Lesbian and Bisexual report 2006
Women’s Health: Common Concerns,
Local Issues
Sexually transmitted infection 18 / 19
and HIV/AIDS
Sexually transmitted
infections and hiv/aids
Lesbian and bisexual women began working with gay, bisexual and transgender men as
part of the community of sexual minorities in a more significant way when the latter started
working on AIDS and HIV issues. Although lesbian and bisexual women were active in the
AIDS campaigns, they were cast mainly in a supporting role, because lesbians were supposed
to be the least vulnerable to the risk of this disease. But this attitude did not take into consi-
deration the fact that in many parts of the world most women, whether they are lesbians or
not, have to be married simply to survive. Hence, the same level of risk to get the virus. While
concern for men’s health rose with worldwide attention to AIDS, the health needs of lesbian
and bisexual women had little support and received no interest from the public. Even today
there is little research on transmission of HIV virus and other sexually transmitted infections
– STI - between two women, as compared to the research made for gay men. This leads to
belief amongst lesbian and bisexual women themselves that they are immune to contracting
sexually transmitted infections when having sex with another woman. Although there is no
unanimity on this issue, some women and lesbian organizations have started to raise aware-
ness and educate their community in order to get one message across: HIV and STIs can also
be transmitted between two women.
Women comprise about half of all people li- SEXUALLY TRANSMITTED
ving with HIV worldwide. In sub-Saharan INFECTIONS (STIs)
Africa, where the epidemic is worst, they PRAZER SEM MEDO. AN INTERWIEW
make up 57% of people living with HIV; and WITH MÍRIAM MARTINHO.
three quarters of young people infected on
the continent are young women aged 15-24. Um Outro Olhar is an information network for
In unprotected heterosexual intercourse, a lesbians, created in 1989, and is the oldest civil
female is about twice as likely as a male to society organization defending lesbian rights in
contract HIV from an infected partner. Fur- Brazil. They work on health issues and human
thermore, in addition to their higher biologi- rights of women and sexual minorities through
cal vulnerability, girls and women are made two main approaches: information, education
particularly vulnerable to HIV by conditions and communication as well as behavioural inter-
of gender inequality. Economic and social de- vention. The organization produced a brochure
pendence on men often limits women’s power called “Prazer sem medo” (Pleasure without
to refuse sex or to negotiate the use of con- fear), which aims at spreading information wi-
doms. And inadequate access to education thin the lesbian and bisexual communities on the
and employment opportunities encourages importance of health care in general and gynae-
many women to sell or barter sex to survive. cological care in particular. It describes how to
Sexual inequality endangers women’s lives, perform breast examination on one’s own, how
and gender issues must be taken into consi- to practice safer sex and gives basic tips on ha-
deration in the design of HIV prevention and ving an active approach towards health.
care programmes.
Your organization is defending lesbian rights,
Unaids 2004
www.unaids.org namely human rights, in Brazil. Why work
specifically on lesbian health issues?
There is a lot of misinformation with regard to
women’s health, specifically the health of wo-
men who have sex with other women. This was
the main reason for us to launch our projects
around the health of lesbians and for lesbians.
We were the first lesbian group to do this in
Lesbian and Bisexual Women’s Health: Ilga report
Common Concerns, Local Issues
Brazil, beginning in 1995, with the support of its plan to provide funding for this campaign
the Health Department.Um Outro Olhar has for the lesbian community. It is currently giving
two main lines of work: health and human ri- priority to more vulnerable groups, such as the
ghts. We address them separately for practical people with AIDS and women in poverty.
reasons, but obviously they are intertwined. www.umoutroolhar.com.br
The right to health is a basic human right. In
our country, access to health services is diffi- HIV/AIDS AND GENDER-BASED
cult for the majority of the population, not to VIOLENCE
speak of socially discriminated people like les-
WHEN GENDER-BASED VIOLENCE IS
bians. We seek to inform the lesbian commu- COMBINED WITH HIV/AIDS, THESE
nity and people in general about the specific TWO SCOURGES ARE EVEN MORE
nature of lesbian health needs, in order to pre- LETHAL THAN EACH WHEN VIEWED
vent prejudice from undermining the quality of AS MUTUALLY EXCLUSIVE.
health care for lesbian patients.
