg

, Conron

et al. Best practices for asking questions about sexual orientation on surveys (SMART). Los Angeles, CA: The Williams Institute, UCLA School of Law; 2009, https://williamsinstitute.law.ucla.edu/wp-content/uploads/Best-Practices-SO-Surveys-Nov-2009.pdf (2026, accessed 31

March

2026).

66.

66. Howell

and Emerson

. So what “should” we use? Evaluating the impact of five racial measures on markers of social inequality. Sociol Race Ethn 2017; 3: 14–30; doi: 10.1177/2332649216648465

67.

Page

, McKenzie

, Bossuyt

et al. The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ 2021; 372: n71; doi: 10.1136/bmj.n71

68.

Abiona

, Adefuye

, Balogun

et al. Gender differences in HIV risk behaviors of inmates. J Womens Health (Larchmt) 2009; 18: 65–71; doi: 10.1089/jwh.2008.0941

69.

Absalon

, Fuller

, Ompad

et al. Gender differences in sexual behaviors, sexual partnerships, and HIV among drug users in New York City. AIDS Behav 2006; 10: 707–715; doi: 10.1007/s10461-006-9082-x

70.

Abubakari

, Smith

MDR

, Boyd

et al. Assessing different types of HIV communication and sociocultural factors on perceived HIV stigma and testing among a national sample of youth and young adults. Int J Environ Res Public Health 2022; 19: 1003; doi: 10.3390/ijerph19021003

71.

Agenor

, Austin

, Kort

et al. Sexual orientation and sexual and reproductive health among African American sexual minority women in the U.S. south. Womens Health Issues 2016; 26: 612–621; doi: 10.1016/j.whi.2016.07.004

72.

Agenor

, Muzny

, Schick

et al. Sexual orientation and sexual health services utilization among women in the United States. Prev Med 2017; 95: 74–81; doi: 10.1016/j.ypmed.2016.11.023

73.

Agenor

, Perez

, Koma

et al. Sexual orientation identity, race/ethnicity, and lifetime HIV testing in a national probability sample of U.S. women and men: An intersectional approach. LGBT Health 2019; 6: 306–318; doi: 10.1089/lgbt.2019.0001

74.

74. Allen

, Ruiz

and O’Rourke

. Differences in the prevalence of risk behaviors between heterosexual and lesbian, gay, bisexual, and questioning (LGBQ) female adolescents in the juvenile justice system. J Gay Lesbian Soc Serv 2016; 28: 171–175; doi: 10.1080/10538720.2016.1158137

75.

Arayasirikul

, Pomart

, Raymond

et al. Unevenness in health at the intersection of gender and sexuality: Sexual minority disparities in alcohol and drug use among transwomen in the San Francisco Bay Area. J Homosex 2018; 65: 66–79; doi: 10.1080/00918369.2017.1310552

76.

Arbeit

, Fisher

, Macapagal

et al. Bisexual invisibility and the sexual health needs of adolescent girls. LGBT Health 2016; 3: 342–349; doi: 10.1089/lgbt.2016.0035

77.

Arend

. The politics of invisibility: HIV-positive women who have sex with women and their struggle for support. J Assoc Nurses AIDS Care 2003; 14: 37–47; doi: 10.1177/1055329003252876

78.

Arend

. The politics of invisibility: Homophobia and low-income HIV-positive women who have sex with women. J Homosex 2005; 49: 97–122; doi: 10.1300/J082v49n01_05

79.

79. Barefoot

, Warren

and Smalley

. Women’s health care: The experiences and behaviors of rural and urban lesbians in the USA. Rural Remote Health 2017; 17: 3875; doi: 10.22605/rrh3875

80.

Barnard

, Free

, Bakolis

et al. Comparing the characteristics of users of an online service for STI self-sampling with clinic service users: A cross-sectional analysis. Sex Transm Infect 2018; 94: 377–383; doi: 10.1136/sextrans-2017-053302

81.

81. Bell

, Ompad

and Sherman

. Sexual and drug risk behaviors among women who have sex with women. Am J Public Health 2006; 96: 1066–1072; doi: 10.2105/AJPH.2004.061077

82.

Bevier

, Chiasson

, Heffernan

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; 85: 1366–1371; doi: 10.2105/ajph.85.10.1366

83.

Bezerra

ALL

, Sorensen

, Rodrigues

et al. HIV epidemic among Brazilian women who have sex with women: An ecological study. Front Public Health 2022; 10: 926560; doi: 10.3389/fpubh.2022.926560

84.

Bible

, Kaplan

, Lieberman

et al. A retrospective analysis of sex education messages received by LGB youth. J LGBT Youth 2022; 19: 287–306; doi: 10.1080/19361653.2020.1819509

85.

Bloomfield

. A comparison of alcohol consumption between lesbians and heterosexual women in an urban population. Drug Alcohol Depend 1993; 33: 257–269; doi: 10.1016/0376-8716(93)90112-4

86.

Bobashev

, Zule

, Osilla

et al. Transactional sex among men and women in the south at high risk for HIV and other STIs. J Urban Health 2009; 86: 32–47; doi: 10.1007/s11524-009-9368-1

87.

Bockting

, Huang

C-Y

, Ding

et al. Are transgender persons at higher risk for HIV than other sexual minorities? A comparison of HIV prevalence and risks. Int J Transgend 2005; 8: 123–131; doi: 10.1300/J485v08n02_11

88.

Brown

, Serovich

, Laschober

et al. Ways of coping and perceived HIV-related stigma among people living with HIV: Moderation by sex and sexual orientation. Psychol Health Med 2020; 25: 867–878; doi: 10.1080/13548506.2019.1680852

89.

89. Buttram

, Surratt

and Kurtz

. Risk and protective factors associated with personal mastery among sexual minority African American female sex workers. J Gay Lesbian Soc Serv 2014; 26: 407–425; doi: 10.1080/10538720.2014.956242

90.

Carter

, Patterson

, Kestler

et al. Sexual anxiety among women living with HIV in the era of antiretroviral treatment suppressing HIV transmission. Sex Res Soc Policy 2020; 17: 765–779; doi: 10.1007/s13178-020-00432-2

91.

