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

Abstract

Women who have sex with women (WSW) have long been considered at low risk of acquiring and transmitting HIV and other sexually transmitted infections (STIs). However, limited research has been conducted on WSW, especially those living in low-and middle-income countries (LMICs). We reviewed available research on sexual health and risk behaviors of WSW in LMICs. We searched CINAHL, Embase, and PubMed for studies of WSW in LMICs published between January 1, 1980, and December 31, 2013. Studies of any design and subject area that had at least two WSW participants were included. Data extraction was performed to report quantifiable WSW-specific results related to sexual health and risk behaviors, and key findings of all other studies on WSW in LMICs. Of 652 identified studies, 56 studies from 22 countries met inclusion criteria. Reported HIV prevalence among WSW ranged from 0% in East Asia and Pacific and 0%-2.9% in Latin America and the Caribbean to 7.7%-9.6% in Sub-Saharan Africa. Other regions did not report WSW HIV prevalence. Overall, many WSW reported risky sexual behaviors, including sex with men, men who have sex with men (MSM), and HIV-infected partners; transactional sex; and substance abuse. WSW are at risk for contracting HIV and STIs. While the number of research studies on WSW in LMICs continues to increase, data to address WSW sexual health needs remain limited.

A scoping review of sexual minority women’s health in Latin America and the Caribbean

“…Sexual health was the most prominent health issue examined. Our results corroborate the work of Tat et al (2015) who found that WSW in LMICs report high rates of risky sexual behaviors. SMW in the current review were at increased risk of STIs primarily related to low use of barrier contraceptive methods during sexual encounters with men (da Silva Oliveira et al, 2017; Mora and Monteiro, 2010;Pinto et al, 2005).…”

“…Although homophobic and sexist attitudes may be higher in LAC than in many parts of the world (International Lesbian, Gay, Bisexual, Trans, and Intersex Association, 2017b), few studies have examined the health status or health needs of SMW in this region. Tat et al (2015) conducted a systematic review of studies on the sexual health of women who have sex with women (WSW) in LMICs. The authors identified increased risk for sexually transmitted infections (STIs), including HIV, in Brazilian SMW that was primarily related to engaging in sexual activity with men without using safer sex practices (Tat et al, 2015).…”

“…Tat et al (2015) conducted a systematic review of studies on the sexual health of women who have sex with women (WSW) in LMICs. The authors identified increased risk for sexually transmitted infections (STIs), including HIV, in Brazilian SMW that was primarily related to engaging in sexual activity with men without using safer sex practices (Tat et al, 2015). With the exception of sexual health, little is known about the health of SMW living in LAC.…”

Safe sexual behaviors intention among female youth: The construction on extended theory of planned behavior

“…A convenience sampling method was employed for data collection. The selection criteria for the participants included female youth: (a) aged between 15–24 years, according to the definition of youth by United Nations (); (b) with no cognitive disabilities to avoid misunderstanding the content of questionnaire; (c) were not homosexual or unsure of their sexual orientation (Heterosexual females probably had both risk of unwanted pregnancy and sexually transmitted disease infection, whereas homosexual women are at main risk for contracting HIV and sexually transmitted disease infection) (Tat, Marrazzo, & Graham, ); (d) both father and mother were alive at the time of the study for collecting the father–child and mother–child sexual communication. Relatively simple models may require sample sizes of 200–500 and thousands of cases may be required for more complex models (Kline, ).…”

Top or Bottom? Varsity youth talk about gay sexuality in a Stepping Stones Workshop: Implications for sexual health

“…The current study was undertaken as a means of addressing such an important gap by focusing on an LGBTI-identified population group and applying principles and processes of the training manual with this group. In so doing, the article contributes to the growing body of work on sexual health and behaviour amongst LGBTI youth (Knight et al 2014;Mustanski, Ryan and Garofalo 2014;Nel 2009;Schalet et al 2014;Tat, Marrazzo and Graham 2015;Waldman and Stevens 2015) by exploring aspects of sexual behaviour practice and relationships.…”