title: Forced sexual experiences as risk factor for self-reported HIV infection among southern African lesbian and bisexual women.
abstract: Even though women who have sex with women are usually understood to be at no or very low risk for HIV infection, we explored whether lesbian and bisexual women in a geographical area with high HIV prevalence (Southern Africa) get tested for HIV and whether, among those women who get tested, there are women who live with HIV/AIDS. The study was conducted in collaboration with community-based organizations in Botswana, Namibia, South Africa and Zimbabwe. Data were collected via written surveys of women who in the preceding year had had sex with a woman (18 years and older; N = 591). Most participating women identified as lesbian and black. Almost half of the women (47.2%) reported ever having had consensual heterosexual sex. Engagement in transactional sex (lifetime) was reported by 18.6% of all women. Forced sex by men or women was reported by 31.1% of all women. A large proportion of the women reported to ever have been tested for HIV (78.3%); number of lifetime female and male partners was independently associated with having been tested; women who had engaged in transactional sex with women only or with women and men were less likely to have been tested. Self-reported HIV prevalence among tested women who knew their serostatus was 9.6%. Besides age, the sole independent predictor of a positive serostatus was having experienced forced sex by men, by women, or by both men and women. Study findings indicate that despite the image of invulnerability, HIV/AIDS is a reality for lesbian and bisexual women in Southern Africa. Surprisingly, it is not sex with men per se, but rather forced sex that is the important risk factor for self-reported HIV infection among the participating women. HIV/AIDS policy should also address the needs of lesbian, bisexual and other women who have sex with women.
authors: HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, New York, United States of America. tgs2001@columbia.edu
authors: Theo G M
authors: TG
authors: Sandfort
authors: Linda R M
authors: LR
authors: Baumann
authors: Zethu
authors: Z
authors: Matebeni
authors: Vasu
authors: V
authors: Reddy
authors: Ian
authors: I
authors: Southey-Swartz
mesh_terms: D000328:Adult; D000353:Africa, Southern / Q000453:epidemiology; D001727:Bisexuality / Q000706:statistics & numerical data*; D005260:Female; D015658:HIV Infections / Q000453:epidemiology*; D006679:HIV Seropositivity / Q000453:epidemiology; D015497:HIV-1 / Q000276:immunology; D018452:Homosexuality, Female / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D012307:Risk Factors; D057566:Self Report; D012725:Sexual Behavior