Engender is a South African NGO engaged in
In the title of your brochure “Prazer sem research and capacity building in the areas of
medo” you link health and sexual pleasure. genders and sexualities, justice and peace. Its
Why did you connect those two subjects objective is to provide participatory research and
together? facilitation services directly to communities of
people, in particular the women’s and peace mo-
As from the 1980’s, with the AIDS pandemic,
vements, for their self-empowerment. Its foun-
there was a widespread fear of catching an
ding Director, Bernedette Muthien explored the
illness through sexual contact. Although les-
intersections between gender violence and HIV/
bians consider themselves immune to AIDS,
AIDS in South Africa and identified the services
the discussions raised around HIV also called
available, if any, to address both problems. More
for the discussion of STI; lesbians then beca-
importantly, she details the impact of HIV/AIDS
me interested and concerned. No one wants
on female survivors of gender violence (rape/
to give up pleasure in erotic-emotional rela-
sexual assault and domestic violence), and talks
tionships; but we do want to enjoy in a heal-
about the needs of these women and how they
thy way, feeling safe. The title of our brochure
can be met. Below are a few extracts that speak
“Prazer sem medo” is meant to stress the fact
for themselves:
that it IS possible to have both things (pleasure
and health) together.
“Southern Africa is at present confronted with
two key epidemics: HIV/AIDS and gender-
How was this brochure welcomed among the
based violence. When gender-based violence
Brazilian lesbian communities?
is combined with HIV/AIDS, these two scourges
It was warmly welcomed. The two printed are even more lethal than each when viewed
versions “sold out”! We are printing the third as mutually exclusive. Since the prevalence
edition in 2006. With around 1300 visitors a of HIV/AIDS in South Africa is at least 10% of
day, the digital version in our website is widely the population nationwide, it can be assumed
used. Some organizations ask us for printed that women (and less frequently children and
versions for them to use in workshops and lec- men) who are subjected to coercive sexual
tures. We did not have problems of any kind intercourse, from stranger rape to sexual in-
with the authorities. On the contrary, both tercourse in relationships subject to domestic
printed editions were sponsored by govern- violence, are at greatest risk of being infected
mental agencies; this will also be true for the with HIV, in part due to their lack of power to
third edition. negotiate safer sex practices.”
What other types of information campaigns “[Due to] the perception that HIV does not af-
on health do you envisage? fect dykes - there is minimal literature on HIV
and dykes. But because of gender-based vio-
Another interesting campaign on lesbian health
lence, dykes are at higher risk, especially spe-
would be one targeted to physicians, especially
cifically [if violated] on the basis of [their]
gynecologists. The government shows interest
in the health topic, but we don’t know if it is in
Sexually transmitted infection 20 / 21
and HIV/AIDS
sexuality. (…) we need to repackage the issue “Since services are geared towards hetero-
and encourage women to test for HIV, perhaps sexual women, lesbians and bisexuals face not
as a sub-issue to why they come in. Broadly, only the silence and stigma about their sexua-
women are very susceptible to [HIV] infection, lity, but also about their experiences of gen-
but they are always referred to heterosexual der-based violence. (…). Homophobic paranoia
organizations. The organization needs to crea- is even worse than for HIV. Lesbian sexuality is
te understanding. Lesbians who have sex with an even greater threat for women’s sexuality,
men are also a huge issue.” with the false belief that lesbians are a danger
to children - what they [shelter residents es-
“(…)“It is worse for lesbians in every sphere, caping domestic violence] fear is that lesbians
for example medical treatment. (…) Intersec- would sexually molest their daughters and/or
tionality of oppressions is important since it sexually molest other shelter residents. So,
compounds one’s experience of oppressions, for example, they won’t go into the bathroom
for example they love you on the stage as an if a lesbian is there already. The biggest fear of
artist, but they don’t want you as part of the moms is of their boys being feminine.”