Cassels

, Pearson

, Walters

et al. Sexual partner concurrency and sexual risk among gay, lesbian, bisexual, and transgender American Indian/Alaska natives. Sex Transm Dis 2010; 37: 272–278; doi: 10.1097/OLQ.0b013e3181c37e3e

92.

Chakrapani

, Newman

, Shunmugam

et al. A scoping review of lesbian, gay, bisexual, transgender, queer, and intersex (LGBTQI+) people’s health in India. PLOS Glob Public Health 2023; 3: e0001362; doi: 10.1371/journal.pgph.0001362

93.

Champion

. Context of sexual risk behaviour among abused ethnic minority adolescent women. Int Nurs Rev 2011; 58: 61–67; doi: 10.1111/j.1466-7657.2010.00857.x

94.

Cheng

, Gipson

, Perez

et al. Same-sex behavior and health indicators of sexually experienced Filipino young adults. Arch Sex Behav 2016; 45: 1471–1482; doi: 10.1007/s10508-014-0389-9

95.

Chu

, Buehler

, Fleming

et al. Epidemiology of reported cases of AIDS in lesbians, US, USA 1980-89. Am J Public Health 1990; 80: 1380–1381; doi: 10.2105/ajph.80.11.1380

96.

96. Coble

, Silver

and Chhabra

. Description of sexual orientation and sexual behaviors among high school girls in New York City. J Pediatr Adolesc Gynecol 2017; 30: 460–465; doi: 10.1016/j.jpag.2017.02.007

97.

97. Cochran

and Mays

. Physical health complaints among lesbians, gay men, and bisexual and homosexually experienced heterosexual individuals: Results from the California quality of life survey. Am J Public Health 2007; 97: 2048–2055; doi: 10.2105/AJPH.2006.087254

98.

Cohen

, Benning

, Weber

et al. Predictors and consequences of prescription opioid use in women living with and without HIV: 20-year follow-up. J Womens Health (Larchmt) 2022; 31: 1188–1196; doi: 10.1089/jwh.2021.0231

99.

99. Conron

, Mimiaga

and Landers

. A population-based study of sexual orientation identity and gender differences in adult health. Am J Public Health 2010; 100: 1953–1960; doi: 10.2105/AJPH.2009.174169

100.

100. Cooperman

, Simoni

and Lockhart

. Abuse, social support, and depression among HIV-positive heterosexual, bisexual, and lesbian women. J Lesbian Stud 2003; 7: 49–66; doi: 10.1300/J155v07n04_04

101.

da Silva Oliveira

and Sampaio Nery I.

Lesbian women in the context of HIV/AIDS: An integrative review. J NursUFPE/Reva Enferm UFPE 2016; 10: 3090–3100; doi: 10.5205/reuol.9373-82134-1-RV1008201637

102.

da Silva Oliveira

, Sampaio Nery

, Gir

et al. Knowledge, attitudes and practices on HIV/AIDS of women who have sex with women. J NursUFPE/Ver Enferm UFPE 2017; 11: 2736–2742; doi: 10.5205/reuol.10939-97553-1-RV.1107201712

103.

103. Daly

, Spicer

and Willan

. Sexual rights but not the right to health? Lesbian and bisexual women in South Africa’s national strategic plans on HIV and STIs. Reprod Health Matters 2016; 24: 185–194; doi: 10.1016/j.rhm.2016.04.005

104.

Deren

, Estrada

, Stark

et al. Sexual orientation and HIV risk behaviors in a national sample of injection drug users and crack smokers. Drugs Soc 1996; 9: 97–108; doi: 10.1300/J023v09n01_06

105.

Diaz

, Vlahov

, Greenberg

et al. Sexual orientation and HIV infection prevalence among young Latino injection drug users in Harlem. J Womens Health Gend Based Med 2001; 10: 371–380; doi: 10.1089/152460901750269698

106.

106. Dolan

and Davis

. Nuances and shifts in lesbian women’s constructions of STI and HIV vulnerability. Soc Sci Med 2003; 57: 25–38; doi: 10.1016/s0277-9536(02)00305-2

107.

107. Dolan

and Davis

. HIV testing among lesbian women: Social contexts and subjective meanings. J Homosex 2008; 54: 307–324; doi: 10.1080/00918360801982264

108.

Eaton

, Kaufman

, Fuhrel

et al. Examining factors co-existing with interpersonal violence in lesbian relationships. J Fam Viol 2008; 23: 697–705; doi: 10.1007/s10896-008-9194-3

109.

Ehrhardt

, Nostlinger

, Meyer-Bahlburg

HFL

et al. Sexual risk behavior among women with injected drug use histories. J Psychol Human Sex 1995; 7: 99–119; doi: 10.1300/J056v07n01_06

110.

110. Einhorn

and Polgar

. HIV-risk behavior among lesbians and bisexual women. AIDS Educ Prev 1994; 6: 514–523; doi: 10.1521/aeap.1994.6.6.514

111.

Engel

, Fairley

, Greaves

et al. Patterns of sexual practices, sexually transmitted infections and other genital infections in women who have sex with women only (WSWO), women who have sex with men only (WSMO) and women who have sex with men and women (WSMW): Findings from a sexual health clinic in Melbourne, Australia, 2011-2019. Arch Sex Behav 2022; 51: 2651–2665; doi: 10.1007/s10508-022-02311-w

112.

Evans

, Cloete

, Zungu

et al. HIV risk among men who have sex with men, women who have sex with women, lesbian, gay, bisexual and transgender populations in South Africa: A mini-review. Open AIDS J 2016; 10: 49–64; doi: 10.2174/1874613601610010049

113.

Farel

, Parker

, Muessig

et al. Sexuality, sexual practices, and HIV risk among incarcerated African-American women in North Carolina. Womens Health Issues 2013; 23: e357-364–e364; doi: 10.1016/j.whi.2013.08.006

114.

114. Ferguson

and Frankis

. Sex and sexual orientation: The effect of group membership on individuals’ judgments about self and others’ HIV risk. J Homosex 2001; 41: 119–143; doi: 10.1300/J082v41n02_07

115.

