Differences in sexual behaviors between sexual minority and heterosexual female youth with a substance use disorder who are experiencing homelessness

• Female sexual minority youth (SMY) enaged in more risky sexual behaviors than their heterosexual peers. • With older age female SMY utilized condoms more compared to their heterosexual peers. • Although there were some differences in sexual risk and protective behaviors between female SMY and their peers, there were more similarities. • Provides working with female youth experiencing homelessness should provide sexual health resources regardless of sexual orientation. The purpose of this study was to examine differences in risky and protective sexual behaviors between sexual minority (SM) and heterosexual female youth with a substance use disorder (SUD) who are experiencing homelessness (YEH). This study uses baseline data from four randomized clinical trials of substance use interventions for YEH between the ages of 12–24 with a substance use disorder (N = 469). Meta-analytic methods were used to aggregate data across studies to estimate differences in sexual risk and protective behaviors. Female SM-YEH had a younger age at first sex, greater risk of lifetime casual sex, were less likely to use contraception during their first sexual encounter, and greater risk of having a STI than heterosexual YEH. Among female SM-YEH, older age was associated with greater utilization of condoms due to concerns about HIV and using condoms the last time they had sex compared to their heterosexual peers. Female SM and heterosexual YEH with a SUD had many similarities in sexual risk and protective behaviors. However, differences between female SM and heterosexual YEH were mixed regarding who was at greater risk, suggesting their unique context may play a role in understanding engagement in risky and protective sexual behavior in addition to sexual orientation.