Disparities in Pap Test Intention between Sexual Minority and Heterosexual Women in Taiwan: Exploring Pap Test Experience and Butch Identity as Effect Modifiers

Objectives: Pap test is an effective way to prevent cervical cancer; however, there still exist sexual orientation disparities in Pap test utilization. This study aimed to examine the differences in health beliefs and to explore the associated factors of Pap test intention among Taiwanese women, separately by their sexual orientation and Pap test experience.

Methods: A sample stratified by region (north, center, south, and east) and age group (21-29 and ≥30) was drawn for heterosexual women, as well as for lesbian/bisexual women in Taiwan. Data from 1,375 participants were collected via an anonymous online survey.

Results: An overwhelming majority of lesbian/bisexual women in Taiwan never had a Pap test (89.1%), compared with their heterosexual counterparts (54.9%). Among women who never had a Pap test, lesbian/bisexual women had lower Pap test intention, received fewer cues to action, and perceived more barriers than heterosexual women. In general, women who received more cues to action had significantly higher Pap test intention, except those heterosexual women who never had a Pap test; by contrast, women who perceived more barriers had significantly lower Pap test intention, except those lesbian/bisexual women with prior Pap test experience. Notably, butch-identity interacted with both sexual orientation and Pap test experience. Specifically, heterosexual women with a butch identity who had Pap test experience had lower Pap test intention (AOR=0.09), unless they perceived higher susceptibility (AOR=4.23); similarly, lesbian/bisexual women with a butch identity who never had a Pap test had lower Pap test intention (AOR=0.48), unless they perceived more benefits (AOR=1.31).

Conclusions: This study demonstrated that sexual orientation disparities in Pap test intention may depend on whether women ever had a Pap test and had a butch identity. As the Taiwan Government strives to eliminate health disparities, more attention should be paid to sexual minorities’ health and gender sensitivity in the healthcare systems.