Southern African Lesbian and Bisexual Women Responses to Symptoms of Sexually Transmitted Infections (original) (raw)
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Reproductive Health Matters, 2016
BACKGROUND In the context of widespread homophobia throughout Africa and other regions in the world, South Africa is often seen as a beacon for upholding sexual rights. After South Africa's transition to democracy, lesbian and gay people's rights became more actionable, given the 1996 Constitution's assurance of equality. 1 Over the past two decades a further set of civil rights, including same-sex marriage, were secured by South Africa's lesbian, gay, bisexual and transgender (LGBT) movement, which is remarkable when compared to the overall negative climate towards sexual minorities elsewhere in Africa. 2 Additionally South Africa has consciously struggled "against policies and laws that sought to exclude and marginalise people based on race, class, sex, gender, religion, age, disability and sexual orientation"…as part of the ongoing agenda of the International Conference on Population and Development. 3 Nevertheless, homophobic discrimination persists in South Africa and a 2008 general population survey by South Africa's Human Sciences Research Council (HSRC) showed that 80% of adults believe that same-sex behaviour is 'always wrong'. 4 LGBT people in South Africa experience discrimination and harassment, particularly in resource-poor settings, in rural areas and townships. 5 Lesbian and bisexual women or women who have sex with women (WSW) experience marginalisation "both as women and as women who have sex with women living in a patriarchal, heterosexist society". 6 Social marginalisation is not an uncommon experience for LGBT people, but in South Africa, where the burden of HIV is among the highest worldwide, lesbian and bisexual women experience greater vulnerability to sexual ill-health. Research conducted within South African LGBT communities over the past decade identified HIV prevalence among black WSW at 9% and found they were at greater risk compared to white WSW. 7,8,9,10,11 A multi-country study found that WSW in South Africa and other countries in Southern Africa face sexual health risks both within same-sex relationships as well as in heterosexual experiences, including transactional sex with, and forced sex by men. Of WSW
Background: Over the past two decades research on sexual and gender minority (lesbian, gay, bisexual and transgender; LGBT) health has highlighted substantial health disparities based on sexual orientation and gender identity in many parts of the world. We systematically reviewed the literature on sexual minority women's (SMW) health in Southern Africa, with the objective of identifying existing evidence and pointing out knowledge gaps around the health of this vulnerable group in this region. Methods: A systematic review of publications in English, French, Portuguese or German, indexed in PubMed or MEDLINE between the years 2000 and 2015, following PRISMA guidelines. Additional studies were identified by searching bibliographies of identified studies. Search terms included (Lesbian OR bisexual OR " women who have sex with women "), (HIV OR depression OR " substance use " OR " substance abuse " OR " mental health " OR suicide OR anxiety OR cancer), and geographical specification. All empirical studies that used quantitative or qualitative methods, which contributed to evidence for SMW's health in one, a few or all of the countries, were included. Theoretical and review articles were excluded. Data were extracted independently by 2 researchers using predefined data fields, which included a risk of bias/quality assessment. Results: Of 315 hits, 9 articles were selected for review and a further 6 were identified through bibliography searches. Most studies were conducted with small sample sizes in South Africa and focused on sexual health. SMW included in the studies were racially and socio-economically heterogeneous. Studies focused predominately on young populations, and highlighted substance use and violence as key health issues for SMW in Southern Africa. Conclusions: Although there are large gaps in the literature, the review highlighted substantial sexual-orientation-related health disparities among women in Southern Africa. The findings have important implications for public health policy and research, highlighting the lack of population-level evidence on the one hand, and the impact of criminalizing laws around homosexuality on the other hand.
PloS one, 2013
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.
2011
South Africa is home to the largest population of people living with HIV/AIDS (PLWHA). Of this population gender non-conforming women like women who have sex with women (WSW) remain undocumented. This study is an attempt to fill this information gap as it describes the demographic, health and sexual behaviours of 72 HIV positive WSW. The data indicate that WSW are not protected from HIV because of their same sex desires. These findings suggest the need to include WSW as a most at risk group for both HIV prevention and treatment programmes. Key words: Women who have sex with women (WSW), lesbians, HIV positive, corrective rape, female-to-female transmission of HIV, South Africa.
Despite the high prevalence of HIV and STIs among women in Africa and the growing literature on HIV and STIs among women who have sex with women, research on the sexual health of women who have sex with women in Africa is scant. This study used mixed methods to describe sexual identity, practices and health among women who have sex with women in Lesotho. Most respondents (48%) described themselves as lesbian, 29% as bisexual and 23% as heterosexual. Almost half (45%) had disclosed their same sex attraction to family, but only 25% had done so with healthcare workers.A total of 8% reported having HIV. Self-reported HIV was associated with having three or more male partners, having male and female partners at the same time and having a history of STIs. Gender norms, the criminalisation of homosexuality, varied knowledge of, and access to, safer-sex strategies, and mixed experiences of HIV/STI testing and sexual healthcare provided social and structural contexts for HIV- and STI-related vulnerability.