“La Solución es la Tijera” (The Solution is Scissors): Sexual Health Programme Oriented to Lesbian and Bisexual Women

Palma, Diana Marcela; Orcasita, Linda Teresa

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Brasil

Psicologia: Teoria e Pesquisa

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Clinical Psychology and Culture • Psic.: Teor. e Pesq. 34 • 2018 • https://doi.org/10.1590/0102.3772e34419 copy

“La Solución es la Tijera” (The Solution is Scissors): Sexual Health Programme Oriented to Lesbian and Bisexual Women

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

The inclusion of lesbian and bisexual women on health promotion agenda is scarce. However, the existing risks in their sexual practices have been scientifically recognized. This article presents the main results of the program “La Solución es la Tijera” oriented to lesbian and bisexual women from Cali, Colombia. Twenty-three women between 18 and 25 years old ((X= 21.7; DS=1.78) participated in this study. The program evaluation was conducted with a pre-post design, using mixed methodologies. Significant changes in the knowledge level and attitudes towards HIV were found. Likewise, a strengthening in their identity and an empowerment in their sexuality and knowledge about sexual and reproductive rights was reported by the participants.

Keywords
sexual health; lesbian and bisexual women; psychosocial intervention; sexuality; STIs; HIV

	Name of Session	Topics addressed
Module 1 Sexuality is not just about sex	1. At the starting line	Concepts, dimensions and functions of sexuality
	2. This is me - I like this!	Social stereotypes about bodies, love and intimacy of LB women. Self image, self concept and self-esteem. The body, erotica and pleasure dimension.
	3. When I decide to speak up	Social support and community resources, coping strategies for revealing your sexual orientation, strategies for disclosure in the context of health, mechanisms for demanding your right to health.
Module 2 In my sexual practices, I’M the one who chooses	4. What HIV has to do with me	Perception of risk. Knowledge about HIV and other STIs. Knowledge of risky sexual practices and ways of prevention. HIV testing and organisations, centres, places of sexual health care.
	5. To love ME is to take care of US	Contraceptive methods. Communication styles. Communication in couples and negotiation of sexual practices.
	6. From the closet to full recognition of my sexual and reproductive rights.	Citizen rights and sexual and reproductive rights. Legislative advances for the LGBT population in Colombia. Ways of demanding and protecting citizens' rights.

Phase	Description
1. Literature review.	Search for research on health and national and international public policies of intervention and action with the population
Interviews with experts.	Interviews with health service providers from disciplines such as psychology, medicine, gynaecology and public health to identify their recommendations and perceived needs for the development of the programme. Interviews with women of the LB community about their sexual health intervention needs.
2. Initial proposal design	Review of intervention guides developed by national and international organisations Reconstruction of the modules and thematic areas from a previous pilot exercise and interviews with different agents.
3. Announcement	Design of the programme image, adjusted to the language of the population and for dissemination
4. Baseline	Signing of informed consent form and application of a questionnaire
5. Programme Implementation	Review and adjustment of the thematic areas of the programme in light of the needs found in the questionnaire and in the initial focus group. Monitoring and follow-up of each session through group evaluation and log-taking. Support of professionals from other areas such as medicine, nursing and law.
6. Final evaluation of the process	Application of the instrument Evaluation of significant learning and aspects to improve in future implementation.

