女同志性健康-安全性行為之初探

Abstract

目的：從民國73年發現第一位愛滋病患以來，同志的安全性行為從疾病為出發點只關注男同志，而沒有女同志。並且國內婦女健康政策也沒有包含女同志，其健康議題長期受到忽視。本研究希望瞭解女同志對安全性行為的觀點，並進一步探究如何影響她們採取安全行為，最後希望瞭解女同志對性健康的需求，讓衛生當局能夠重視並在日後給予適當的協助。 方法：自2008年12月至2009年5月，以18歲以上女同志為研究對象以半結構式的訪談大綱進行深入訪談，總共訪談10位；並以非正式訪問以及參與觀察的方式來增加資料完整性。 結果：雖然女同志有性傳染病的風險，但在本次的研究結果顯示在（一）安全性行為觀點和態度方面：（1）對性行為的界定不同，（2）性資訊來源曖昧不明，主要透過網路資訊並需將異性戀的資料轉化，（3）認為安全性行為男女有別，對女女安全性行為的想法來源主要來自人際網絡、自身經驗的轉化以及傳播媒體的訊息；（二）安全性行為的實際行動方面：（1）性關係對象除了固定伴侶，也會透過網路徵姦、酒吧及朋友關係發展非伴侶關係，（2）安全行為以剪指甲和清潔身體為主要方式，保險套、指套、口交膜等防護用品較少或甚沒有使用，除了認為不需要外，不認識防護用品且取得不易也是另一項主因，（3）性關係呈現較平等的權力關係；（三）性健康需求方面：（1）女同志性行為的資訊不足且不合用，因此期望有更多訊息，（2）防護用品取得不易，希望增加可及性，（3）友善具性別敏感的醫療環境。 結論：異性戀預設模式下，女同志安全性行為資訊來源分散、不適用，女同志使用的防護用品取得不易，有潛在的性傳染病風險。應建立女同志健康統計資料、衛生政策應包含多元性別、增加資源可及性並針對醫護人員做性別（同志）再教育。

Objective: Since 1980s the first AIDS patient was discovered, attention was only paid to the safe sex behavior of gays, but not lesbians from the viewpoint of disease prevention. Moreover, the health of lesbians was not considered in the health policy of women in Taiwan. The health issue of lesbians has been neglected for a long time. This study examines the lesbians’ viewpoints of safe sex behavior, further investigates how these viewpoints affect them to adopt the safe behavior as well as tries to understand lesbians’ sexual health demand. This may enable the public health authority to take lesbians’ sexual health seriously and to give suitable assistance in the future. Methods: From December 2008 to May 2009, face-to-face in-depth interviews were conducted with 10 lesbians aged above 18 years old. The study also used informal interviews and participant observations to increase data integrity. Results: Although lesbians have the risk of getting sexually transmitted diseases (STDs), in the present study it is found that (1) on the views and attitudes of safe sex behavior: (i) definition of sexual behavior is different from each other, (ii) sexual information sources are dubious, mainly obtained through the interne, and is necessary to be transformed from heterosexual resources, (iii) participants think that safe sex behaviors are different on gender, the idea of safe sex behavior of women who have sex with women (WSW) are mainly from the experience of interpersonal networks, self-experiences, as well as the transformation of the media messages; (2) actual action on safe sex behaviors: (i) besides stable relationship partner, participants would also find sexual partners through network, bars and friendships to develop non-partner relations, (ii) shearing nails and cleaning the body are the main ways in safe conducts, but the use of other barrier methods (condoms, finger gloves, and oral-dam) is very few. This is due to the reason that they think that they do not need them; furthermore, they have limited knowledge and accessibility to barrier materials, (iii) the participants have more equal power in sexual relations; (3) sexual health demands: (i) more lesbian sexual information provided, (ii) barrier materials more accessible, (iii) friendly and gender-sensitive medical environment. Conclusions: Under condition of compulsory heterosexuality, lesbian safer sex information sources are insufficient and inadequate, and suggested lesbian barrier materials are not easily accessible. This may increase the risk of lesbians getting STDs. The public health authority should establish statistics for lesbian health, have more focus on diversity of gender, to increase resources accessibility and provide gender (LGBT) further education for health care professionals.