Fethers

, Marks

, Mindel

et al. Sexually transmitted infections and risk behaviours in women who have sex with women. Sex Transm Infect 2000; 76: 345–349; doi: 10.1136/sti.76.5.345

116.

Filipe

, Strauss

, Beck

et al. Sexual behaviour among London GUM clinic attenders: Implications for HIV education. Int J STD AIDS 1994; 5: 346–352; doi: 10.1177/095646249400500512

117.

117. Fishman

and Anderson

. Perception of HIV and safer sexual behaviors among lesbians. J Assoc Nurses AIDS Care 2003; 14: 48–55; doi: 10.1177/1055329003255591

118.

Flentje

, Shumway

, Wong

et al. Psychiatric risk in unstably housed sexual minority women: Relationship between sexual and racial minority status and human immunodeficiency virus and psychiatric diagnoses. Womens Health Issues 2017; 27: 294–301; doi: 10.1016/j.whi.2016.12.005

119.

Friedman

, Bolyard

, Khan

et al. Group sex events and HIV/STI risk in an urban network. J Acquir Immune Defic Syndr 2008; 49: 440–446; doi: 10.1097/qai.0b013e3181893f31

120.

Friedman

, Bolyard

, Mateu-Gelabert

et al. Some data-driven reflections on priorities in AIDS network research. AIDS Behav 2007; 11: 641–651; doi: 10.1007/s10461-006-9166-7

121.

Friedman

, Ompad

, Maslow

et al. HIV prevalence, risk behaviors, and high-risk sexual and injection networks among young women injectors who have sex with women. Am J Public Health 2003; 93: 902–906; doi: 10.2105/ajph.93.6.902

122.

Gil-Llario

, Morell-Mengual

, Garcia-Barba

et al. HIV and STI prevention among Spanish women who have sex with women: Factors associated with dental dam and condom Use. AIDS Behav 2023; 27: 161–170; doi: 10.1007/s10461-022-03752-z

123.

Glick

, Beckham

, White

et al. The importance of sexual orientation in the association between social cohesion and client condom coercion among women who exchange sex in Baltimore, MD. AIDS Behav 2022; 26: 2632–2642; doi: 10.1007/s10461-022-03599-4

124.

Goldenberg

, Liyanage

, Braschel

et al. Structural barriers to condom access in a community-based cohort of sex workers in Vancouver, Canada: Influence of policing, violence and end-demand criminalisation. BMJ Sex Reprod Health 2020; 46: 301–307; doi: 10.1136/bmjsrh-2019-200408

125.

Gonzales

, Washienko

, Krone

et al. Sexual and drug-use risk factors for HIV and STDs: A comparison of women with and without bisexual experiences. Am J Public Health 1999; 89: 1841–1846; doi: 10.2105/ajph.89.12.1841

126.

Goodenow

, Szalacha

, Robin

et al. Dimensions of sexual orientation and HIV-related risk among adolescent females: Evidence from a statewide survey. Am J Public Health 2008; 98: 1051–1058; doi: 10.2105/AJPH.2005.080531

127.

127. Gray

and Fisher

. Predictors of contraceptive self-efficacy and condom use among young Black women who have sex with women and men. J Bisexuality 2021; 21: 380–404; doi: 10.1080/15299716.2021.1971592

128.

Harbison

, Austin

, Hook

3rd

et al. Is there a continuum of risk for sexually transmitted infections among African American women? Sex Transm Dis 2018; 45: e20–e22; doi: 10.1097/OLQ.0000000000000750

129.

Harris

, Thiede

, McGough

et al. Risk factors for HIV infection among injection drug users: Results of blinded surveys in drug treatment centers, King County, WA 1988-1991. J Acquir Immune Defic Syndr (1988) 1993; 6: 1275–1282.

130.

Iversen

, Dolan

, Ezard

et al. HIV and hepatitis C virus infection and risk behaviors among heterosexual, bisexual, and lesbian women who inject drugs in Australia. LGBT Health 2015; 2: 127–134; doi: 10.1089/lgbt.2014.0116

131.

131. Jacobs

, Sklar

and Kane

. Sexual behaviors and perceptions of HIV risk in a multiethnic U.S. sample of women who have sex with women. J Soc Serv Res 2018; 44: 614–623; doi: 10.1080/01488376.2018.1476293

132.

Jenkins

, Phillips

2nd , Rodriguez

et al. Behaviors associated with HIV transmission risk among rural sexual and gender minority and majority residents. AIDS Care 2023; 35: 1452–1464; doi: 10.1080/09540121.2023.2179592

133.

Juran

. Sexual behavior changes among heterosexual, lesbian and gay bar patrons as assessed by questionnaire over an 18-month period. J Psychol Hum Sex 1992; 4: 111–121; doi: 10.1300/J056v04n03_08

134.

134. Kerr

, Ding

and Thompson

. A comparison of lesbian, bisexual, and heterosexual female college undergraduate students on selected reproductive health screenings and sexual behaviors. Womens Health Issues 2013; 23: e347–e355; doi: 10.1016/j.whi.2013.09.003

135.

Koh

. Use of preventive health behaviors by lesbian, bisexual, and heterosexual women: Questionnaire survey. West J Med 2000; 172: 379–384; doi: 10.1136/ewjm.172.6.379

136.

Koh

, Gomez

, Shade

et al. Sexual risk factors among self-identified lesbians, bisexual women, and heterosexual women accessing primary care settings. Sex Transm Dis 2005; 32: 563–569; doi: 10.1097/01.olq.0000175417.17078.21

137.

Kral

, Lorvick

, Bluthenthal

et al. HIV risk profile of drug-using women who have sex with women in 19 United States cities. J Acquir Immune Defic Syndr Hum Retrovirol 1997; 16: 211–217; doi: 10.1097/00042560-199711010-00011

138.

Lagunas

, Caceres

, Silva

et al. Sexual and gender minority health in Chile: Findings from the 2016-2017 Health Survey. Rev Saude Publica 2022; 56: 96; doi: 10.11606/s1518-8787.2022056004086

139.

