Fuzzy Logic: vulnerability of women who have sex with women to sexually transmitted infections / Lógica Fuzzy: vulnerabilidad de las mujeres que tienen relaciones sexuales con mujeres a las infecciones de transmisión sexual / Lógica Fuzzy: vulnerabilidade de mulheres que fazem sexo com mulheres às infecções sexualmente transmissíveis

ABSTRACT Objective: To describe the possibility of applying Fuzzy Logic in analyzing the vulnerability of Women Who Have Sex with Women to Sexually Transmitted Infections/HIV/AIDS. Methods: We developed a Fuzzy Logic system with 17 input variables and one output variable, using data related to vulnerability in a municipality located in the Midwest region of the State of São Paulo, Brazil. Results: The factor with the greatest positive impact was the confirmation that a low understanding of Sexually Transmitted Infections/HIV/AIDS is associated with higher vulnerability. Conversely, the statement "Not disclosing sexual activity to healthcare professionals," where individuals do not admit to having sex with women, had the least impact. Conclusions: Fuzzy Logic facilitates the identification of vulnerability, expressed through the analysis of interaction between variables in each dimension. This makes it a promising method to assist in analyzing the vulnerability of specific populations.

RESUMEN Objetivo: Describir la posibilidad de aplicación de la Lógica Difusa en el análisis de la vulnerabilidad de las Mujeres que tienen Relaciones Sexuales con Mujeres a las Infecciones de Transmisión Sexual/VIH/sida. Métodos: Se desarrolló un sistema de Lógica Difusa con 17 variables de entrada y una de salida, utilizando datos relacionados con la vulnerabilidad en un municipio ubicado en el Centro-Oeste del Estado de São Paulo, Brasil. Resultados: El factor de mayor impacto positivo fue la confirmación de que la baja comprensión sobre las Infecciones de Transmisión Sexual/VIH/sida está asociada con una mayor vulnerabilidad. Por otro lado, la declaración "No exponerse ante el profesional de la salud", donde la persona no admite tener relaciones sexuales con mujeres, tuvo el menor impacto. Conclusiones: La Lógica Difusa permite la identificación de la vulnerabilidad, expresada por el análisis de interacción entre las variables de cada dimensión. Esto la convierte en un método prometedor para ayudar en el análisis de la vulnerabilidad de poblaciones específicas.

RESUMO Objetivo: descrever a possibilidade de aplicação da Lógica Fuzzy na análise da vulnerabilidade de Mulheres que fazem Sexo com Mulheres às Infecções Sexualmente Transmissíveis/HIV/aids. Métodos: Desenvolveu-se um sistema de Lógica Fuzzy com 17 variáveis de entrada e uma de saída, utilizando dados relacionados à vulnerabilidade em um município localizado no Centro-Oeste do Estado de São Paulo, Brasil. Resultados: O fator de maior impacto positivo foi a confirmação de que a baixa compreensão sobre Infecções Sexualmente Transmissíveis/HIV/aids está associada a uma maior vulnerabilidade. Por outro lado, a declaração "Não se expor para a profissional de saúde", onde a pessoa não admite ter relações sexuais com mulheres, teve o menor impacto. Conclusões: A Lógica Fuzzy oportuniza a identificação da vulnerabilidade, expressa pela análise de interação entre as variáveis de cada dimensão. Isso a torna um método promissor para auxiliar na análise da vulnerabilidade de populações específicas.

Gynecological Care Among Brazilian Women Who Have Sex with Women: A Respondent-Driven Sampling Study.