Sexual practices				Use of preventative measures
Use of sex toys	10 (45.5%)			Women	Men
Exchange of sex toys without washing	6 (46.2%)		Condom	18.2%	30.8%
Experience of sexual abuse	7 (31.8%)		Latex barrier	4.8%	0.0%
Sexual relations under the effect of alcohol	19 (86.4%)		Latex gloves	4.8%	0.0%
Sexual relations under the effect of psychoactive substances	15 (68.2%)
	vaginal	anal	Reasons for non-use	Pre (%)	Post (%)
Given oral sex WITHOUT protection	21(95.5%)	3 (13.6%)	I am in a long-standing, stable relationship with only one person	50.0%	57.9%
Given oral sex WITH protection	1 (4.5%)	1 (4.5%)	I don’t think HIV is something that will affect me	13.6%	0.0%
Received oral sex WITHOUT protection	21 (95.5%)	5 (22.7%)	I don’t think I can contract any sexually transmitted infection	9.1%	0.0%
Received oral sex WITH protection	1 (4.5%)	0%	I don’t have any preventative methods to hand when the opportunity for sexual relations presents itself	54.5%	42.1%
Use of receptive sex toy WITHOUT a condom	4 (18.2%)	0%	There are no preventative methods designed for homosexual women*	36.4%	0.0%
Use of receptive sex toy WITH a condom	4 (18.2%)	3 (13.6%)	I don’t know where to buy preventative methods**	52.4%	5.3%
Use of penetrative sex toy WITHOUT a condom	1 (4.3%)	0%	Gay women do not need to care for ourselves in terms of HIV.	9.1%	0.0%
Use of penetrative sex toy WITH a condom	4 (18.2%)	1 (4.5%)	I don’t know how to use protective methods properly***	54.5%	0.0%
Receptive digital penetration WITHOUT a condom	23 (100%)	3 (13.6%)	I don’t think either I or my partner are at risk in terms of HIV	13.6%	0.0%
Receptive digital penetration WITH a condom	3 (13.6%)	2 (9.5%)	I think using barrier methods reduce pleasure	13.6%	0.0%
Insertive digital penetration WITHOUT a condom	22 (100%)	0%	I feel that even if I ask my partner to practice safe sex, she/he won’t do it*	0.0%	26.3%
Insertive digital penetration WITH a condom	2 (9.1%)	0%	I can’t afford to buy condoms or other protective methods	13.6%	10.5%
Penile penetration WITHOUT a condom	7 (31.8%)	1 (4.5%)
Penile penetration WITH a condom	11 (50%)	2 (9.5%)

	pre-test (%)			post-test (%)
Item	F	T	DK	F	T	DK
You can tell if a person has HIV just by looking at them	82.6	4.4	13.0	100	0.0	0.0
Anal sexual relations are high risk for transmitting HIV	8.7	69.6	21.7	0.0	95.7	4.3
Oral sex does not represent a risk for transmitting HIV * (P=0.022)	65.2	8.7	26.1	95.7	4.3	0.0
A person can be exposed to HIV from just one sexual encounter	0.0	91.3	8.7	0.0	100	0.0
You can avoid getting HIV by practicing sport regularly	78.3	0.0	21.7	91.3	0.0	8.7
When you have sexual relations with the same partner during a long-term relationship, it is not necessary to keep using a condom	82.6	8.7	8.7	91.3	8.7	0.0
Taking a bath after sex reduces the possibility of getting HIV* (P= 0.016)	69.6	4.3	26.1	100.0	0.0	0.0
When engaging in oral sex, not ingesting your partner’s bodily fluids helps to prevent HIV* (p= 0.002)	39.1	17.4	43.5	69.6	30.4	00
People who contract HIV show symptoms immediately or soon after* (P=0.034)	56.5	8.7	34.8	82.6	13.0	4.3
Reducing the number of sexual partners prevents HIV	47.8	34.8	17.4	65.3	30.4	4.3
HIV is not transmitted between homosexual women	91.3	0.0	8.7	100	0.0	0.0
In the world, cases of homosexual women with HIV have been found* (P=0.001)	0.0	43.5	56.5	4.3	91.4	4.3
A homosexual women can only get HIV by having sexual relations with a man	78.3	4.3	17.4	100	0.0	0.0
Sharing a toothbrush can facilitate the transmission of HIV* (P=0.000)	47.8	4.4	47.8	13.0	87.0	0.0
Pre-ejaculatory fluids can contain HIV* (P=0.000)	0.0	34.8	65.2	0.0	100	0.0
Injectable drug users are at risk of HIV when sharing needles	0.0	95.7	4.3	0.0	100	0.0
Vaginal sexual relations are high risk for the transmission of HIV*(P=0.001)	13.0	43.5	43.5	13.0	87.0	0.0
Only homosexual men are at risk of getting HIV	95.7	4.3	0.0	100	0.0	0.0
Women who exclusively practice homosexual relations are not at risk of getting HIV	91.3	0.0	8.7	87.0	4.3	8.7
Sharing kitchen or bathroom utensils with a person who is living with HIV represents a risk of getting HIV	56.5	17.4	26.1	56.5	39.2	4.3
HIV can be transmitted by a mosquito bite* (P=0.004)	60.9	4.3	34.8	100	0.0	0.0
A negative result on an HIV test can occur even when a person has the virus* (P=0.004)	0.0	47.8	52.2	8.7	82.6	8.7
The HIV virus can be transmitted from a sneeze* (P=0.002)	65.2	0.0	34.8	100	0.0	0.0
Donating blood does not represent a risk of HIV to the donor	39.2	30.4	30.4	43.5	43.5	13
Mutual masturbation does not lead to increased risk unless the person has wounds or scratches* (P=0.004)	8.7	52.2	39.1	22.7	77.3	0.0
People who got HIV through injecting drugs can transmit it through sexual relations* (P=0.054)	0.0	82.6	17.4	0.0	100	0.0
Only men transmit HIV	87.0	0.0	13.0	95.7	4.3	0.0
Currently there is no cure for HIV (P=0.001)	13.0	43.5	43.5	8.7	91.3	0.0
Exchanging sex toys increases the possibility of getting HIV* (P= 0.001)	21.7	43.5	34.8	95.7	4.3	0.0
The HIV virus can be transmitted through breast milk* (P=0.00)	13.0	30.4	56.6	4.3	95.7	0.0
level Of Knowledge	Pre			Post
Low	0%			0%
Medium	21.7%			0%
High	78.3%			100%

