I often hear, are lesbians really at risk for HIV and AIDS? What is the likelihood of transmission of the HIV virus from one female to another? Do lesbians really need to worry about safer sex?
Let's start with the basics. Anyone who is sexually active is at risk for HIV. Yes, female-to-female transmission of HIV is possible and it has happened. Unfortunately, to date there have not been many studies that have examined lesbian sexual acts and the transmission of HIV.
First: Who are Lesbians?
What makes a lesbian? Lesbians are women who have sex with other women. But does that mean they do not have sex with men? Remember, women can identify as lesbian and still have sex with men, use drugs, have sex for money, be victims of rape or abuse or have
According to the Centers for Disease Control, documented cases of female-to-female transmission of HIV appears to be a rare occurrence. The CDC reports there are case reports of female-to-female transmission of HIV, but it does not specify how many. From the CDC web site: "The well documented risk of female-to-male transmission of HIV shows that vaginal secretions and menstrual blood may contain the virus and that mucous membrane (e.g., oral, vaginal) exposure to these secretions has the potential to lead to HIV infection."
Why are the Reported Cases of Lesbians with HIV rare?
To understand why there have been so few cases of female-female HIV reported, you must understand how the CDC documents transmission. If a woman has sex with another woman and has other risk factors, such as drug use, the CDC would traditionally classify the transmission under one of those factors or as “undetermined.” Under the CDC guidelines, heterosexual sex is not ruled out as a risk factor unless a woman hasn’t had sex with a man since 1978.
Sexism is a Factor
It took more than 10 years for the CDC to expand it’s definition of AIDS to include opportunistic infections that affected females. A saying from the late 1980s was, “Women don’t get AIDS, they just die from it.”
From the CDC’s website: Through December 1998, 109,311 women were reported with AIDS. Of these, 2,220 were reported to have had 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). Of the 347 (out of 2,220) women who were reported to have had sex only with women, 98% 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 the 109,311 case reports, possibly because the physician did not elicit the information or the woman did not volunteer it.
Documented Cases of Transmission
According to Selfhelp Magazine, the first suspected case of transmission from one woman to another was in 1984. Other cases soon followed in 1986, 1987 and 1993.
In 2003 a 20-year-old African American lesbian from Philadelphia contracted HIV from her female partner. Most likely she was infected from the use of sex toys, "used vigorously enough to cause exchange of blood-tinged body fluids," according to the journal Clinical Infectious Diseases. This young woman had no other risk factors: she did not use intravenous drugs, had never had sex with a man, never had a blood transfusion, had no tattoos or piercings and only had sex with her partner for the previous two years.
Lesbians with HIV/AIDS
In 1992 the Lesbian AIDS project was started in New York City. It started with a caseload of 30 women and by the end of two years had jumped to 400 HIV positive lesbians. Currently the Lesbian AIDS project serves more than 1,000 HIV positive lesbians.
These are the known cases of lesbians with HIV or AIDS. Other studies have shown that there is reason to believe lesbians may be at a higher risk than the CDC is willing to admit.
Injection Drug Use
According to the Center for AIDS Prevention Studies at University of California, San Francisco, among injection drug users, women who have sex with other women have higher HIV rates than do women who have sex with men only. A study of female injection drug users in 14 US cities found that, compared to heterosexual women, women who had a female sex partner were more likely to share syringes, to exchange sex for drugs or money, to be homeless and to seroconvert.
Lesbians and Bisexual Women who have Sex with Men
Women who identify as lesbian or bisexual and have sex with men may be at higher risk for HIV than heterosexual women. Lesbians and bisexual women may have sex with gay or bisexual men and not use condoms.
What is Lesbian Sex? Lesbians have different sexual practices, which have different levels of risk for HIV. Oral sex is thought to pose a relatively low risk. Acts such as sharing sex toys, hand play with long fingernails or cuts pose higher risk.
Lesbian Youth and AIDS Young lesbians and bisexual women just coming out often experiment sexually with their gay male friends. Societal pressure and negative attitudes about homosexuality may increase young lesbians risk for contracting HIV. A study in San Francisco found that young lesbians engaged in high rates of alcohol and drug use, unprotected sex with men and sexual experimentation with young gay men as a way of coping with homophobia and societal pressures.
What does it all mean? Just because there have not been adequate studies of lesbians and AIDS does not mean that lesbians are not at risk or HIV and AIDS. The fact is, homophobia and lesbian invisibility exist. Lesbians who have HIV may not be honest with their health care providers for fear of discrimination. My guess is, there are more lesbians with AIDS than we know about.