Purpose: This study aimed to describe the gynecological care provided to Brazilian women who have sex with women (WSW). Methods: Respondent-driven sampling was used to recruit Brazilian WSW. The survey questions, concerning gynecological care, were designed in Portuguese by medical professionals, medical students, and LGBTQIA+ community members, including the authors. The statistical analyses were weighted to account for the likelihood of recruitment. Results: From January to August of 2018, 299 participants were recruited in 14 recruitment waves. The mean age of the WSW was 25.3 years. Most (54.9%) identified as lesbian and had been involved in past-year sexual intercourse mainly with cisgender women (86.1%). The WSW also reported having sex with cisgender men (22.2%), transgender men (5.3%), nonbinary people (2.3%), and transgender women (5.3%) in the last year. More than a quarter of the WSW did not have regular appointments with a gynecologist: 8.0% (95% confidence interval [CI] = 4.2-11.6) and 19% (95% CI = 12.8-25.2) stated that they had never gone to the gynecologist or they had only gone for emergencies, respectively. Almost one-third had never had cervical cancer screening (cervical cytology, Pap test or Pap smear). Most women justified avoiding the test because they felt healthy, thought it would hurt, or feared a health professional might mistreat them. Conclusion: Gynecologists should avoid heteronormative assumptions, inquire about sexual practices, orientation, and identity separately, and provide Pap tests as advised to WSW.

Mulheres que fazem sexo com mulheres na juventude e a prevenção de infecções sexualmente transmissíveis: um estudo de representações sociais / Women who have sex with women in youth: the prevention of sexually transmitted infections: a study of social representations

Este estudo teve o objetivo de analisar as representações sociais de mulheres que fazem sexo com mulheres (MSM) sobre as infecções sexualmente transmissíveis (IST) e as práticas de prevenção, e tem como um dos objetivos específicos, discutir as relações estabelecidas entre as representações sociais de MSM sobre as IST e as práticas de prevenção. Trata-se de um estudo descritivo, qualitativo, com abordagem qualitativa, ancorado na abordagem estrutural da Teoria das Representações Sociais. Participaram 100 jovens mulheres homossexuais, moradoras do município do Rio de Janeiro, na faixa etária entre 18 e 29 anos. Foram aplicados dois instrumentos de coleta de dados, um questionário para caracterização sociodemográfica, das práticas sexuais e de prevenção de IST; e um formulário para captação das evocações livres, com os termos indutores DST e Prevenção de DST. Os dados sociodemográficos foram organizados no software Excel. A análise das evocações foi feita através do software EVOC com a construção do quadro de quatro casas. Para o termo indutor DST, os possíveis núcleos centrais foram os cognemas sexo, doenças, prevenção e sífilis. A palavra sexo teve a maior frequência e foi a mais prontamente evocada no núcleo central, demonstrando a relevância da palavra para o grupo investigado, no entanto, as palavras relacionadas a ela se concentraram na zona de contraste e segunda periferia. Na análise de similitude, esse elemento estabeleceu conexões com todos os elementos da árvore, e teve o maior número de ligações (cinco). O termo indutor Prevenção de DST teve somente o cognema preservativos no provável núcleo central e sete nas periferias, onde mencionaram cuidado, relacionamento-afetivo, tratamento, entre outros relacionados ao autocuidado, sugerindo um imaginário alinhado com a temática. Já na análise de similitude pode-se notar que o termo preservativos é central e apresenta sete ligações com os demais termos presentes no quadro, tendo maior índice as ligações com os termos cuidado, exames, relacionamento-afetivo e informação. Conclui-se que, apesar de as jovens demonstrarem conhecimento acerca da temática, informaram o desuso do preservativo nas relações sexuais com parcerias fixas e casuais, corroborando com outras investigações. Ademais, apesar de reconhecerem a maioria das IST, o termo HPV que é uma infecção recorrente nesse grupo, foi mais tardiamente evocado pelas participantes. Desse modo, é notória a importância da disseminação de informação acerca da prevenção das IST nesse grupo, como também para os profissionais de saúde, que, em geral, possuem um comportamento heteronormativo nos atendimentos às mulheres lésbicas, subestimando o potencial de contaminação que pode existir nas relações homossexuais entre mulheres.