family”. The issue of lesbianism is further exa- “Strategic Interventions:
cerbated by the large-scale invisibility of wo- Intersections between Gender-Based Violence & HIV/
men in general.” AIDS” by Bernedette Muthien / Engender
www.engender.org.za
GENDER, HEALTH AND AIDS
NEGOTIATING SAFER SEX IS OFTEN NOT A REALISTIC EXPECTATION
The issue of women and AIDS is centred on empowerment and training women to negotiate
for safer sex, for their bodily integrity. Often women do not have much choice and are not in
a position to negotiate in developing countries. If lesbians and bisexual women are at risk at
all, it is from having relations still with a man because of the unequal status of women. In a
developing country, negotiating is often not a realistic expectation. When a woman negotiates
for safer sex or refuses sex, she can become a victim of violence. The Philippines is one of
the biggest suppliers of labor in the world. Most of them are domestic helpers and seafarers.
Seafarers’ wives do not see their husbands for years. When the men return, sex is on demand
and unprotected. The women presume that their husbands had been celibate. Many HIV ca-
ses have arisen due to the situation wherein a woman gets a sexually transmitted infection
from her husband who demands unprotected sex. (…) The difference between the way men
and women behave in sex is that women are conditioned to be celibate or monogamous while
men are allowed many partners. Even men having sex with men feel a sense of entitlement
whether to have safe or unsafe sex. Gay men must also look into women’s issues, these being
an issue of disempowerment or disenfranchisement. The lower status of women must be
addressed.
Anna Leah Sarabia. From the workshop held on Gender,
Health and Aids at the 22nd ILGA World Conference, November 2003, The Philippines.
Lesbian and Bisexual Women’s Health: Ilga report
Common Concerns, Local Issues
HARMFUL CULTURAL PRACTICES AND HIV/AIDS
WHAT IS A NAMIBIAN WOMAN’S CHANCE TO SURVIVE THE HIV/AIDS
PANDEMIC?
“Young women are given away to uncles and cousins, usually men who are much older then
themselves. Young women in these communities do not have a choice; parents and other clan
members decide to whom they will be given into marriage. This is done in order to keep the
wealth in the extended family. This harmful practice violates young women’s rights to choice
and freedom of association, and puts them at risk of HIV and AIDS.”
“The practice of ‘dry sex’, in which women use herbs to dry out the vagina and thereby enhan-
ce the sexual pleasure of men, leads to the tearing of the wall of vagina and exposes women
further to infection with HIV.”
“A ‘good marriageable woman’ is believed to be silent, obedient and shy. Our girls are raised
not to challenge and demand, but to obey. This is further reinforced by different religions
that teach women to obey their husbands at all costs. What is a Namibian woman’s chance
to survive the HIV/AIDS pandemic? Discussions of sex are seen as dirty and taboo, and men
are seen as the ones who are supposed to take the initiative in sexual matters. How can wo-
men and young women confront boys and men in such situations? Moreover, divorce is out of
question for many women, who have to endure domestic violence, including the violation of
becoming infected by a promiscuous husband ‘until death do us part.’ ”
“Some traditional healers encourage men to sleep with babies and virginal young girls to
cure themselves from HIV/AIDS.”