Lampon

III

., Lesbians and safer sex practices. Fem Psychol 1995; 5: 170–176; doi: 10.1177/0959353595052005

140.

140. Lee

and Hahm

. HIV risk, substance use, and suicidal behaviors among Asian American lesbian and bisexual women. AIDS Educ Prev 2012; 24: 549–563; doi: 10.1521/aeap.2012.24.6.549

141.

Lehavot

, Beaver

, Rhew

et al. Disparities in mental health and health risk behaviors for LGBT veteran subgroups in a national U.S. survey. LGBT Health 2022; 9: 543–554; doi: 10.1089/lgbt.2022.0039

142.

Lemp

, Jones

, Kellogg

et al. HIV seroprevalence and risk behaviors among lesbians and bisexual women in San Francisco and Berkeley, CA. Am J Public Health 1995; 85: 1549–1552; doi: 10.2105/ajph.85.11.1549

143.

Lindley

, Barnett

, Brandt

et al. STDs among sexually active female college students: Does sexual orientation make a difference? Perspect Sex Reprod Health 2008; 40: 212–217; doi: 10.1363/4021208

144.

Liu

, Fu

, Chen

et al. Discordance between perceived risk and actual risky sexual behaviors among undergraduate university students in mainland China: A cross-sectional study. BMC Public Health 2022; 22: 729; doi: 10.1186/s12889-022-13132-w

145.

145. Logan

and Leukefeld

. HIV risk behavior among bisexual and heterosexual drug users. J Psychoactive Drugs 2000; 32: 239–248; doi: 10.1080/02791072.2000.10400446

146.

Logie

, James

, Tharao

et al. HIV, gender, race, sexual orientation, and sex work: A qualitative study of intersectional stigma experienced by HIV-positive women in Ontario, Canada. PLoS Med 2011; 8: e1001124; doi: 10.1371/journal.pmed.1001124

147.

Logie

, James

, Tharao

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; doi: 10.7448/IAS.15.2.17392

148.

Logie

, Lacombe-Duncan

, Wang

et al. Sexual orientation differences in health and wellbeing among women living with HIV in Canada: Findings from a national cohort study. AIDS Behav 2018; 22: 1987–2001; doi: 10.1007/s10461-017-1781-y

149.

Logie

, Lacombe-Duncan

, Weaver

et al. A pilot study of a group-based HIV and STI prevention intervention for lesbian, bisexual, queer, and other women who have sex with women in Canada. AIDS Patient Care STDS 2015; 29: 321–328; doi: 10.1089/apc.2014.0355

150.

150. Logie

, Navia

and Loutfy

. Correlates of a lifetime history of sexually transmitted infections among women who have sex with women in Toronto, Canada: Results from a cross-sectional internet-based survey. Sex Transm Infect 2015; 91: 278–283; doi: 10.1136/sextrans-2014-051745

151.

Luvuno

, McHunu

, Ncama

et al. Evidence of interventions for improving healthcare access for lesbian, gay, bisexual and transgender people in South Africa: A scoping review. Afr J Prim Health Care Fam Med 2019; 11: e1–e10; doi: 10.4102/phcfm.v11i1.1367

152.

Lyons

, Kerr

, Duff

et al. Youth, violence and non-injection drug use: Nexus of vulnerabilities among lesbian and bisexual sex workers. AIDS Care 2014; 26: 1090–1094; doi: 10.1080/09540121.2013.869542

153.

Macaulay

, Kitzinger

, Green

et al. Unconventional conceptions and HIV. AIDS Care 1995; 7: 261–276; doi: 10.1080/713612974

154.

154. Mackesy-Amiti

, Boodram

, Handanagic

, NHBS Study Group. et al.; Latent classes of sexual risk behavior and engagement in outreach, intervention and prevention services among women who inject drugs across 20 US cities. J Acquir Immune Defic Syndr 2018; 79: 305–314; doi: 10.1097/QAI.0000000000001816

155.

155. Mackesy-Amiti

, McKirnan

and Ouellet

. Relationship characteristics associated with anal sex among female drug users. Sex Transm Dis 2010; 37: 346–351; doi: 10.1097/OLQ.0b013e3181c71d61

156.

156. Magura

, O’Day

and Rosenblum

. Women usually take care of their girlfriends: Bisexuality and HIV risk among female intravenous drug users. J Drug Issues 1992; 22: 179–190; doi: 10.1177/002204269202200112

157.

157. Marrazzo

, Koutsky

and Handsfield

. Characteristics of female sexually transmitted disease clinic clients who report same-sex behaviour. Int J STD AIDS 2001; 12: 41–46.

158.

Massad

, Xie

, Minkoff

et al. Abnormal pap tests and human papillomavirus infections among HIV-infected and uninfected women who have sex with women. J Low Genit Tract Dis 2014; 18: 50–56; doi: 10.1097/LGT.0b013e3182942733

159.

Matebeni

, Reddy

, Sandfort

et al. “I thought we are safe”: Southern African lesbians’ experiences of living with HIV. Cult Health Sex 2013; 15: 34–47; doi: 10.1080/13691058.2013.764016

160.

160. Mathieson

, Bailey

and Gurevich

. Health care services for lesbian and bisexual women: Some Canadian data. Health Care Women Int 2002; 23: 185–196; doi: 10.1080/073993302753429059

161.

McElrath

, Stana

, Taylor

et al. Race/sex interactions and HIV testing among college students. J Racial Ethn Health Disparities 2017; 4: 112–121; doi: 10.1007/s40615-016-0208-1

162.

Menza

, Lipira

, Bhattarai

et al. Prevalence and correlates of transactional sex among women of low socioeconomic status in Portland, OR. BMC Womens Health 2020; 20: 219; doi: 10.1186/s12905-020-01088-1

163.

163. Mojola

and Everett

. STD and HIV risk factors among U.S. young adults: Variations by gender, race, ethnicity and sexual orientation. Perspect Sex Reprod Health 2012; 44: 125–133; doi: 10.1363/4412512

164.

