Abstract
Even though women who have sex with women are usually understood to be at no or very low risk for HIV infection, we explored whether lesbian and bisexual women in a geographical area with high HIV prevalence (Southern Africa) get tested for HIV and whether, among those women who get tested, there are women who live with HIV/AIDS. The study was conducted in collaboration with community-based organizations in Botswana, Namibia, South Africa and Zimbabwe. Data were collected via written surveys of women who in the preceding year had had sex with a woman (18 years and older; N = 591). Most participating women identified as lesbian and black. Almost half of the women (47.2%) reported ever having had consensual heterosexual sex. Engagement in transactional sex (lifetime) was reported by 18.6% of all women. Forced sex by men or women was reported by 31.1% of all women. A large proportion of the women reported to ever have been tested for HIV (78.3%); number of lifetime female and male partners was independently associated with having been tested; women who had engaged in transactional sex with women only or with women and men were less likely to have been tested. Self-reported HIV prevalence among tested women who knew their serostatus was 9.6%. Besides age, the sole independent predictor of a positive serostatus was having experienced forced sex by men, by women, or by both men and women. Study findings indicate that despite the image of invulnerability, HIV/AIDS is a reality for lesbian and bisexual women in Southern Africa. Surprisingly, it is not sex with men per se, but rather forced sex that is the important risk factor for self-reported HIV infection among the participating women. HIV/AIDS policy should also address the needs of lesbian, bisexual and other women who have sex with women.
Highlights
Because the risk of sexual transmission of HIV between women is assumed to be low if not nonexistent, lesbian women and other women who have sex with women (WSW) are generally not seen as vulnerable to HIV infection
Studies have shown that human papillomavirus (HPV) is common among WSW, while evidence strongly suggests that HPV transmission occurs among WSW [20,21,22]
Bacterial vaginosis (BV) in WSW was found to be associated with number of female sexual partners, but not with sex with men, suggesting that bacterial vaginosis (BV) is sexually transmitted between women [23]
Summary
Because the risk of sexual transmission of HIV between women is assumed to be low if not nonexistent, lesbian women and other women who have sex with women (WSW) are generally not seen as vulnerable to HIV infection. On many occasions and in several forums, lesbian activists have strongly objected to their omission and the deprioritization of their risk for HIV transmission [10,11]. This lack of attention might reinforce the myth of ‘‘lesbian immunity’’ [12,13,14,15,16], and the idea among lesbian women of not being at risk [13,17], leaving them ill-equipped to protect themselves and their partners. Bacterial vaginosis (BV) in WSW was found to be associated with number of female sexual partners, but not with sex with men, suggesting that BV is sexually transmitted between women [23]
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