This study aimed to analyze the social representations of women who have sex with women (WSW) about sexually transmitted infections (STIs) and prevention practices, and has as one of the specific objectives, to discuss the relationships established between the social representations of WSW about STIs and prevention practices. This is a descriptive, qualitative study with a qualitative approach, anchored in the structural approach of the Theory of Social Representations. 100 young people participated, all homossexual women, living in the city of Rio de Janeiro, aged between 18 and 29 years. Two data collection instruments were applied, a questionnaire for sociodemographic characterization, sexual practices and STI prevention; and a form to capture the free evocations, with the terms STD inducers and STD Prevention. The sociodemographic data were organized in Excel software. The analysis of the evocations was made through the EVOC software with the construction of the frame of four houses. For the term STD inducer, the possible central nuclei were the cognames sex, diseases, prevention and syphilis. The word sex had the highest frequency and was the most readily evoked in the nucleus central, demonstrating the relevance of the word for the investigated group, however, the words related to it focused on the contrast zone and second periphery. In similitude analysis, this element established connections with all the elements of the tree, and had the highest number of calls (five). The inducing term STD Prevention had only the cognama condoms in the probable central nucleus and seven in the peripheries, where they mentioned care, affective relationship, treatment, among others related to self-care, suggesting an imaginary aligned with the theme. As for the analysis of similarity, it can be noted that the term condoms is central and has seven links with the other terms presente in the table, with a higher index of links with the terms care, examinations, relationship-affective and information. It is concluded that, although the young women demonstrate knowledge. On the subject, they reported the disuse of condoms in sexual relations with partners fixed and casual, corroborating with other investigations. Moreover, although they recognize the most STIs, the term HPV which is a recurrent infection in this group, were more belatedly evoked by the participants. Thus, the importance of dissemination of information about the prevention of STIs in this group, as well as for the health professionals, who, in general, have a heteronormative behavior in the care for lesbian women, underestimating the potential for contamination that can exist in homosexual relations between women.

HIV epidemic among Brazilian women who have sex with women: An ecological study.

The influences of public policies fighting HIV among women who have sex with women is scarcely studied. This study aimed to analyse the time series of human immunodeficiency virus (HIV) epidemic, between 2007 and 2020, among Brazilian women who have sex with women, in order to evaluate the effect of Brazilian policies for fighting HIV in this subpopulation compared to women who have sex with men (WSM). This ecological study employed HIV and acquired immunodeficiency syndrome (AIDS) new cases among women who have sex strictly with women (WSW), women who have sex with men and women (WSMW), and WSM reported to the Sistema de Informação de Agravos de Notificação from 2007 to 2020. Crude Brazilian and regional annual age-adjusted HIV/AIDS population-level incidence rates were calculated for WSW, WSMW and WSM. The rates were then analyzed using the Joinpoint regression model. A total of 102,890, 757, and 1,699 notifications of WSW, WSMW, and WSM living with HIV/AIDS were reported during the study period, respectively. South Brazilian region had the greatest HIV/AIDS incidence rates among WSM and bisexual women while the North region had the greatest incidence among WSW. In the WSM population, the temporal trends showed at least one stable or an increasing trend period from 2007 to 2013 or 2014, followed by one decreasing trend in all Brazilian regions. While among the WSMW most of the regions had a stable trend period from 2007 to 2020, in WSW group most of the trends had only one decreasing period. The decreasing trends were faster in WSM than in WSW. These results suggest a low efficiency of Brazilian policies for fighting HIV among WSW and WSMW and show the necessity of implementing new policies specific to this population.

[Literature review on studies of women who have sex with women]. / Revisión narrativa sobre estudios de mujeres que tienen sexo con mujeres.

Women who have sex with other women are a group that has been mostly invisible from public health policies. This category includes the group of lesbians, bisexual women, heterosexual behaviour, and homosexual practices, who have sexual relations with transsexual and transgender (trans) women and trans men who have sex with women. In the absence of a Spanish literature review of a study that addresses women who have sex with other women, a narrative bibliographic review was done using the PubMed/MEDLINE, Scopus, Dialnet, and Taylor and Francis databases. From a universe of 679 articles and after applying the inclusion criteria, 40 documents were analysed, from 1998 to 2019. Three meta-categories were identified (sexual education, the incidence of certain sexually transmitted infections, and aspects related to sexual practices), concerning prevention and risky behaviours. Women who have sex with other women are a particularly vulnerable group when it comes to sexually transmitted infections. These may include bacterial vaginitis, human papillomavirus and acquired immunodeficiency virus. Likewise, there is a lack of specific training and information in health and education professionals, as well as in women who have sex with other women.