164. Molin

, De Blasio

and Olsen

. Is the risk for sexually transmissible infections (STI) lower among women with exclusively female sexual partners compared with women with male partners? A retrospective study based on attendees at a Norwegian STI clinic from 2004 to 2014. Sex Health 2016; 13: 257–264; doi: 10.1071/SH15193

165.

Monteiro

, Cecchetto

, Vargas

et al. Sexual diversity and vulnerability to AIDS: The role of sexual identity and gender in the perception of risk by young people (Rio de Janeiro, Brazil). Sex Res Soc Policy 2010; 7: 270–282; doi: 10.1007/s13178-010-0030-1

166.

166. Mor

and Davidovich

. Sexual orientation and behavior of adult Jews in Israel and the association with risk behavior. Arch Sex Behav 2016; 45: 1563–1571; doi: 10.1007/s10508-015-0631-0

167.

167. Mora

and Monteiro

. Vulnerability to STIs/HIV: Sociability and the life trajectories of young women who have sex with women in Rio de Janeiro. Cult Health Sex 2010; 12: 115–124; doi: 10.1080/13691050903180471

168.

168. Morrow

and Allsworth

. Original Research: Sexual risk in lesbians and bisexual women. J Gay Lesbian Med Assoc 2000; 4: 159–165; doi: 10.1023/A:1026507721501

169.

Mosack

, Weinhardt

, Kelly

et al. Influence of coping, social support, and depression on subjective health status among HIV-positive adults with different sexual identities. Behav Med 2009; 34: 133–144; doi: 10.3200/BMED.34.4.133-144

170.

170. Muller

and Hughes

. Making the invisible visible: A systematic review of sexual minority women’s health in Southern Africa. BMC Public Health 2016; 16: 307; doi: 10.1186/s12889-016-2980-6

171.

Muzny

, Austin

, Harbison

et al. Sexual partnership characteristics of African American women who have sex with women; impact on sexually transmitted infection risk. Sex Transm Dis 2014; 41: 611–617; doi: 10.1097/OLQ.0000000000000194

172.

Muzny

, Harbison

, Pembleton

et al. Misperceptions regarding protective barrier method use for safer sex among African-American women who have sex with women. Sex Health 2013; 10: 138–141; doi: 10.1071/SH12106

173.

Muzny

, Sunesara

, Martin

et al. Sexually transmitted infections and risk behaviors among African American women who have sex with women: Does sex with men make a difference? Sex Transm Dis 2011; 38: 1118–1125; doi: 10.1097/OLQ.0b013e31822e6179

174.

Nemoto

, Bodeker

, Iwamoto

et al. Practices of receptive and insertive anal sex among transgender women in relation to partner types, sociocultural factors, and background variables. AIDS Care 2014; 26: 434–440; doi: 10.1080/09540121.2013.841832

175.

Norman

, Perry

, Stevenson

et al. Lesbian and bisexual women in small cities–at risk for HIV? HIV prevention community collaborative. Public Health Rep 1996; 111: 347–352.

176.

Operario

, Gamarel

, Grin

et al. Sexual minority health disparities in adult men and women in the United States: National Health and Nutrition Examination Survey, 2001-2010. Am J Public Health 2015; 105: e27–e34; doi: 10.2105/AJPH.2015.302762

177.

Oshri

, Handley

, Sutton

et al. Developmental trajectories of substance use among sexual minority girls: Associations with sexual victimization and sexual health risk. J Adolesc Health 2014; 55: 100–106; doi: 10.1016/j.jadohealth.2013.11.009

178.

Outlaw

, Turner

, Marro

et al. Student characteristics and substance use as predictors of self-reported HIV testing: The Youth Risk Behavior Survey (YRBS) 2013-2015. AIDS Care 2022; 34: 708–716; doi: 10.1080/09540121.2021.1922576

179.

Owen

, Baggaley

, Maheu-Giroux

et al. Patterns and trajectories of anal intercourse practice over the life course among US women at risk of HIV. J Sex Med 2020; 17: 1629–1642; doi: 10.1016/j.jsxm.2020.06.007

180.

180. Parekh

, Gimm

and Kitsantas

. Sexually transmitted infections in women of reproductive age by disability type. Am J Prev Med 2023; 64: 393–404; doi: 10.1016/j.amepre.2022.10.013

181.

Parsons

, Starks

, Millar

et al. Patterns of substance use among HIV-positive adults over 50: Implications for treatment and medication adherence. Drug Alcohol Depend 2014; 139: 33–40; doi: 10.1016/j.drugalcdep.2014.02.704

182.

Paschen-Wolff

, Reddy

, Matebeni

et al. HIV and sexually transmitted infection knowledge among women who have sex with women in four Southern African countries. Cult Health Sex 2020; 22: 705–721; doi: 10.1080/13691058.2019.1629627

183.

183. Pathela

and Schillinger

. Sexual behaviors and sexual violence: Adolescents with opposite-, same-, or both-sex partners. Pediatrics 2010; 126: 879–886; doi: 10.1542/peds.2010-0396

184.

Perez

, Gamarel

, van den Berg

et al. Sexual and behavioral health disparities among African American sexual minority men and women. Ethn Health 2020; 25: 653–664; doi: 10.1080/13557858.2018.1444149

185.

185. Perkins

, Voisin

and Stennis

. Brief research report: Sociodemographic factors associated with HIV status among African American women in Washington, DC. Int J Womens Health 2013; 5: 587–591; doi: 10.2147/IJWH.S47162

186.

Perry

. Lesbian alcohol and marijuana use: Correlates of HIV risk behaviors and abusive relationships. J Psychoactive Drugs 1995; 27: 413–419; doi: 10.1080/02791072.1995.10471705

187.

Peteet

, Staton

, Miller-Roenigk

et al. Rural incarcerated women: HIV/HCV knowledge and correlates of risky behavior. Health Educ Behav 2018; 45: 977–986; doi: 10.1177/1090198118763879

188.

Phillips

2nd , McCuskey

, Felt

et al. Association of HIV education with HIV testing and sexual risk behaviors among US youth, 2009-2017: Disparities between sexual minority and sexual majority youth. Prev Sci 2020; 21: 898–907; doi: 10.1007/s11121-020-01153-z

189.

