Abstract:

Background:
The notion that women who have sex with women (WSW) may not be at risk for HIV may influence not only their risk perception and behavior, but public health education as well. Some WSW had their first sexual encounter (and possibly multiple encounters) with a man. Cases of HIV infection transmitted solely by sexual contact between women who have sex with women are difficult to ascertain. Other, more common, modes of transmission, such as injection drug use and heterosexual sex, usually are difficult to rule out. U.S. national health officials have asserted that while it is rare they advise that precautions should be taken nonetheless. Female-to-female transmission is possible because HIV can be found in vaginal fluid and menstrual blood. Albeit not as risky as exchanging bodily fluids with men, HIV transmission continues to pose a risk between women through other forms of sexual activity, including digital sex, oral sex and sharing sex toys.

Methods:
A multiethnic community-based sample of 239 WSW aged 18-68 years attending LGBTQ pride events in three cities completed a 53-item anonymous questionnaire (offered in English/Spanish) regarding sexual behaviors and perceptions of HIV-risk. Sexual orientation was identified by using the 7-point Kinsey’s Heterosexual-Homosexual Rating Scale. Data were analyzed using SPSS.

Results:
Twenty-three percent of participants reported being in a committed, monogamous relationship with a woman. In the past 6 months, 18% of participants reported 1 or more male partners. Participants reported engaging in HIV-risk behaviors with men and women. Perception of HIV-risk was associated with having more male partners (r=.244, p<.01), no primary relationship (r =.185, p<.01), shorter time with primary partners (r=.191, p<.05), multiple female partners (r=.169, p<.05), and a primary relationship with a man (r =.208; p<.01).

Conclusions:
Understanding perceptions of risk while taking into account the unique contexts of the lives of WSW may help guide targeted public health interventions that address HIV-risk in this group. Healthcare providers should collaborate with HIV educators and public health officials to help them understand the HIV risk posed to WSW. HIV education programs for WSW need to include facts and statistics on WSW and HIV, condom and barrier use instructions, HIV testing information to increase the knowledge about HIV and perceived susceptibility to HIV. Providing HIV education and creating increased awareness of risk factors can help decrease the stigma surrounding the disease. Designing successful HIV prevention efforts that focus on reducing HIV risk behaviors and enhancing protective factors in WSW may require an understanding of the interplay of a variety of factors. Efforts designed on reducing HIV-risk behaviors and enhancing protective factors may require an understanding of the interplay of a variety of factors.

Keywords:

Lesbians, WSW, bisexual women, HIV risk, sex education, sexual behavior.