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E-mail: [ protected]. To estimate the prevalence of same-sex sexual behavior in women in the United States; to describe demographic and behavioral characteristics and the prevalence of herpes simplex virus type 2 HSV-2 infection. As part of the National Health and Nutrition Examination Surveys during —, women aged 18 to 59 years were interviewed about sexual behaviors using audio computer assisted self-interview. Persons aged 14 to 49 years were tested for antibodies to HSV Among sexually experienced women aged 18 to 59 years, 7. The prevalence of WSW-ever correlated negatively with age, highest 9.

Among WSW-ever, Among WSW-ever, demographic characteristics were similar but sexual behaviors were different by sexual orientation: In comparison, among women who reported no same-sex partners, the prevalence of HSV-2 was In this population-based sample of women, self-reported same-sex behaviors were increasingly more prevalent in younger women. A nationally representative survey found that same-sex behavior women who have sex with women was increasing in younger women, and that among WSW, HSV-2 seroprevalence was higher in those who reported their sexual orientation as heterosexual or bisexual.

Recent surveys suggest that the prevalence of same-sex sexual behavior in women may be increasing in the United States and some other developed countries. Survey participants are selected through complex, multistage probability sampling and are interviewed and undergo a medical examination, during which biologic samples are obtained.

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Because HSV-2 is an infection that is almost always sexually transmitted and is not curable, it can serve as a biologic marker for cumulative sexual risk. The purpose of this study is to determine the prevalence of same-sex behavior in women 18 to 59 years of age in the general population in the United States and to assess its trend over time. Participants were chosen according to a complex, stratified, multistage probability sampling de to select a nationally representative sample of the US civilian noninstitutionalized population and were interviewed and examined by medical professionals.

The questionnaire about sexual and drug use behaviors was administered in a private room using audio computer assisted self-interview in either English or Spanish. During NHANES —, about female participants of all ages were sampled for interview and examination during each 2-year period. Blood samples from survey participants were collected during health examinations at the mobile examination centers.

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Serum antibodies to HSV-2 were detected using a type-specific immunodot assay. Purified glycoprotein gG-2 of HSV-2 was used as the antigen in the immunodot assay. The immunodot assay is highly sensitive and specific and can discriminate HSV-2 infection from the closely related infection of herpes simplex virus type 1.

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Survey participants aged 18 to 59 years were interviewed about the of male and female partners in lifetime and in the past 12 months. Women who have had sex with a woman in the past year WSW-pastyear was defined as reporting 1 or more female partner in the past 12 months. For this article, the term WSW only applies to behavior have a female sex partner, ever or in the past yearwhereas sexual orientation refers to or be synonymous with self-identification.

All prevalence estimates were weighted to represent the noninstitutionalized civilian US population and to for oversampling and nonresponse to the interview and the examination.

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Medians are computed through an estimate of the cumulative distribution function based on ungrouped data. Whereas t -tests were used to compute the P -values to compare the central tendency, a logarithmic transformation was applied to positively skewed variables before performing a t -test. Among these, WSW-ever was reported by 7. From US Census Januarythe population counts of noninstitutionalized civilian women aged 18 to 59 years were Based on the prevalence of WSW-ever at 7.

The prevalence of WSW-pastyear was lower 2. The prevalence of WSW-ever was ificantly different by age, highest in women aged 18 to 29 years and lowest in those aged 50 to 59 years. The prevalence of WSW-ever was ificantly lower in women born outside of the United States, but did not differ by education level or poverty level.

Similarly, the prevalence of WSW-pastyear also differed ificantly by age and birthplace Table 1. To further examine the change in WSW prevalence with age, we analyzed the prevalence of WSW behavior by age, after excluding women who reported their birthplace was outside of the 50 US states or Washington, DC. This analysis removes the possible impact by immigrants on the trend of WSW behavior in the United States.

Among all women aged 18 to 59 years who had had sex, the overall prevalence of heterosexual or straight was The remaining 0.

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Because our survey data were collected over an interval of 6 years —a study participant born in the same year could end up in different age groups depending on the year of interview. To further demonstrate the trend over time, we analyzed sexual orientation in US-born women by birth cohort. The percent of women who reported their sexual orientation as homosexual or lesbian appeared unchanged, although some estimates may not be reliable because of small sample size Fig.

Among WSW-ever, more than half Among heterosexual WSW-ever, the mean age was There were no statistically ificant differences in age, race-ethnicity, education level, or poverty level by sexual orientation. However, birthplace and marital status differed ificantly by sexual orientation. More than half of heterosexual WSW-ever Overall, Among WSW-ever, only Nevertheless, when compared to non-WSW, both WSW-pastyear and WSW-ever were more likely to report having a larger of total partners lifetime and past year and having ever used cocaine Table 3. Among WSW-ever, the percent having first sex at 14 years of age or younger differed ificantly by sexual orientation: Among non-WSW, Among WSW-ever, this percentage was highest in bisexuals Bisexual WSW-ever reported the highest median of male partners and total partners Table 3.

The overall HSV-2 seroprevalence was The mean age of WSW-pastyear was We estimated that there are 5.

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Of WSW-ever, only Among all women aged 18 to 59 years who had had sex, the prevalence of homosexual and bisexual orientation was 1. The prevalence of WSW behavior is increasing among younger women. Our study suggests that WSW, together as a group, reported higher risk behaviors and had a higher burden of HSV-2 infection than non-WSW, but there were ificant differences among subsets of WSW; self-reported sexual orientation is an important predictor of risk behaviors and burden of STIs. In NSFG conducted in However, this difference should not be surprising because prior research shows that in women, the criteria or definitions of homosexual contact reflected by the different wording in the surveys can profoundly affect the reported prevalence in population-based surveys.

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Furthermore, in NSFG there was a clear trend for increasing prevalence of bisexual orientation with younger age, from 2. The observed increases in the proportions of women who report sex with other women ever or in the past year and in the prevalence of bisexual orientation in more recent birth cohorts of US women need further confirmation and exploration. The higher prevalence in younger women may be in part because of higher willingness to report as a result of lessened social stigma associated with disclosure of homosexual behavior.

Furthermore, studies in recent years have shown that sexual identity are more fluid in women, especially in young people, 23,24 making it difficult to interpret trend data. However, it is conceivable that the practice of same-sex behavior is increasing in women in the US in light of the changes in social norms and public attitude in the last 2 decades. The limitations of population-based surveys include the small of women who reported same-sex sexual contact because this condition is relatively rare and may be geographically concentrated in large cities. In addition, reporting bias resulting from differences in respondents' willingness to report socially censured behaviors such as WSW is a concern.

The use of audio computer assisted self-interview instead of face-to-face interview in the NHANES is likely to increase the willingness to report.

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Among WSW-ever, although demographic characteristics, including age, race-ethnicity, and education level, were comparable between the groups defined by self-reported sexual orientation, behavioral characteristics differed. Heterosexual and bisexual women had higher sexual risk and higher HSV-2 prevalence than homosexual women. Medical care providers and public health practitioners should consider sexual behavior and sexual orientation when assessing risks for some STIs and determining appropriate care and prevention services for these women.

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