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HIV/AIDS and U.S. Women Who

Have Sex With Women (WSW)

Female-to-female transmission of HIV appears to be a rare occurrence.

However, case reports of female-to-female transmission of HIV and the well

documented risk of female-to-male transmission of HIV indicate that vaginal

secretions and menstrual blood are potentially infectious and that mucous

membrane (e.g., oral, vaginal) exposure to these secretions have the potential

to lead to HIV infection.

Through December 1998, 109,311 women were reported

with AIDS. Of these, 2,220 were reported to have had

sex with women; however, the vast majority had other

risks (such as injection drug use, sex with high-risk men,

or receipt of blood or blood products). Of the 347 (out of

2,220) women who were reported to have had sex only

with women, 98% also had another risk— injection drug

use in most cases.

Note: information on whether a woman had sex with women is missing in

half of the 109,311 case reports, possibly because the physician did not elicit

the information or the woman did not volunteer it.

Women with AIDS whose only reported risk initially is sex with women are

given high priority for follow-up investigation. As of December 1998, none

of these investigations had confirmed female-to-female HIV transmission,

either because other risks were subsequently identified or because, in a few

cases, women declined to be interviewed. A separate study of more than

1 million female blood donors found no HIV-infected women whose only

risk was sex with women. These findings suggest that female-to-female

transmission of HIV is uncommon. However, they do not negate the

possibility because it could be masked by other behaviors.

Surveys of risk behaviors have been conducted in groups of WSW. These

surveys have generally been surveys of convenient samples of WSW that

differ in sampling, location, and definition of WSW. As a result, their findings are not generalizable to all populations of WSW. These surveys suggest

that some groups of WSW have relatively high rates of high-risk behaviors,

such as injection drug use and unprotected vaginal sex with gay/bisexual men

and injection drug users.

HIV

Prevention Prevention

What do surveillance tools tell us about transmission between women?

What do investigations of female-to-female transmission show?

What are the behaviors that place WSW at risk of HIV infection?
 2 HIV/AIDS and U.S. WSW, July 2003

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What can WSW do to reduce their risk of contracting HIV?

Although female-to-female transmission of HIV apparently is rare, female sexual contact should be considered a

possible means of transmission among WSW. These women need to know:

❖ that exposure of a mucous membrane, such as the mouth, (especially nonintact tissue) to vaginal

secretions and menstrual blood is potentially infectious, particularly during early and late-stage

HIV infection when the amount of virus in the blood is expected to be highest.

❖ that condoms should be used consistently and correctly each and every time

for 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 or approved by the FDA. However, natural rubber latex sheets, dental

dams, cut-open condoms, or plastic wrap may offer some protection from contact

with body fluids during oral sex and possibly reduce the risk of HIV transmission.

❖ their own and their partner’s HIV status. This knowledge can help uninfected

women begin and maintain behavioral changes that reduce their risk of becoming infected. For women

who are found to be infected, it can assist in getting early treatment and avoiding infecting others.

Health professionals also need to remember:

❖ that sexual identity does not necessarily predict behavior, and that women who identify as lesbian may be at risk for HIV through unprotected sex with men.

❖ that prevention interventions targeting WSW must address behaviors that put WSW at risk for

HIV infection, including injection drug use and unprotected vaginal-penile intercourse.

For information about national HIV prevention activities, see the following CDC fact sheets:

* CDC’s Role in HIV and AIDS Prevention

* Linking Science and Prevention Programs—The Need for Comprehensive Strategies

For more information...

CDC National AIDS Hotline:

1-800-342-AIDS

Spanish: 1-800-344-SIDA

Deaf: 1-800-243-7889

CDC National Prevention Information Network:

P.O. Box 6003

Rockville, Maryland 20849-6003

1-800-458-5231

Internet Resources:

NCHSTP: http://www.cdc.gov/nchstp/od/nchstp.html

DHAP: http://www.cdc.gov/hiv

NPIN: http://www.cdcnpin.org