Sexual and Drug Use Behavior Among Women Who Have Sex With Both Women and Men: Results of a Population-Based Survey

Recent US HIV/AIDS trends suggest a relative increase in HIV infections among women attributed to injection drug use or heterosexual contact. While unknown, the biological risk of female-to-female sexually transmitted HIV is thought to be much lower than the risk of transmission between men and women. Yet studies have shown that some subgroups of women who have sex with women (WSW) exhibit high levels of sexual risk behaviors with men as well as unsafe injection drug use. Thus, if risk assumptions are based on self-reported or presumed sexual identity, possible risks for HIV infection may be underestimated in some subgroups of WSW.

The current study describes sexual and drug use behaviors associated with HIV and other STDs among WSW who responded to a door-to-door population-based survey of women ages 18 to 29. It was conducted between April 1996 and January 1998 among residents of low-income neighborhoods in northern California.

Of 2,457 women, 88 percent reported sex exclusively with men; 7 percent reported sex with men and women; 1 percent reported sex exclusively with women. Of the seven HIV-positive women, four reported only male partners; 2 reported both male and female partners; one reported only female partners. None of the 16 WSW who reported sex exclusively with women reported any injection drug use. Therefore, analyses of risk were limited to those who reported sex with both men and women and those who reported sex exclusively with men.

Compared with women who had sex exclusively with men, women who had sex with men and women were significantly more likely to report past and recent high-risk sexual behavior, including sex with an HIV-positive man; multiple male sex partners; sex with a man who had sex with other men; sex with an injection drug user; trading sex for drugs or money; and anal sex. They were also more likely to report past and recent injection drug use, and they were more likely to have serological markers for hepatitis B and C. Rates for HIV and other STDs did not significantly differ, owing to the small number of these infections.

Rates of sexual and injection drug risk activities exhibited by women who reported sex with both women and men place this group at potentially higher risk of HIV and other STDs than women who were exclusively sexual with either men or women. "Prevention efforts should avoid assumptions based on reported sexual identity and should acknowledge that women who report sex with both women and men may be at increased risk for HIV and other STDs," the authors concluded.

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