| Women, Sex, & HIV
In the early years of the HIV epidemic, most believed that women
could not get HIV. HIV was 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 30% 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.
Globally, women represented 50% of the 42 million people living
with HIV/AIDS at the end of 2002. At the end of 2001, 58% of new
infections were among people under 25 years of age. There are 12
million cases of HIV/AIDS in 15-24 year olds worldwide.
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)
By 2000, 38% of women reported HIV transmission as a result of heterosexual
exposure. The majority of these women were infected through unprotected
sex with an injection drug user.
Injection Drug Use (IDU)
In 2000, 25% of 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?
Because so little is known about lesbian sexual practices or which
of these practices increase the risk of transmission, women who
have sex with women (WSW) have to decide which behaviors carry more
risk for them. Generally the guideline is as follows:
Respect Yourself! Protect Yourself
HIV is avoidable! Whether you sleep with men and/or women, there
are certain things you need to know about how to protect yourself.
Get Tested!
Knowing your HIV status
is very important.
If you test negative, you can take steps to remain negative by
educating yourself about safer sex practices and implementing them.
If you test positive, you can take steps to prevent the spread
of the virus to your partner(s). You will be able to make critical
decisions about your care. Also, you will need support to deal with
all the feelings and this new situation in your life.
Know your partner's HIV status!
Whenever possible, knowing your partner's HIV status will help
you make decisions about the level of risk you feel comfortable
with. With this knowledge you and your partner can choose methods
that reduce your chances of HIV transmission.
Educate Yourself!
Learn about available barrier methods (male and female condoms,
dental dams, etc.). The consistent and proper use of condoms has
been proven to significantly reduce the risk of HIV and other STD
transmission.
Get GYN exams and STD checks!
If you have a sexually transmitted disease (STD) like herpes, chlamydia,
gonorrhea or syphilis, it is easier to get HIV! Gynecological care
is very important. If left untreated, these diseases have other
significant health implications for women.
Reduce other high risk activities!
All alcohol and drug use impairs your judgment and puts you at
risk for HIV transmission. When you are "high" you may do
things you would not do when you are not, such
as engaging in risky sexual behavior or getting into unsafe situations
that could result in sexual violence. If you don't want to stop
using drugs and/or alcohol, you can still take steps to reduce your
risk for HIV transmission:
- Don't share needles. Clean your works.
- Know the people around you when you get high.
- Keep condoms and other barriers nearby, just in case you feel
frisky.
Injecting Drugs and Not Ready to Quit?
You can still protect yourself!
- Use a new needle every time you shoot up. In New York State
you can get clean needles from a needle exchange program or from
a local pharmacy without a prescription.
- Don't share your needles.
- If you can't get new needles, clean your "works" (the needle,
syringe, cooker, cotton and other equipment used to mix, prepare,
and inject intravenous drugs).
How to clean works
Step 1: Draw clean water all the way up into your
set, shake it and squirt it out. Repeat this process three times.
Step 2: Next, repeat this process twice using
full strength household bleach. Leave the bleach in for a total
of 30 seconds or more. You can also take your works apart and let
them soak in a bowl or pan full of 100% bleach for 10 minutes.
Step 3: Finally, flush again three times with
clean cold water (cold water rinsing prevents blood coagulation).
Step 4: Wipe the cooker with bleach-soaked cotton
and rinse with water. Throw away any cotton used for shooting drugs.
NEVER share or reuse the water, bleach, cooker or any parts of the
cotton.
It Takes Two! HIV Transmission and Talking
About Sex
Talk to your partner about sex and drug
use!
- Knowing you are in a mutually monogamous or open relationship
allows you to make different decisions about HIV
prevention.
- If your partner is using drugs intravenously and you are having
unprotected sex, you are at high-risk for HIV transmission. Although
you can't stop your partner from using drugs, you can protect
yourself by using a barrier when having sex.
What if I can't talk to my partner about
safer sex?
Talking about sex can be very difficult for women. It is not always
safe, either. If you are in a situation where your partner could
be physically violent or is physically violent toward you, your
first step is to get help. Talk to a professional who can support
you in making whatever changes you need to ensure your safety.
