Forced Sexual Experiences as Risk Factor for Self-Reported HIV Infection among Southern African Lesbian and Bisexual Women

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.

Women Who Have Sex with Women in Kenya and Their Sexual and Reproductive Health

“…Discussion This is the first study to report on sexual and reproductive health issues among WSW living in Kenya. As was found in other studies among WSW in Africa, 14,19 women who have sex with women seldom do so exclusively: a substantial proportion of women had sex with men as well, exposing them to all risks associated with heterosexual sex. One out of seven women reported ever having an abortion and one out of three women reported having had at least one STI.…”

“…Furthermore, it is not clear whether the findings are generalizable to all Kenyan WSW (subject recruitment occurred through community organizations; women who could not communicate in English were excluded from participating; and sampling was not random and only took place in the three biggest cities in Kenya). The fact that most women in this study were young (18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29) suggests that the representativeness of the sample is, indeed, limited.…”

Women Who Have Sex with Women Living in Low- and Middle-Income Countries: A Systematic Review of Sexual Health and Risk Behaviors

“…All four WSW in a participatory action research project in South Africa had been raped, 28 while from 31.1%-33.3% of WSW in two multi-national studies reported forced sex by men or women. 25,26 WSW who had experienced forced sex were more likely to be HIV-positive. 26 Data on the following risk behaviors were also reported: transactional sex (18.6%); 26 condom use in last sexual encounter with male partners (48.0%); 27 and having both male and female partners in the past year (40.0%).…”

“…Four studies surveyed WSW about male partners: 47.2%-80.0% had ever had sex with men; [24][25][26] nearly 20% reported sex with a man in the past year; 26 and 8.1%-26.3% had ever been married. [25][26][27] Three studies reported data on forced sex. All four WSW in a participatory action research project in South Africa had been raped, 28 while from 31.1%-33.3% of WSW in two multi-national studies reported forced sex by men or women.…”

Professionalism is key in providing services to lesbian, gay, bisexual, transgender and intersex South Africans

“…A 1999 report from the American Institute of Medicine, which evaluated the strength of existing research on the physical and mental health of lesbian women, suggested that 'misconceptions about risk … can negatively affect both the ability of lesbians to seek health care and access treatment' . [2] In South Africa (SA), we know that 10% of women who identify themselves as lesbian or bisexual or have occasional sex with women are infected with HIV, [3] but this knowledge is not usually included in infectious disease education. Women who have sex with women (WSW) are not mentioned in the Department of Health's current National Strategic Plan for HIV, TB and STIs.…”