	Pre-			Post-
Item	D	A	DK	D	A	DK
I would reject sitting near someone who has HIV	82.6	8.7	8.7	82.6	4.3	13.0
I’m not the type of person who could get HIV (P=0.008)	52.2	4.3	43.5	87.0	8.7	4.3
People with HIV should be isolated to guarantee the safety of others	95.7	0.0	4.3	100	0.0	0.0
I would feel comfortable sharing a bathroom with someone who has HIV	26.1	43.5	30.4	34.8	39.1	26.1
I think I could get HIV	8.7	65.2	26.1	13.0	73.9	13.0
I am able to tell my partner if I have had sex with a bisexual person	13.0	82.6	4.3	8.7	91.3	0.0
Stopping during the sexual act to put on a condom makes the sex less enjoyable	60.9	17.4	21.7	69.6	13.0	17.4
I think it is really important to use condoms every time you have sex	4.3	82.6	13.0	0.0	91.3	8.7
I insist that my sexual partner uses a condom	52.2	30.4	17.4	30.4	60.9	8.7
I am able to tell my partner that I have had sex with men	8.7	82.6	8.7	100	0.0	0.0
I think only homosexual men need to worry about HIV	87.0	8.7	4.3	100	0.0	0.0
I think homosexual women should get laboratory tests done to identify an STI	91.3	0.0	8.7	100	0.0	0.0
I think that preventative methods adapted for our sexual practices do not exist for homosexual women (p=0.002)	8.7	65.2	26.1	47.8	52.2	0.0
Healthcare workers generally treat people with HIV well	13.0	0.0	87.0	30.4	4.3	65.2
TYPES OF ATTITUDES*	Pre-			Post-
Negative	0.0			0.0
Neutral	65.2			39.1
Positive	34.8			60.9

Familial behaviour	Low		Moderate		High
Level	2(8.7%)		9 (39.1)		12(52.2%)
Who do you most often approach for help?	Family (34.8%)		Friends (60.9%)		Others (4.3%)
Sexual orientation disclosure Person (%)	Perceived support
Person (%)	Good	Regular		Bad	Indifferent
Mother (69.6%)	10 (62.4%)	3(18.8%)		3(18.8%)	0
Father (39.1% )	4 (44.5%)	3(33.3%)		1(11.1%)	1(11.1%)
Friends (100%)	20(87.0%)	2 (8.7%)		0	1 (4.3%)
Extended family (34.8%)	5 (62.5%)	1(12.5%)		1(12.5)	1(12.5%)
Others (34.8)	9 (100%)	0		0	0

Place	% pre	% post	Place	% pre	% post
Family	10 (43.5%)	10 (43.5%)	Shopping Centre	6 (26.1%)	7 (30.4%)
Friends	0	2 (8.7%)	Public Transport	5 (21.7%)	8 (34.8%)
School	7 (30.4%)	5 (21.7%)	Health Centre *	0	10 (43.5%)
University	5(21.7%)	7(30.4%)	Public Spaces	11 (47.8%)	16 (69.6%)

Instituto de Psicologia, Universidade de Brasília Instituto de Psicologia, Universidade de Brasília, 70910-900 - Brasília - DF - Brazil, Tel./Fax: (061) 274-6455 - Brasília - DF - Brazil
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