From a Press statement issued by Women’s
Leadership Centre, Namibia, 24 November 2005
Sexually transmitted infection 22 / 23
and HIV/AIDS
approach than traditional sexual
health advertising. Equal is keen
ACON to promote the different ways to FREEDOM AND ROAM
www.acon.org.au have safer sex, including mutual UGANDA (FAR)
It is an Australian health promo- wanking and using sex toys. All the www.faruganda.4t.com
tion organization based in the gay, images are real lesbians that live in This lesbian association was es-
lesbian, bisexual and transgender Glasgow. tablished in 2003 by a group of
communities with a central focus on lesbians who were constantly ha-
HIV/AIDS. It provides HIV prevention, STIs are the domain of gay men rassed, insulted and discriminated
health promotion, advocacy, care and heterosexuals right? Wrong. against by a misinformed society
and support services to members Oral and other kinds of sex carry a in Uganda. Its objective is the at-
of those communities. ACON de- risk for lesbians, too; and it’s worth tainment of full equal rights of les-
veloped and produced a campaign knowing about them. Nicky Coia, bians, bisexuals and transgender
around HIV and STI prevention for Senior Health Promotion Officer, women, as well as the removal of
lesbian and gay people called “Ma- of NHS Greater Glasgow said: “One all forms of discrimination based
tes look after each other”. challenge with the women’s work on sexual orientation.
has been issues of how women
choose to be represented visually The organization has a regular
without falling into stereotypes, radio talk show aimed at raising
AIDE SUISSE and also about how risque langua- awareness about the existence of
CONTRE LE SIDA ge could be used. A small number LGBT people in Uganda and infor-
www.aids.ch of women really didn’t like the hea- ming, educating, as well as calling
dline in STI image, although by far lesbians to join forces and support
The Swiss AIDS Federation is active
and away the majority did. This has the struggle. It also offers counsel-
in the fight against the spread of HIV/
been difficult to balance with the ling services to lesbian, bisexual
AIDS and other sexually transmitted
needs of other women who have and transgender women. The FAR
infections and is committed to ensu-
berated us for not daring to use the team also participates in the for-
ring quality of life for those infected.
word c*nt to describe vagina!” mulation of the Uganda HIV/AIDS
The website provides general infor-
mation about HIV/AIDS in English, policy and works hand in hand with
French, German and Italian. Sexual Minorities-Uganda (SMUG),
an alliance of LGBT organizations
EURO-MEDITERRANEAN in Uganda.
The manual “La santé: Parlons-en!”
UNIVERSITIES
(Let’s talk about health) is intended
OF HOMOSEXUALITIES
for lesbian and bisexual women.
(UEEH)
Among others, the booklet talks
www.ueeh.org GENDERDOC – M
about gynecological examinations,
menopause, HIV/AIDS, violence The Euro-Mediterranean Univer- www.gay.md/lesbi/eng
towards women and among same- sities of Homosexualities take The Informational Center on Gen-
sex couples. The last chapter gives place every year in July when se- der Studies is the only organization
a list of Swiss lesbian, women and veral hundred LGBT people meet for gays and lesbians in Moldova
AIDS organizations. The manual is in Marseille, France. The UEEH is with a juridical status. The main
available in German and in French a place for exchange, debates, dis- goals of the organization are to pro-
on www.aids.ch/shop/e. cussions, conferences, workshops, mote health and sexual education
exhibitions. for youth, help them in their tran-
sition from adolescence to adult
In 2005, a workshop on lesbian life, support those representatives
EQUAL safer sex was proposed by Faina of sexual minorities who are discri-
www.equalonline.co.uk Grossman and Clotilde Genon. The minated against and help them find
content of this workshop included justice.
Equal was set up when several or-
prevention of STI for lesbians, such
ganizations agreed to work jointly
as the various types of STI contami- In November 2004 GenderDoc or-
to promote and enhance the sexual
nation; awareness raising; how to ganised a one-day seminar on les-
health information available to the
protect yourself; the link between bian and bisexual women STIs and
lesbian, gay and bisexual commu-
alcohol, drugs and prevention; the safer sex practices. It was mana-
nity in the West of Scotland, UK.
risk of hierarchisation of sexual ged by a team of lesbian activists:
A three-year campaign was laun-
practices; exclusion of those con- Faina Grossman, Lada Pascar and
ched in 2004 featuring advertising
sidered sick; access to the various Olesea Bondarenko. Participants
that tackles lesbian and gay sexual
means of protection; how to facili- discussed different issues in rela-
health issues so that people can
tate discussion on lesbian sexua- tion to STIs: what is safer lesbian
enjoy more fun and fulfilling sex
lity. The workshop was for lesbians, sex, the degree of danger in trans-
lives, regardless of whether you
women and transgender women mitting HIV/AIDS among female
have no partner or lots of partners!
