Women Who Have Sex With Women (WSW)
According to a report by the International Gay and Lesbian Human Rights Commission, African lesbians have lower HIV prevalence rates 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). 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. In India, decriminalization of same sex activity due to a recent court ruling makes it more likely that HIV services reach those at risk (Misra, 2009).
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 women’s vulnerability based on sexual orientation. 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). WSW may be at risk of HIV acquisition through rape, even if they have no male partners or injecting drug use. WSW want and do have children and have needs for sexual and reproductive health services.
Additional consideration should be given to the effects of homophobia. Recent reports document violence and rape against WSW in South Africa for being lesbian (Martin et al., 2009). “The invisibility and marginalization of WSW is leading to the sexual and reproductive health needs not being adequately met” (Tallis, 2008). 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.