Las mujeres que tienen sexo con otras mujeres son un colectivo invisibilizado en gran parte de las políticas públicas de salud. Comprende el conjunto de mujeres lesbianas, bisexuales, con conductas heterosexuales y con prácticas homosexuales, que tienen relaciones sexuales con mujeres transexuales y/o transgénero (trans) y hombres trans que tienen sexo con mujeres. Al no identificar una revisión bibliográfica en español sobre estudios que aborden las mujeres que tienen sexo con otras mujeres, se plantea una revisión narrativa haciendo uso de las bases de datos MEDLINE/PubMed, Scopus, Dialnet y Taylor and Francis; a partir de un universo de 679 artículos. Tras aplicar los criterios de inclusión, se analizaron 40 documentos insertos en un intervalo comprendido entre 1998 y2019. A través de los cuales se identificaron tres metacategorías refrentes a cuestiones relacionadas con la educación sexual, la incidencia de determinadas infecciones de transmisión sexual y aspectos relacionados con prácticas sexuales, tanto preventivas como de riesgo. Los resultados obtenidos ponen de manifiesto que las mujeres que tienen sexo con otras mujeres son un grupo especialmente vulnerable en lo que se refiere a infecciones de transmisión sexual y, especialmente, en la vaginosis bacteriana, el virus del papiloma humano y el virus de inmunodeficiencia adquirida. Asimismo, se constata la falta de formación e información específica en los profesionales del ámbito sanitario y educativo, así como en las mujeres que tienen sexo con otras mujeres, lo cual se reproduce tanto en el imaginario como en las prácticas sexuales que llevan a cabo.

Disclosure of Sexual Orientation Among Women Who Have Sex With Women During Gynecological Care: A Qualitative Study In Brazil.

BACKGROUND: Evidence shows that women who have sex with women (WSW) face disparities in access to health care when compared to heterosexual women in several countries. AIM: To investigate the experiences WSW have after disclosure of sexual orientation during gynecological care in Brazil. METHODS: We performed a qualitative study using content analysis. We recorded and transcribed interviews with 34 WSW from the 5 regions in Brazil. Data were analyzed using descriptive content analysis. OUTCOMES: The main categories of analysis were decision-making process to disclose and attitude of gynecologists after disclosure. RESULTS: WSW disclosed their sexual orientation in an un-favorable environment. Gynecologists rarely asked about patients' sexual orientation and used a script for hetero-normative anamnesis. The reactions of gynecologists were discriminatory, resulting in abbreviated consultations and un-comfortable gynecological exams. They missed a window of opportunity for prevention, diagnosis, and treatment of various diseases. The experiences Brazilian WSW had during gynecological care demonstrated the dominant hetero-normativity in the health care scenario. The attitudes of the gynecologists precarized the existence of WSW in health service. CLINICAL IMPLICATIONS: This study suggests that gynecologists missed an opportunity to use WSW's sexual orientation disclosure to offer specific care to them. STRENGTHS & LIMITATIONS: This is the first qualitative study about WSW's experiences during gynecological care in Brazil. Future studies should be developed from a wider sampling, especially among lower-class WSW. CONCLUSION: The results point out the need for a change in medical training and guidelines to assist WSW in the country. Rufino AC, Madeiro A, Trinidad AS, et al. Disclosure of Sexual Orientation Among Women Who Have Sex With Women During Gynecological Care: A Qualitative Study In Brazil. J Sex Med 2018;15:966-973.

Same-Sex Behavior and its Relationship with Sexual and Health-Related Practices Among a Population-Based Sample of Women in Puerto Rico: Implications for Cancer Prevention and Control.

This secondary data analysis aimed to estimate the prevalence of same-sex behavior and sexual and health-related practices of a population-based sample (n=560) of women aged 16-64 years in Puerto Rico (PR). Data collection included interviews and biologic samples. Seven percent of the sample had had sex with other women (WSW). Age-adjusted logistic regression models indicated that WSW had higher odds of history of cancer, having ≥ 7 lifetime sexual partners, using sex toys and sharing them, and use of tobacco and illicit drugs. Future research is needed to address the health needs of WSW, including cancer-related risk factors and sexual practices.