Within this context and contrary to prevailing perceptions, local research and anecdotal evidence suggest that lesbian women face multiple risks for STI’s and HIV.    

The de-prioritisation of lesbian health issues in HIV policy making and implementation and a complete lack of target group specific interventions in the public sector, augment the notion amongst lesbian women that they are not at risk for HIV transmission. In a quantitative representative study undertaken in Gauteng 9% of black and 5% of white lesbian women self-reported to be HIV positive (Wells and Polders, 2004). In another study on the sexual practices of lesbian women (Wells, Mbatha, and Van Dyk, 2007) 27% reported not knowing their HIV status and only 40% knew their partner’s status – 1% reported their partners to be HIV positive. With regard to testing practices, the lesbian women in this study reported as follows:

*             45% were “too scared to test”

*             40 % reported being “not at risk”

*             7.5% “don’t know where to get tested”

*             25% had “never tested for HIV”

We can deduce from these findings that low risk perception amongst lesbians negatively influences their uptake of safer sex practices. For lesbian women risky sexual behaviours with female partners may include:

*             Sex without the presence of a barrier – such as a dental dam or

condom use during vaginal-vaginal contact, digital-vaginal contact, digital-anal contact, oral sex or sadomasochistic activities that draw blood.

*             Using sex toys without a condom. When sharing the toys the same

condom should not be re-used on both persons. Partner should also be aware of any cuts on fingers or in the mouth.

High levels of sexual violence against women and hate crimes against lesbian women in particular (eg. “corrective rape”) increase vulnerability to HIV infection. In addition lesbian women may not be aware, or consider, that their female partners may, for a range of reasons, engage in unprotected sex with men.

Being asymptomatic for STIs means that we could be transmitting STIs to each other, unknowingly, thus increasing vulnerability to HIV infection.

<http://www.avert.org/chlamydia.htm> Chlamydia and <http://www.avert.org/gonorrhea.htm> Gonorrhea, although rare in lesbian women, may be passed on through sharing sex toys or vaginal-vaginal contact.

There is a risk of infertility for women who have had untreated chlamydia.

Sex between women can also transmit HPV (Human Pappiloma Virus), the virus associated with cervical cancer. A pap smear can detect pre-cancerous cells and facilitate early treatment.

As lesbian women we have a right to be informed of health issues that may impact upon our wellbeing. We also have a right to access treatment and care services that are both appropriate to our needs and affirming of our sexualities. Such services are largely non existent. Prejudiced attitudes and discriminatory experiences within the healthcare system negatively impact on patterns of health-seeking behaviour and health-risk factors. The assumption of heterosexuality by health care workers and in some cases the outright denial of health care to lesbians are also factors that undermine health rights (see Overall research findings on levels of empowerment among LGBT people in Gauteng, South Africa for related statistics). These systemic discriminations compromise the sexual rights and choices of lesbian women.

In addition, negative social attitudes towards sexual diversity and resultant discrimination create the context for further vulnerability. For example, being kicked out of home or fired from a job as a direct result of homophobia undermines the economic independence of lesbians. This could increase engaging in transactional sex with men for material need (where, as a result of power dynamics, there is less likelihood of condom usage) thereby increasing susceptibility to HIV infection.

Public health responses to the sexual health rights and needs of lesbian women in relation to HIV/AIDS should include:

*             Targeted prevention messages that are relevant, appropriate and

affirming of lesbian sexualities across diverse contexts.

*             Dedicated research to further explore the factors that

disproportionately affect lesbians in relation HIV/AIDS.

*             Making available appropriate safer sex materials and barrier methods

eg. Dental dams, gloves etc.

*             Training of mainstream health care providers to better respond to

the health needs and rights of lesbian women

*             Ensuring access to health care for lesbians and addressing systemic

exclusion and marginalization within public healthcare settings

*             Campaigns to promote the sexual health and rights of lesbian women

within a sexual and reproductive rights framework.

The OUT Clinic and Wellness Centre offers free pap smears and HIV and STI testing to lesbian women. Contact OUT at (012) 344 5108 for more information.

The authors can be contacted on:

Melanie Judge (Advocacy and Mainstreaming Manager, OUT LGBT Well-being) – programmes@out.org.za

Delene van Dyk (Mental Health Manager, OUT LGBT Well-being) –

mentalhealth@out.org.za

Other readings:

*             Judge, M. ‘Invisibility in plain sight’..lesbian women and HIV. AIDS

Legal Quarterly. March 2008. Cape Town: AIDS Legal Network.

*             Polders, L. & Wells, H. 2004. Overall research findings on levels of

empowerment among LGBT people in Gauteng, South Africa. Pretoria: OUT LGBT Well-being.

*             Wells, H., Mbatha, C. & Van Dyk, D. 2007. Behaviours and Practices

of Lesbian Women in Gauteng, South Africa, with regard to Mental Health and Transmission of HIV and other STI’s. Pretoria: OUT LGBT Well-being.