Women Who Have Sex With Women (WSW)
At least seventy-six countries criminalize consensual samesex relations, making access to HIV prevention, treatment and care a challenge for women who have sex with women (UN General Assembly, 2011). According to a report by the International Gay and Lesbian Human Rights Commission, although prevalence rates are lower than heterosexual women, same-sex practicing South African women self-report HIV prevalence between nine and fifteen percent, with no targeted HIV prevention, treatment or care services (IGLHRC, 2007). While the risk of HIV transmission is low in sex between females and HIV risk from shared sex toys is minimal (Helena et al., 2003 cited in IGLHRC, 2007), providers and programmers should not make assumptions about womens vulnerability based on sexual orientation.
Lesbian and bisexual women may be at risk also from HIV through sexual relations with partners of the opposite sex, blood transfusions, sex work, injecting drug use, artificial insemination and occupational exposure (Mora and Monteiro, 2010; Cloete et al., 2011). In Kyrgyzstan, for example, 20% of WSW reported having sex with a man during the previous six months with only half using condoms (Alisheva et al., 2007). Women who identify as lesbian may participate in riskier sexual practices with male partners as sex workers (Roberts et al., 2010). A study of 72 HIV-positive WSW found that 21 were currently married to men and 47 reported having children (Cloete et al., 2011). WSW may be at risk of HIV acquisition through rape, even if they have no male partners or injecting drug use. Many WSW in South Africa report gang rape by men who target them because of their sexual preferences (Cloete et al., 2011; Henderson et al., 2011; Martin et al., 2009). Additional consideration should be given to the effects of homophobia. The UN has reported homophobic violence in all regions of the world (UN General Assembly, 2011).
Lesbian, bisexual and women who have sex with women have rarely been the focus of programs or research efforts with an understanding of the complexities of lesbian sex and sexuality. This can increase their risk for HIV acquisition. For example, "women who have sex with women are a population that has been largely ignored in research considering HIV risks within partnerships with people who inject drugs. While historically female same sex relationships have been considered low risk partnerships, there is evidence of significant HIV risks through the same injection and sexual risk channels that affects heterosexual partnerships" (Roberts et al., 2010: 12).
WSW want and do have children and have needs for HIV, sexual and reproductive health services. Unfortunately, "the invisibility and marginalization of WSW is leading to the sexual and reproductive health needs not being adequately met" (Tallis, 2008). Decriminalization could potentially increase the accessibility of HIV services for WSW and some feel that the recent court ruling decriminalizing same sex activity in India will make it more likely that HIV services will reach those at risk (Misra, 2009).
Almost no data from developing countries exist to identify what works to prevent HIV in women who have sex with women. Some organizations, such as the Triangle Project (www.triangle.org.za) in South Africa advocate and provide services for lesbian, bisexual and women who have sex with women. Further efforts are needed to identify what works to prevent HIV in women who have sex with women.