only. lovers, the issue of trust between
The ads have been designed to
take on a slightly more humoristic long-time partners, vaginal infec-
tions that are not transmitted du-
Lesbian and Bisexual report 2006
Women’s Health: Common Concerns
and Local Issues
ring sex, the necessity of open dia- how to deal with artificial insemi- and provides emotional support,
logue between partners in relation nation. A special section is dedi- sexual health promotion and in-
to STIs and sexual practices. cated to prostitution and advices formation to women. Lesbian line
for those using drugs and sharp is for women and staffed by wo-
GenderDoc produced a brochure instruments, piercing and tattoos. men who are lesbian. Many of their
on STIs and safer sex practices It also mentions lighter subjects, calls are about coming out, sexual
for lesbian and bisexual women. such as sports and other recrea- identity in general, sexual health,
The brochure covers the following tional activities and gives listings relationships, isolation and other
issues: information about STIs; of venues where one can buy pro- health and emotional matters.
vaginal infections and HIV/AIDS, tective devices and sex toys. There
including their symptoms; probabi- is a dictionary of terminology, the The leaflet “Lesbian Sex - Are you
lity of transmission to women ha- contact details of different groups as safe as you think?” describes
ving sex with women; preventative and an SOS line. The brochure is how lesbians are at risk of STI, It is
measures and treatment; safer sex distributed free of charge among not what you do but the way you do
practices and measures of protec- the lesbian communities in Serbia that can put you at risk is its main
tion while using different types of and Montenegro, Slovenia, Croatia, message. It details how STI can
lesbian sex (fingering, cunnilingus, Macedonia and Bosnia. be transmitted and how to protect
penetrative sex, anal sex, using yourself. This brochure has been
sex toys, etc). The brochure is dis- distributed to women’s organiza-
tributed free of charge among the tions and counselling centres.
lesbian and bisexual women com- LECRIPS
munity in Moldova and is available www.lecrips.net/L/
in Russian and Romanian. This French website offers various
documents and brochures that can MIXANGES
be easily printed out and dissemi- mixanges@yahoo.fr
nated. The brochure dedicated to Mixanges gathers a group of French
LABRIS gynecological follow up describes artists who carry out prevention
www.labris.org.yu/en/ how a gynecological visit is usually projects, namely via exhibitions.
A Serbian lesbian human rights carried out and why it is important The organization created STI/AIDS
group, Labris works on the elimi- to have preventive visits. The STI prevention postcards specifically
nation of all forms of violence and brochure describes the various targeted at young lesbians to make
discrimination against lesbians infections than can be contracted up for the lack of STI/AIDS preven-
and women of different sexual during sexual intercourse with tion information for young lesbians
orientation. Labris’ goals are to women, but also with men. The and bisexual women. The reverse
support lesbians and women of brochure on sexual orientation side of the postcards can be adap-
different sexual orientation in ac- describes coming out and negative ted and customised by any organi-
cepting their identities, promote and positive myths about homo- zation that wishes to use them for
the right to lesbian existence and sexuality. The website also propo- prevention purposes.
reduce public homophobia, coope- ses a game to be played in couple
rate with lesbian groups from for- or among friends to push people to
mer Yugoslavia and lesbian and gay talk freely about sexuality.
groups in Serbia and Montenegro, OUT
work on the change of legislation www.out.org.za
that would acknowledge the rights The pamphlet “Woman loving wo-
of the same-sex oriented people, LOTHIAN GAY & LESBIAN man and STI” provides information
lobbying non-governmental and SWITCHBOARD to both lesbian women and gay
governmental organizations to ac- www.lgls.co.uk men on HIV and STIs in South Afri-
knowledge lesbian rights as part of A help and support organization ca. It is targeted at younger, under-
human rights. for the LGBT community within the resourced gay and lesbian people.
