Abesha Care Intiative

HIV/AIDS among Women Who Have Sex With Women

To date, there are no confirmed cases of female-to-female sexual
transmission of HIV in the United States database (K. McDavid,
CDC, oral communication, March 2005). However, case reports of
female-to-female transmission of HIV and the well-documented risk
of female-to-male transmission [1] indicate that vaginal secretions
and menstrual blood are potentially infectious and that mucous
membrane (for example, oral, vaginal) exposure to these secretions
has the potential to lead to HIV infection.

STATISTICS

The following information comes from CDC unpublished data.

Through December 2004, a total of 246,461 women were
reported as HIV infected. Of these, 7,381 were reported to
have had sex with women; however, most had other risk
factors (such as injection drug use, sex with men who are
infected or who have risk factors for infection, or, more
rarely, receipt of blood or blood products).

Of the 534 (of 7,381) women who were reported to have had
sex only with women, 91% also had another risk factor—
typically, injection drug use.

HIV-infected women whose only initially reported risk factor is
sex with women are given high priority for follow-up
investigation. As of December 2004, none of these
investigations had confirmed female-to-female HIV
transmission, either because other risk factors were later
identified or because some women declined to be interviewed.

A study of more than 1 million female blood donors found no
HIV-infected women whose only risk factor was sex with
women. Despite the absence of confirmed cases of female-to-
female transmission of HIV, the findings do not negate the
possibility. Information on whether a woman had sex with
women is missing in more than 60% of the 246,461 case
reports―possibly because the physician did not ask or the
woman did not volunteer the information.

RISK FACTORS AND BARRIERS TO PREVENTION

Surveys of behavioral risk factors have been conducted in groups
of women who have sex with women (WSW). These surveys
generally have been of WSW samples that differ in criteria for
participation, location for recruitment, and definition of WSW. As a
result, the findings of these surveys cannot be generalized to all
WSW. The findings have, however, suggested that some WSW
have other behavioral risk factors, such as injection drug use and
unprotected vaginal sex with men who have sex with men (MSM) or
men who inject drugs.

PREVENTION

Although there are no confirmed cases of female-to-female
transmission of HIV, female sexual contact should be considered a
possible means of transmission among WSW. These women need
to know

their own and their partner’s HIV serostatus. This
knowledge can help women who are not infected to change
their behaviors and thus reduce their risk of becoming
infected. For women who are infected, this knowledge can
help them get early treatment and avoid infecting others.

the risk for exposure through a mucous membrane.
Potentially, HIV can be transmitted through the exposure of a
mucous membrane (in the mouth, for example), especially if
the tissue is cut or torn, to vaginal secretions and menstrual
blood. The potential for transmission is greater during early
and late-stage HIV infection, when the amount of virus in the
blood is expected to be highest.

the potential benefits of using condoms. Condoms
should be used consistently and correctly during every
sexual contact with men or when using sex toys. Sex toys
should not be shared. No barrier methods for use during oral
sex have been evaluated as effective by the Food and Drug
Administration. However, natural rubber latex sheets, dental
dams, condoms that have been cut and spread open, or
plastic wrap may offer some protection from contact with
body fluids during oral sex and thus may reduce the
possibility of HIV transmission.

Health care providers need to remember that sexual identity does
not necessarily predict behavior and that some women who identify
themselves as WSW or lesbian may be at risk for HIV infection
through unprotected sex with men.

REFERENCE
1. CDC. HIV and AIDS: Are You at Risk?

Content Source:
Divisions of HIV/AIDS Prevention
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention