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HIV/AIDS Prevention

HIV/AIDS Among Women Who Have Sex with Women

July, 1997

While the biologic risk of HIV transmission through female-to-female sexual contact is unknown, case reports of female-to-female transmission and the well documented risk of female-to-male transmission of HIV indicate that vaginal secretions and menstrual blood are potentially infectious and that mucous membrane (e.g., oral, vaginal) exposure to these secretions can potentially lead to HIV infection. Information from HIV/AIDS surveillance, however, suggests that female-to-female transmission of HIV is a rare occurrence.

  • Through December 1996, of the total 85,500 AIDS cases reported among adult and adolescent females, 1,648 women reported having sex with women÷however, the vast majority had other risks (such as injection drug use, sex with high-risk men, or receipt of blood or blood products). Even though 333 of the 1,648 reported having sex only with women, 97 percent of these women also had another risk -- injection drug use in most cases. (Note: information on whether a woman had sex with women is missing in half of case reports, possibly because the physician did not elicit the information or the woman did not volunteer it.)

  • Women with AIDS whose only initial reported risk is sex with women are prioritized for follow-up investigation. As of December 1996, none of these investigations had resulted in a confirmed AIDS case report of female-to-female HIV transmission, either because other risks were subsequently identified or because, in a few cases, women declined to be interviewed.

  • A study of more than 1 million female blood donors found no HIV-infected women whose only risk was sex with women.

These findings suggest that female-to-female transmission of HIV is uncommon. However, they do not negate the possibility because it could be masked by other behaviors.

Prevalence of Risk Behaviors among Women Who Have Sex with Women (WSW)

Surveys of risk behaviors have been conducted in groups of WSW. These generally have been surveys of convenience samples of WSW that differ in sampling, location, and definition of WSW. As a result, their findings are not comparable, nor are they necessarily representative of all WSW.

These surveys do suggest that some groups of WSW have relatively high rates of high-risk behaviors, such as injection drug use and unprotected vaginal sex with gay/bisexual men and injecting drug users.

Preventing HIV Transmission Among WSW

Although female-to-female transmission of HIV is apparently rare, female sexual contact should be considered a possible means of transmission among WSW, and WSW should be aware that vaginal secretions and menstrual blood are potentially infectious. Women also should be aware of appropriate barrier methods they can use for different sexual activities to prevent transmission of HIV. Condoms should be used consistently and correctly each and every time for sexual contact with men or when using sex toys. Sex toys should not be shared. No barrier methods for use during oral sex have been approved by the Food and Drug Administration; however, women can use dental dams, cut-open condoms, or plastic wrap to protect themselves from contact with body fluids during oral sex.

WSW should know their own and their partner's HIV status. This knowledge can help uninfected women initiate and sustain behavioral changes that reduce their risk of becoming infected and can assist infected women in getting early treat- ment and avoiding infecting others.

Health care providers should understand that sexual identity does not necessarily predict behavior. Women who identify as lesbian still may be at risk for HIV through unprotected sex with men.

Prevention interventions targeting WSW must address behaviors that put WSW at risk for HIV infection, specifically injection drug use and unprotected vaginal or anal intercourse with men.

For further reading on female-to-female HIV transmission...

Chu SY, Buehler JW, Fleming PL, Berkelman RL. Epidemiology of reported cases of AIDS in lesbians: United States, 1980-89. Am J Pub Health 1990;80:1380-81

Chu SY, Hammett TA, Buehler JW. Update: epidemiology of reported cases of AIDS in women who report only sex with other women, United States, 1980-91. AIDS 1992;6:518-19

Einhorn L, Polgar M. HIV risk behavior among lesbians and bisexual women. AIDS Prevention Education 1994;6:514-523

Kennedy, MB, Scarlett MI, Duerr AC, Chu SY. Assessing HIV risk among women who have sex with women: scientific and communication issues. J Am Med Wom Assoc 1995;50:103-107

Lemp GF, Jones M, Kellog TA, et al. HIV seroprevalence and risk behaviors among lesbians and bisexual women in San Francisco and Berkeley, California. Am J Pub Health 1995;85:1549-52

Marmor M, Weiss LR, Lyden M, et al. Possible female-to-female transmission of human immunodeficiency virus (letter). Ann Intern Med 1986;105:969

Monzon OT, Capellan JMB. Female-to-female transmission of HIV (letter). Lancet 1987;2:40-41

Perry S, Jacobsberg L, Fogel K. Orogenital transmission of HIV. Ann Intern Med 1989;111: 951-952

Petersen LR, Doll L, White C, Chu S, and the Blood Donor Study Group. No evidence for female-to-female transmission among 96,000 female blood donors. J Acquir Immun Defic Syndr 1992;5:853-855

Rich JD, Buck A, Tuomala RE, Kazanjian PH. Transmission of human immunodeficiency virus infection presumed to have occurred via female homosexual contact. Clinical Infect Dis 1993; 18:1003-1005

Sabatini MT, Patel K, Hirsh- man R. Kaposi's sarcoma and T-cell lymphoma in an immunodeficient woman: a case report. AIDS Res 1984;1:135-137

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This article was provided by U.S. Centers for Disease Control and Prevention. Visit the CDC's website to find out more about their activities, publications and services.