Phillips

2nd , Wang

, Ruprecht

et al. Associations between HIV testing and consent policies among sexually active adolescents: Differences by sexual behavior. AIDS Care 2022; 34: 862–868; doi: 10.1080/09540121.2021.1991878

190.

Pinto

, Tancredi

, Tancredi Neto

et al. Sexually transmitted disease/HIV risk behaviour among women who have sex with women. AIDS 2005; 19: S64–S69; doi: 10.1097/01.aids.0000191493.43865.2a

191.

191. Polihronakis

, Velez

and Watson

. Bisexual women’s sexual health: A test of objectification theory. Psychol Sex Orientat Gend Divers 2023; 10: 21–33; doi: 10.1037/sgd0000492

192.

192. Poon

MKL

and Ho

PTT

. A qualitative analysis of cultural and social vulnerabilities to HIV infection among gay, lesbian, and bisexual Asian youth. J Gay Lesbian Soc Serv 2002; 14: 43–78; doi: 10.1300/J041v14n03_03

193.

Poteat

, Logie

, Adams

et al. Sexual practices, identities and health among women who have sex with women in Lesotho—A mixed-methods study. Cult Health Sex 2014; 16: 120–135; doi: 10.1080/13691058.2013.841291

194.

Poteat

, Logie

, Adams

et al. Stigma, sexual health, and human rights among women who have sex with women in Lesotho. Reprod Health Matters 2015; 23: 107–116; doi: 10.1016/j.rhm.2015.11.020

195.

Prado

, Pratt

, Feaster

et al. Differences in adjustment in HIV+ African American heterosexual and homosexual women. J Gay Lesbian Med Assoc 2002; 6: 19–26; doi: 10.1023/A:1020336731655

196.

Pyra

, Weber

, Wilson

et al. Sexual minority status and violence among HIV infected and at-risk women. J Gen Intern Med 2014; 29: 1131–1138; doi: 10.1007/s11606-014-2832-y

197.

Pyra

, Weber

, Wilson

et al. Sexual minority women and depressive symptoms throughout adulthood. Am J Public Health 2014; 104: e83–e90; doi: 10.2105/AJPH.2014.302259

198.

198. Rahm-Knigge

, Norris

and Dunsiger

. The moderating effects of alcohol use on the association between sexual orientation and HIV testing: Results from the 2013-2018 National Health Interview Study. AIDS Care 2023; 35: 1299–1305; doi: 10.1080/09540121.2023.2206093

199.

Raiteri

, Fora

, Gioannini

et al. Seroprevalence, risk factors and attitude to HIV-1 in a representative sample of lesbians in Turin. Genitourin Med 1994; 70: 200–205; doi: 10.1136/sti.70.3.200

200.

Reisner

, Mimiaga

, Case

et al. Sexually transmitted disease (STD) diagnoses and mental health disparities among women who have sex with women screened at an urban community health center, Boston, MA, 2007. Sex Transm Dis 2010; 37: 5–12; doi: 10.1097/OLQ.0b013e3181b41314

201.

Richters

, Bergin

, Lubowitz

et al. Women in contact with Sydney’s gay and lesbian community: Sexual identity, practice and HIV risks. AIDS Care 2002; 14: 193–202; doi: 10.1080/09540120220104703

202.

Richters

, Lubowitz

, Bergin

et al. HIV risks among women in contact with Sydney’s gay and lesbian community. Venereology 1998; 11: 35–38.

203.

Richters

, Prestage

, Schneider

et al. Do women use dental dams? Safer sex practices of lesbians and other women who have sex with women. Sex Health 2010; 7: 165–169; doi: 10.1071/SH09072

204.

Robbins

, Fennell

, Gillison

et al. Prevalence of and risk factors for oral human papillomavirus infection among HIV-positive and HIV-negative people who inject drugs. PLoS One 2015; 10: e0143698; doi: 10.1371/journal.pone.0143698

205.

Rosario

, Meyer-Bahlburg

, Hunter

et al. Sexual risk behaviors of gay, lesbian, and bisexual youths in New York City: Prevalence and correlates. AIDS Educ Prev 1999; 11: 476–496; doi: 10.1521/aeap.1999.11.6.476

206.

Ross

, Gold

, Wodak

et al. Sexually transmissible diseases in injecting drug users. Genitourin Med 1991; 67: 32–36; doi: 10.1136/sti.67.1.32

207.

207. Ross

, Wodak

and Gold

. Sexual behaviour in injecting drug users. J Psychol Human Sex 1992; 5: 89–104; doi: 10.1300/J056v05n01_06

208.

Ross

, Wodak

, Gold

et al. Differences across sexual orientation on HIV risk behaviours in injecting drug users. AIDS Care 1992; 4: 139–148; doi: 10.1080/09540129208253085

209.

209. Rotheram-Borus

, Marelich

and Srinivasan

. HIV risk among homosexual, bisexual, and heterosexual male and female youths. Arch Sex Behav 1999; 28: 159–177; doi: 10.1023/A:1018719922709

210.

Rouhani

, White

, Park

et al. High willingness to use overdose prevention sites among female sex workers in Baltimore, MD. Drug Alcohol Depend 2020; 212: 108042; doi: 10.1016/j.drugalcdep.2020.108042

211.

Runkel

. Sexual behaviour and AIDS in the Federal Republic of Germany. Nord Sexol 1991; 9: 75–97.

212.

212. Ryan

and Bradford

. The national lesbian health care survey: An overview. In: Garnets

and Kimmel

. (eds.) Psychological Perspectives on Lesbian and Gay Male Experiences. New York, NY: Columbia University Press, 1993; pp. 541–556.

213.

Sandfort

, Baumann

, Matebeni

et al. Forced sexual experiences as risk factor for self-reported HIV infection among southern African lesbian and bisexual women. PLoS One 2013; 8: e53552; doi: 10.1371/journal.pone.0053552

214.