If you are unsure about how to begin a conversation about sex and
drugs with your partner, there is plenty of help. You can attend
a safer sex workshop in your community.
Barrier to Barrier
Male condoms
The consistent and proper use of condoms has been proven to significantly
reduce the risk of HIV transmission. Male condoms are made of latex
and some women have sensitivity to latex. If so, consult your health
care provider or local health clinic about other options. Do not
use condoms made of lambskin. Ribbed and textured condoms tend to
tear easily.
Gloves and finger cots - should be used for vaginal
and anal penetration.
Dental dams - are pieces of latex. Dental dams
are placed over the vagina, clitoris, and anus to prevent the transmission
of HIV and other STDs during oral sex. It is sometime referred to
as a latex barrier. We recommend that you use a dental dam when
you go down on a woman or when a male and/or female partner goes
down on you.
There are a lot of dental dams on the market and some women use
Saran Wrap as well. However only one, the Glyde dental
dam, has been approved by the FDA for STD prevention. If you are
using a lube to go down on a woman, remember: lube on one side of
the barrier and tongue on the other.
How to use a dental dam
Step 1: Rinse the powdery talc from the dental
dam, pat dry with a towel or let it air dry.
Step 2: Place water-based lubricant on the side
that faces either the female genital (vulva) or the anus.
Step 3: Place barrier on the genitals or anus.
Do not move the barrier back and forth between the vagina and the
anus as this can cause infection.
Step 4: Throw away the barrier after use. NEVER
share or reuse dams.
| Enemies of Latex
Unless stated, male condoms, dental dams, gloves and finger
cots are made out of latex: Do not use the following with
them: |
Vaseline
Crisco
animal fats
whipping cream
hand lotion
chocolate sauce |
mineral oil
baby oil
peanut butter
liqueurs
vegetable oil
|
massage oil
olive oil
butter
suntan oil
oil based perfumes |
Female Condoms
Female condoms are specifically designed for women. Female condoms
are made by only one company in the United States and are FDA approved
for the prevention for HIV and other STDs. They provide another
option for women to protect themselves from HIV and other STD transmission.
If you have sensitivity to latex, then the female condom may be
an option because it is made out of polyurethane. They are available
in most major drug store chains. In most cases, the condoms are
not displayed and you may have to ask for them. Female condoms are
significantly more expensive than male condoms but Medicaid will
pay for them as a contraceptive method.
Sex Toys
Use a condom when you share your sex toys for anal and vaginal
sex.
Lubricants
The use of "lubes" can add a lot of fun to sex. Lubes come in all
kinds of flavors and colors. There are two basic types: oil-based
and water (or silicon) based lubes. NEVER use oil-based lubricants
with male condoms. They break down latex and plastic wrap.
Sensitivity
Some people have sensitivity to some lubricants, condoms, gloves
and finger cots. This may irritate the vaginal wall which could
facilitate transmission of HIV and/or other STDs. You can test your
sensitivity by placing a finger full of the lube or placing the
barrier (condom or dental dam) in your vagina. If your body shows
signs of irritation ask your health care provider or local clinic
for alternatives.
NEVER use lubricants with Nonoxynol-9 (also known as N-9).
This is a chemical found in some spermicides and lubricants.
Recent research confirms that it is not an effective prevention
method for HIV and may irritate the vaginal wall and facilitate
the transmission for HIV. Many condoms come already lubricated with
N-9. When purchasing a condom that is already lubricated, make sure
that the lubricant does not contain N-9.
Microbicides
Microbicides are substances (e.g., creams, gels, etc.) that can
be inserted into the vagina and provide protection against HIV and
other STD transmission. Microbicides are still in the experimental
phase. Although you may find advertisements for microbicides on
the internet, the FDA has not approved ANY substances as proven
and safe methods for STD prevention. When an approved microbicide
becomes available it will provide women with another choice of STD
prevention. It is hoped that microbicides will provide a fully female
controlled method (i.e., unlike the male and female condoms, the
woman will not have to negotiate its use with her partner). To learn
more about microbicides or to get involved in community organizing
efforts to advocate for more federal and global funding for microbicide
research, check out the Global Campaign for Microbicides or the
Alliance for Microbicide Development.
© 2003 Gay Men's Health Crisis |
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