Despite the popular image of “invulnerability,” women who have sex with women (WSW) in southern Africa are living with, or are at risk of contracting HIV. This is according to a new study led by the Human Sciences Research Council (HSRC) of South Africa and Columbia University, along with partner organisations in four southern African countries. The findings suggest that WSW need to be tested for HIV and other STIs, and public health authorities need to undertake significant HIV outreach, support and education to lesbians and other women who have sex with women.

This participatory research project conducted in 2010, explored the risks of HIV infection, infection rates and vulnerability among WSW in four high HIV-prevalence southern African countries: Botswana, Namibia, South Africa and Zimbabwe. Working through community organisations, a total of 591 women (18 years and older) were recruited to participate in the study. All participants had sex with a woman in the preceding year, most identified themselves as lesbian, and a large majority described themselves as black.

Over three-quarters (78.3%) of the women had been tested at least once for HIV. Those reporting more sexual partners (both female and male) were more likely to have been tested. However, women who had engaged in sex in return for money, goods, or favours (i.e., “transactional” sex), were less likely to have received an HIV test. Over one out of six of the respondents (18.6%) reported that they had engaged in transactional sex at some point in their life.

Self-reported HIV prevalence among women who knew their serostatus was 9.6%.  Age was a strong predictor of HIV positive serostatus, as was having experienced forced sex by men, by women, or by both men and women. Just over 31% of all participants reported that they had forced sex by men or women. Almost half of the women reported having had sex with men at some point in their lives. An HIV prevalence of 9.6%, although lower than overall seroprevalence in the respective communities, is significantly higher than would commonly be expected.  This is in contrast with the overall  perception that WSW are not at risk of contracting HIV, and the few research studies that have been conducted about female-to-female transmission rates suggest that such transmission is extremely rare, if not zero.

“There is a common misperception that lesbian women don’t have to worry about HIV infection. These data remind us that this is not the case,” noted investigator Dr Theodorus Sandfort of the HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute and Columbia University.

“This study could not test for the possibility of female-to-female transmission. Several of the women living with HIV had, however, none of the traditional risk factors. Some women had no idea how they contracted the virus. We clearly established that self-identification as ‘lesbian’ should not be interpreted as ‘no HIV’ or ‘no risk’,” said Sandfort. “The relatively high prevalence of HIV among the study participants and the fact that forced sex was the most important risk factor indicates the importance of acknowledging WSW living with HIV, and at the same time, addressing HIV prevention needs of WSW.”

The research project was designed and implemented in collaboration with the following community organisations: Behind the Mask SA, Durban Lesbian and Gay Community & Health Centre SA, Forum for the Empowerment of Women SA, Gays and Lesbians of Zimbabwe, LeGaBiBo (Lesbians, Gays and Bisexuals of Botswana), OUT LGBT Well-Being SA, Out-Right Namibia, and Triangle Project SA. The project was funded by Open Society Initiative for Southern Africa, United Nations Development Programme, and Open Society Foundations; these organizations also participated in the study.

Study findings were published in PLOS ONE, accessible through: http://dx.plos.org/10.1371/journal.pone.0053552

For interviews or further information:

Vasu Reddy, Human Sciences Research Council, Pretoria South Africa, +27 82 3372057, vasureddy@hsrc.ac.za

Linda Baumann, Out-Right Namibia,  Namibia, +264 81 2528259

Theo Sandfort, New York State Psychiatric Institute and Columbia University, New York, USA, +1 212 543 5925, tgs2001@columbia.edu