Saxton

PJW

, McAllister

, Thirkell

et al. Population rates of HIV, gonorrhoea and syphilis diagnoses by sexual orientation in New Zealand. Sex Transm Infect 2022; 98: 376–379; doi: 10.1136/sextrans-2021-055186

215.

215. Scheer

, Peterson

, Page-Shafer

, Young Women’s Survey Team. et al.; Sexual and drug use behavior among women who have sex with both women and men: Results of a population-based survey. Am J Public Health 2002; 92: 1110–1112; doi: 10.2105/ajph.92.7.1110

216.

Shotsky

. Women who have sex with other women: HIV seroprevalence in New York State counseling and testing programs. Women Health 1996; 24: 1–15; doi: 10.1300/J013v24n02_01

217.

Stemmler

, Hall

, Prokopik

et al. Time-site survey of substance use, sexual behaviours, and HIV-testing practices among women attending social venues in Prague. Cent Eur J Public Health 2015; 23: 135–141; doi: 10.21101/cejph.a3954

218.

Stevens

. HIV prevention education for lesbians and bisexual women: A cultural analysis of a community intervention. Soc Sci Med 1994; 39: 1565–1578; doi: 10.1016/0277-9536(94)90008-6

219.

219. Stevens

and Hall

. Participatory action research for sustaining individual and community change: A model of HIV prevention education. AIDS Educ Prev 1998; 10: 387–402; doi: 10.1521/aeap.1998.10.5.387

220.

220. Stevens

and Hall

. Sexuality and safer sex: The issues for lesbians and bisexual women. J Obstet Gynecol Neonatal Nurs 2001; 30: 439–447; doi: 10.1111/j.1552-6909.2001.tb01563.x

221.

221. Stevens

, Korchmaros

and Miller

. A comparison of victimization and perpetration of intimate partner violence among drug abusing heterosexual and lesbian women. J Fam Violence 2010; 25: 639–649; doi: 10.1007/s10896-010-9321-9

222.

222. Sweet

and Welles

. Associations of sexual identity or same-sex behaviors with history of childhood sexual abuse and HIV/STI risk in the United States. J Acquir Immune Defic Syndr 2012; 59: 400–408; doi: 10.1097/QAI.0b013e3182400e75

223.

Tabaac

, Benotsch

, Agenor

et al. Use of media sources in seeking and receiving sexual health information during adolescence among adults of diverse sexual orientations in a US cohort. Sex Educ 2021; 21: 723–731; doi: 10.1080/14681811.2021.1873122

224.

Teti

, Bowleg

, Rubinstein

et al. Present but not accounted for: Exploring the sexual risk practices and intervention needs of nonheterosexually identified women in a prevention program for women with HIV/AIDS. J LGBT Health Res 2007; 3: 37–51; doi: 10.1080/15574090802226592

225.

225. Thoma

, Huebner

and Rullo

. Unseen risks: HIV-related risk behaviors among ethnically diverse sexual minority adolescent females. AIDS Educ Prev 2013; 25: 535–541; doi: 10.1521/aeap.2013.25.6.535

226.

Timm

, Reed

, Miller

et al. Sexual debut of young Black women who have sex with women. Youth Soc 2013; 45: 167–183; doi: 10.1177/0044118x11409445

227.

Tolou-Shams

, Tarantino

, McKirnan

et al. Depressive symptoms, illicit drug use and HIV/STI risk among sexual minority young adults. J Gay Lesbian Ment Health 2013; 17: 96–102; doi: 10.1080/19359705.2013.740210

228.

228. Tordoff

, Minalga

, Perry

, Seattle Trans and Nonbinary Sexual Health (STARS) Advisory Board. et al.; Heterogeneity in HIV/sexually transmitted infection prevalence and prevention among the partners of transgender and nonbinary people. Sex Transm Dis 2023; 50: 280–287; doi: 10.1097/OLQ.0000000000001796

229.

Trinh

, Agenor

, Austin

et al. Health and healthcare disparities among U.S. women and men at the intersection of sexual orientation and race/ethnicity: A nationally representative cross-sectional study. BMC Public Health 2017; 17: 964; doi: 10.1186/s12889-017-4937-9

230.

Tsuyuki

, Chan

, Lucea

et al. Characterising a syndemic among Black women at risk for HIV: The role of sociostructural inequity and adverse childhood experiences. Sex Transm Infect 2023; 99: 7–13; doi: 10.1136/sextrans-2021-055224

231.

231. Walch

and Rudolph

. Negative affect and risk for human immunodeficiency virus: One size may not fit all. Am J Health Promot 2006; 20: 324–333; doi: 10.4278/0890-1171-20.5.324

232.

Walters

, Rivera

, Reilly

et al. Exchange sex among persons who inject drugs in the New York metropolitan area: The importance of local context, gender and sexual identity. AIDS Behav 2018; 22: 2773–2787; doi: 10.1007/s10461-018-2039-z

233.

Wang

, Norris

, Liu

et al. Health-related attitudes and risk factors for sexually transmitted infections of Chinese women who have sex with women. Chin Med J (Engl) 2012; 125: 2819–2825; doi: 10.3760/cma.j.issn.0366-6999.2012.16.004

234.

Whitlock

. ‘I never realised that sex between two women was not safe’: Narratives of lesbian safer sex. Cult Health Sex 2022; 24: 288–299; doi: 10.1080/13691058.2020.1855367

235.

Williams

, Dangerfield

2nd , Kral

et al. Correlates of sexual coercion among people who inject drugs (PWID) in Los Angeles and San Francisco, CA. J Urban Health 2019; 96: 469–476; doi: 10.1007/s11524-018-0238-6

236.

236. Woods

, Samples

, Melchiono

, Boston HAPPENS Program Collaborators. et al.; Initiation of services in the Boston HAPPENS Program: Human immunodeficiency virus-positive, homeless, and at-risk youth can access services. AIDS Patient Care STDS 2002; 16: 497–510; doi: 10.1089/10872910260351276

237.

Ybarra

, Rosario

, Saewyc

et al. Sexual behaviors and partner characteristics by sexual identity among adolescent girls. J Adolesc Health 2016; 58: 310–316; doi: 10.1016/j.jadohealth.2015.11.001

238.

