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Women

In the early years of the HIV epidemic, most believed that women could not get HIV. HIV was though of as a "gay disease." However, the proportion of adolescent and adult women living with AIDS has tripled in the last decade. The CDC reports that in 1986 women represented 7% of all reported AIDS cases and by 1999 this number jumped to 25%. Today women represent 27% of new HIV infections and the majority of these new infections are among women of color. Today HIV/AIDS is the fifth leading cause of death for women ages 25-44.

Am I at risk for HIV transmission?

Because of biological and societal factors ALL women are at risk for HIV infection. In the U.S., if you are a woman of color (particularly African-American and Hispanic) you have a greater risk for HIV infection.

Resources: Kaiser Family Foundation, UNAIDS, United States Centers for Disease Control and Prevention

How is HIV transmitted?

The Human Immunodeficiency Virus (HIV) is transmitted from one person to another through the following means:
•    Blood (including menstrual blood)
•    Semen (including pre-seminal fluid or "pre-cum")
•    Mother to child - perinatally (pregnancy, labor, delivery) and/or breast milk

What are the most common routes of HIV transmission for women?

Unprotected sex with men (vaginal and anal) In 2007 there were an estimated 107,000 women in the U.S. who reported HIV transmission as a result of a heterosexual exposure. The majority of these women were infected through unprotected sex with an injection drug user.
Injection Drug Use (IDU) In 2007, an estimated 39,000 women reported HIV transmission as a result of injection drug use (sharing needles and 'works').
Pregnancy, labor, delivery or breast-feeding accounts for 91% of mother to child transmission of HIV in the United States. The number of perinatal transmissions have declined 75% since 1998, however it still remains a risk factor among child-bearing women. The best way to prevent mother to child transmission remains early prenatal care and HIV counseling and testing during pregnancy.

Resources: United States Centers for Disease Control and Prevention

I am not sexually active and I don't use drugs. Am I at risk?

For some women refraining from all sexual activity is the preferred method of HIV and other STD prevention. In these situations, your risk is not biological exposure but social. All women, regardless of sexual activity are at risk for HIV transmission from sexual violence (rape, incest and sexual abuse). Once you decide to become sexually active, it will be important to know your partner's status to ensure that you stay negative.
Abstinence is defined in various ways. For some, abstinence means refraining from some types of sexual activity but not all. For example, some choose to refrain from vaginal penetration but not from oral sex. Some women refrain from vaginal but not anal sex. However, if you plan to engage in any sexual activity, it is important to know the level of risk for HIV transmission for that activity.

Lesbians & HIV

The latest CDC report on woman to woman (WTW) transmission of HIV reports that it is rare. Of the 109,311 cases of AIDS reported among women through 1998, 2,220 reported having sex with women. However, the majority of these women also reported other high risk behaviors such as drug use and unprotected sex with high-risk men (gay and bisexual men). Of these cases, 347 women reported having sex only with women.

In February 2003, AIDSmap.com reported a rare case of female to female transmission from the Clinical Infectious Disease Journal. The case refers to HIV transmission in a serodiscordant couple in which one of the females was HIV-positive. The HIV-positive partner was also having sex with men and while she used protection with her male partners, she did not use any barriers with her female partner. The report postulates that HIV transmission could have occurred as a result of transmission blood transferred from sex toys.

Can lesbians get HIV?

YES. Sexual orientation is not the same as sexual behavior. Many women who identify as either heterosexual or lesbian have sex with men for a variety of reasons that run the gamut from pleasure to cultural expectations and taboos to committed relationships (including marriage). A woman's sexual behavior (i.e., the partners she chooses) may not be consistent with her stated sexual orientation.

What are the behaviors that place lesbians at risk?

Primarily, the behaviors that put lesbians at risk are:

  • Unprotected sex (anal and vaginal) with men (gay, bisexual, heterosexual)
  • Injection Drug use
  • Exposure of mucous membranes to vaginal secretions and menstrual blood in woman to woman sex

Can I get HIV from having unprotected sex with only women?

If your partner is HIV-positive, the HIV virus will be in her vaginal secretions and menstrual blood. Exposure to these secretions through the mucous membranes (mouth and vagina) could lead to HIV transmission. For this reason, the CDC contends that WTW sexual contact is a possible means of HIV transmission. There is still much we don't know about HIV transmission between women. In part, this is due to the wide range of sexual practices between women. However, there are documented cases of HIV transmission between women whose only risk is unprotected sex with another woman. The most recent recorded case was in February of 2003. The decisions you make about HIV and STD risk are best discussed with your partner. If you can't discuss it with your partner or you don't have a regular sexual partner, it is important to educate yourself about levels of risk and take appropriate steps to reduce the potential of HIV transmission.

What can I do to reduce the risk of woman to woman HIV transmission?

Generally the guideline is as follows:

  • High-risk behaviors include direct contact with menstrual blood and vaginal secretions, unprotected sex with high-risk men and intravenous drug use
  • Medium risk behaviors include oral sex, assuming your partner does not have sexually transmitted infections and your partner is not menstruating
  • Lower risk behaviors include any activity that does not come into direct contact with menstrual blood and vaginal secretions

Resources: United States Centers for Disease Control and Prevention, aidsmap.com, Lesbian AIDS Project Safer Sex Brochure

 

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