HIV Risks in Women Who Have Sex with Women

In 1995, the Centers for Disease Control (CDC) called a meeting of lesbian HIV experts to request input on policy, prevention and outreach to women who have sex with women (WSW). An article written by CDC staff members (Meaghan Kennedy, Margaret Scarlett, Ann Duerr and Susan Chu) in the May/August 1995 issue of the Journal of the American Medical Women's Association concluded that data on HIV risk faced by WSW are scarce. The authors advised that while the biologic risk of female-to-female transmission is unknown, such transmission is biologically possible, but likely to be uncommon. The article focused attention on other risk behaviors of WSW, including unprotected sex with men, injection drug use and alternative insemination. Surveys continue to verify that some groups of WSW engage in multiple high-risk behaviors. Those that do have higher than expected seroprevalence of HIV and experience difficulties when trying to communicate with health care providers.

This group of CDC researchers has apparently continued to be concerned about issues related to WSW. The CDC recently (April, 1997) published a two-page fact sheet, entitled "HIV/AIDS And Women who Have Sex with Women (WSW) in the United States," that includes prevention recommendations for sexual contact between women. The CDC National AIDS Clearinghouse provides resources and literature on the subject of WSW.

At the National Conference on Women and HIV in May 1997, Kennedy reported on a recent survey of 700 HIV-positive women. The survey found that 22% reported a history of female sexual contact and 5% reported such contact within the last eight months. By self-report, none of these latter women had receptive oral sexual contact while menstruating, 22% said they "always" use a barrier, 15% claimed to "sometimes" use a barrier, and 63% reported "never" using a barrier. Kennedy concluded that decision-making about use of barriers is strongly related to varied perceptions of the barriers' ability to decrease risk of HIV transmission.

Susan Chu presented behavioral and prevention aspects for WSW in a "state-of-the-art" lecture. The CDC AIDS Surveillance Report (April 1997), stated that the CDC prioritizes for investigation AIDS cases whose only reported risk of transmission is WSW. As of December 1996, the CDC had not identified any AIDS cases with the transmission category of WSW, but said that surveillance programs are instructed to ask about WSW behavior, and that female-to-female transmission of HIV could be masked by other risk behaviors. The report further stated that "in some convenience samples of WSW, the prevalence of multiple high-risk behaviors is very high," including anal sex, sex with high-risk male partners, injection drug use, needle use for piercing and tattooing, and use of unscreened semen from sources other than licensed sperm banks."

This information may not be new or surprising at this point, but there is now a paradigm for tracking risk behaviors and HIV seroprevalence in WSW. The job is to get that tracking implemented at the state and local levels, where WSW are often ignored.