Gender-Specific Sexual Minority Disparities in Sexually Transmitted Illness, Substance Use, and Mental Health Outcomes among Adults in the United States

background:  In the United States, sexual minorities are disproportionately affected by disparities in HIV, other STIs, substance use and mental health problems. Current literature focusing on sexual minority health disparities has examined differences between heterosexual and non-heterosexuals. This research investigates gender differences among sexual minorities in the US.

methods: We analyzed nationally representative data from adults ages 20 to 49 who participated in the 2001 to 2010 waves of the National Health and Nutrition Examination Survey (NHANES) (N = 5,287). We estimated the weighted prevalence of HIV, herpes simplex virus type-2 (HSV-2), human papillomavirus, chlamydia, hepatitis-B and hepatitis-C, as well as mental health, alcohol, smoking, and illicit drug use. All models were adjusted for key sociodemographic variables.

results: After adjustment for sociodemographic characteristics, sexual minority men had higher prevalence of biologically confirmed HIV and HSV-2 and self-reported lifetime diagnoses of gonorrhea and chlamydia compared to heterosexual men. Sexual minority women were more likely to test positive for Hepatitis C, report more drinks per day, lifetime heavy use of alcohol, use of marijuana, lifetime cocaine/heroin/methamphetamine use, and injection drug use compared to heterosexual women. Both sexual minority men and women were more likely to report greater mental health problems compared to their heterosexual counterparts.

conclusions: Findings provide further confirmation of the increased risk of adverse health outcomes faced by sexual minorities in the United States.  Many health risks faced by sexual minorities are specific to gender. Our results demonstrate the need to develop gender-appropriate public health interventions for sexual minorities.