238. Young

, Friedman

and Case

. Exploring an HIV paradox: An ethnography of sexual minority women injectors. J Lesbian Stud 2005; 9: 103–116; doi: 10.1300/J155v09n03_10

239.

Young

, Friedman

, Case

et al. Women injection drug users who have sex with women exhibit increased HIV infection and risk behaviors. J Drug Issues 2000; 30: 499–523; doi: 10.1177/002204260003000302

240.

Zaidi

, Ocholla

, Otieno

et al. Women who have sex with women in Kenya and their sexual and reproductive health. LGBT Health 2016; 3: 139–145; doi: 10.1089/lgbt.2014.0121

241.

Zhan

, Fu

, Wu

et al. Inequities in the utilization of HIV counseling and testing services among undergraduates in mainland China. BMC Public Health 2021; 21: 2216; doi: 10.1186/s12889-021-12252-z

242.

Zhang

, Shannon

, Tibashoboka

et al. Prevalence and correlates of having sexual and reproductive health priorities met by HIV providers among women living with HIV in a Canadian setting. Sex Reprod Healthc 2021; 30: 100666; doi: 10.1016/j.srhc.2021.100666

243.

Sulistina

, Martini

, Prasetyo

et al. A systematic review and meta-analysis of HIV transmission risk behaviors, genetic variations, and antiretroviral (ARV) resistance in LGBT populations. J Public Health Res 2024; 13: 22799036241239464; doi: 10.1177/22799036241239464

244.

Hughes

, Veldhuis

, Drabble

et al. Research on alcohol and other drug (AOD) use among sexual minority women: A global scoping review. PLoS One 2020; 15: e0229869; doi: 10.1371/journal.pone.0229869

245.

Stannah

, Soni

, Lam

JKS

et al. Trends in HIV testing, the treatment cascade, and HIV incidence among men who have sex with men in Africa: A systematic review and meta-analysis. Lancet HIV 2023; 10: e528–e542; doi: 10.1016/S2352-3018(23)00111-X

246.

Dong

, Peng

, Liu

et al. The prevalence of HIV among MSM in China: A large-scale systematic analysis. BMC Infect Dis 2019; 19: 1000; doi: 10.1186/s12879-019-4559-1

247.

247. Westergaard

, Spaulding

and Flanigan

. HIV among persons incarcerated in the USA: A review of evolving concepts in testing, treatment, and linkage to community care. Curr Opin Infect Dis 2013; 26: 10–16; doi: 10.1097/QCO.0b013e32835c1dd0

248.

Turan

, Budhwani

, Fazeli

et al. How does stigma affect people living with HIV? The mediating roles of internalized and anticipated HIV stigma in the effects of perceived community stigma on health and psychosocial outcomes. AIDS Behav 2017; 21: 283–291; doi: 10.1007/s10461-016-1451-5

249.

Chou

, Evans

, Hoverman

et al. Preexposure prophylaxis for the prevention of HIV infection: Evidence report and systematic review for the US preventive services task force. JAMA 2019; 321: 2214–2230; doi: 10.1001/jama.2019.2591

250.

Gandhi

, Bedimo

, Hoy

et al. Antiretroviral drugs for treatment and prevention of HIV infection in adults: 2022 recommendations of the International Antiviral Society-USA Panel. JAMA 2023; 329: 63–84; doi: 10.1001/jama.2022.22246

251.

251.UNAIDS. The path that ends AIDS: UNAIDS Global AIDS Update 2023. Joint United Nations Programme on HIV/AIDS: Geneva, Switzerland, https://www.unaids.org/sites/default/files/media_asset/2023-unaids-global-aids-update_en.pdf (2026, accessed 6

April

2026).

252.

252. Pillay

, Ntetmen

and Nel

. Queering global health: An urgent call for LGBT+ affirmative practices. Lancet Glob Health 2022; 10: e574–e578; doi: 10.1016/S2214-109X(22)00001-8

253.

Bol

, Sheffel

, Zia

et al. How to address the geographical bias in academic publishing. BMJ Glob Health 2023; 8: e013111; doi: 10.1136/bmjgh-2023-013111

254.

254.Executive Office of the President. Executive Order 14168: Defending women from gender ideology extremism and restoring biological truth to the federal government [90 Fed Reg 8615]. Office of the Federal Register: Washington, DC, https://www.federalregister.gov/documents/2025/01/30/2025-02090/defending-women-from-gender-ideology-extremism-and-restoring-biological-truth-to-the-federal (2026, accessed 6 April 2026).

255.

Dion

. Regulation of sexuality in the global south. Oxf Res Encycl Polit 2020; doi: 10.1093/acrefore/9780190228637.013.1183

256.

256. Fisher

and Mustanski

. Reducing health disparities and enhancing the responsible conduct of research involving LGBT youth. Hastings Cent Rep 2014; 44: S28–S31; doi: 10.1002/hast.367

257.

Yan

, Wang

et al. Refocus attention on HIV/AIDS: Due to neglect during the COVID-19 pandemic. Clin Microbiol Infect 2022; 28: 1522–1524; doi: 10.1016/j.cmi.2022.06.011

258.

258.Transitioning to endemicity with COVID-19 research. Lancet Infect Dis 2022; 22: 297; doi: 10.1016/S1473-3099(22)00070-6

259.

Adams

, Pearce

, Veale

et al. Guidance and ethical considerations for undertaking transgender health research and institutional review boards adjudicating this research. Transgend Health 2017; 2: 165–175; doi: 10.1089/trgh.2017.0012

260.

Moher

. CONSORT: An evolving tool to help improve the quality of reports of randomized controlled trials. Consolidated standards of reporting trials. JAMA 1998; 279: 1489–1491; doi: 10.1001/jama.279.18.1489

261.

261. von Elm

, Altman

, Egger

, STROBE Initiative. et al.; The strengthening the reporting of observational studies in epidemiology (STROBE) statement: Guidelines for reporting observational studies. Lancet 2007; 370: 1453–1457; doi: 10.1016/S0140-6736(07)61602-X

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