Lesbians and HIV


Hi there,

My partner is HIV-pos and living with AIDS. She tested positive before we got together and has always been honest with me about it. I am in love and we practice the safest sex we know, but are frustrated about the facts. I went to get tested (I'm neg) and the woman at the clinic basically told me that lesbians don't transmit HIV to other women. HELLO! Am I right to think this is incredably ignorant? There just is not enough information about female partners and HIV. Any advice about what is "safe" and what is not?



Refer the woman at the clinic to a recent article by Kwakwa et al., "Female-to-female transmission of human immunodeficiency virus" in Clinical Infectious Diseases, 36, 1 February 2003. It provides evidence of female-to-female transmission to a 20-year-old woman from Philadelphia in a monogamous lesbian relationship. The couple's sexual practices included sharing sex toys and oral sex. These activities did not occur during menstruation, but the sex toys had occasionally been used vigorously enough to draw blood. The authors suggest the infection occurred via sharing these sex toys. The newly infected woman had a negative HIV test six months prior to her first positive test. The genotype of her newly acquired virus was strikingly similar to her HIV-positive partner's viral genotype.

We do know that female-to-female sexual practices are generally associated with lower risk of HIV transmission, but cases such as the one published above have been reported. The exact incidence is difficult to determine, due to other possible risky behaviors intravenous drug use, unprotected sex with men, etc. The CDC doesn't track lesbian HIV statistics accurately. For instance, if a lesbian is diagnosed as HIV-positive, but has ever had sex with a man, the case is counted as "heterosexual."

The bottom line here is that lesbian and bisexual women can and do get HIV and other STD's. As for what is safe and not safe, the same rules apply. Oral sex, for instance, has a low, but not completely nonexistent risk for HIV transmission. "Dental dams" (a square piece of latex) can make cunnilingus even safer, but the taste is far from Julia Childs (her cooking, not the lady herself). Alternatively, plastic wrap is more readily available than dental dams, has essentially no rubbery taste, and has the added benefit of being see-through! Whenever I'm at the local supermarket, I always look to see who's buying the plastic wrap and wonder if it will wind up in the bedroom or kitchen. I never thought it worked all that well in the kitchen!

Hope that helps.

Dr. Bob