Edinburgh and Lothian area and It deals with variations in women
“Sigurniji Lezbejski Sex” (Lesbian those living in other parts of United who have sex with women (WSW);
safer sex). This brochure is inten- Kingdom. It provides assistance to myths about the sexual health of
ded for women who identify them- families, friends and other suppor- WSWs; STIs, including common
selves as lesbians and for women ting organizations. Main services symptoms; what to do if you have
who have sex with other women. It include telephone and email sup- an STI; transmission of STIs, inclu-
includes detailed information about port and information on a range ding HIV; dealing with rape; safer
HIV/ AIDS; describes the anatomy of issues, including sexuality, rela- sex strategies.
of a vagina (called “inside story”); tionships and coming out.
and lists different types of lesbian
sex practices, including the use of The Lothian Lesbian Line is a vo-
dental dams, sex toys, dildos and lunteer run community service,
anal toys. It explains how to ne- part of Lothian Gay & Lesbian
gotiate sex and protection, how Switchboard. The helpline has
to take preventive measures and been in existence for over 30 years
Sexually transmitted infection 24 / 25
and HIV/AIDS
SENSOA THE YOUNG WOMEN’S
www.sensoa.be HEALTH PROJECT
Sensoa is the Belgian Flemish ex- www.likt.org.uk
pert organization on sexual health This British organization is run by
and HIV. Its strategy is determined and for young lesbian and bisexual
by five target group programmes: women. It works to improve young
children, young people and their lesbian and bisexual women’s
parents; adults; homosexuals, les- health by promoting activities
bians and bisexuals; migrants; and which address six areas of well-
people with HIV. ness: physical, emotional, intel-
lectual, spiritual, occupational and
The organization published an social/community. The organization
article in its 2005 yearbook on also issues a quarterly magazine
the health needs of lesbians in called LIK:T.
Flanders. The article contains an
analysis based upon a literature The organization created a “Guide
overview, a questionnaire taken to sex and relationships” to en-
amongst lesbians and interviews courage positive attitudes to being
with experts. It compares hetero- lesbian or bisexual. The guide con-
sexual to homosexual and gay male tains safer sex information, but
to gay female health problems and also a quiz on assertiveness, and
behaviours. Female cancers, do- information on relationships.
mestic violence, alcohol addiction,
relational problems with health
care professionals and institutions
seem to be different for lesbian THE WOMEN’S SUPPORT
and bisexual women. Motherhood, GROUP
menopause and aging also seem to www.wsglanka.com
have a different course specific to This organization supports lesbian,
lesbians. But above all, the article bisexual and transgender women
underlines that ignorance concer- in Sri Lanka. They regularly hold
ning homosexuality and absence of workshops on sexual health, sexual
items specific to homosexual men rights and sexuality. The purpose of
and women in the usual statistical having these workshops is to raise
collections contribute to the lack of awareness on women’s issues
reliable data. regarding sexuality and to give
Risico’s van onzichtbaarheid - Sek- knowledge about women’s health
suele, lichamelijke en emotionele related to STI/HIV, etc.
aspecten van de gezondheid van
lesbische vrouwen in Vlaanderen The Women’s Support Group has
(Risks related to lack of visibility - undertaken a series of workshops
Physical, psychological and sexual in the rural areas of the country,
aspects specific to female homo- with women leaders of the com-
sexual health in Flanders) - by munities. The main aim is to raise
Mark Sergeant. visibility of the organization as a
support group for lesbian, bisexual
and transgender women. In most
instances, they have held these
workshops for women community
workers who are leaders in their
own villages and districts. By ad-
dressing these women, they wish
to bring attention to the stigma and
discrimination faced by LGBT peo-
ple in their own surroundings. In
their activities they focus on gender
awareness in relation to society, as
sexuality and gender are intrinsi-
cally connected.