This is an archived article.

August 6, 1996

First study of small-town lesbian and bisexual women indicates significant percentage may be at risk for contracting HIV

In the first study of lesbian and bisexual women living in small towns and their behavior and knowledge concerning HIV, researchers have found that a significant percentage of them may be at risk for contracting the virus. While some of the women may believe being lesbian or bisexual protects them, their high-risk behavior puts them in danger of contracting HIV, according to the study published in the current issue of Public Health Reports, a journal of the U.S. Public Health Service.
Researchers from the University of Washington and the Medical College of Wisconsin in Milwaukee surveyed more than a thousand women who frequented gay bars in 16 cities and found that their sexual behavior and risk of contracting HIV are comparable to a group of San Francisco lesbian and bisexual women surveyed in 1995.

“The problem is some women in our study are not thinking about what the major risks are and how they can protect themselves,” said Ann Duecy Norman, director of the UW Women’s Health Project in the School of Social Work and lead author of the article. “In addition to IV drug use and sharing contaminated needles, there are a number reasons why these women may be at risk for HIV. Lesbian and bisexual women, like other women, may not be able to negotiate successfully for safe sex with men. They also may feel their sexual identity protects them and they ignore taking precautions.

“We didn’t find any evidence of woman-to-woman transmission of HIV. All of the women who were infected reported intravenous drug use or having unsafe sex with a man, (more) but we can’t rule out other explanations. A women may have become infected in some other way, such as through a blood transfusions or artificial inseminations. Although the biologic risk of HIV infection through female-to-female sex remains unknown, it shouldn’t be ignored.”

The researchers asked women who entered gay bars to fill out anonymous questionnaires. The survey collected information about the women’s social and drug behaviors, knowledge of AIDS and demographic data. The bars were located in four cities in Wisconsin and New York and two each in Washington, North Carolina, West Virginia and Montana. The cities ranged in population between 50,000 and 180,000 and were at least 50 miles from cities of similar or larger size.

Of 1057 respondents, 565 women identified themselves as lesbians and 285 were classified as bisexual. Of these women, 44 percent said they had been tested for HIV and 1.4 percent of that group tested HIV positive.

Norman said the infection rate may be understated because many people in small towns don’t want it known that they’ve been tested or that they are HIV positive. In addition, 56 percent of the lesbians and bisexuals hadn’t been tested and some are likely to be HIV positive.

The 1.4 percent HIV infection rate is similar to the 1.2 percent reported in the San Francisco survey. The San Francisco infection rate was estimated to be two to three times higher than that of straight adult and adolescent women living in the area.

The women in the small towns were generally well informed about HIV transmission, according to the survey. However, 9 percent of the lesbians and bisexuals reported IV drug use and 6 percent said they had unprotected sex with men — some of whom were engaging in high-risk behavior — during two months prior to the survey. Because of this behavior, Norman estimated that at least 23 percent of the bisexual women and 9 percent of the lesbians were putting themselves at high-risk for contracting HIV.

Norman emphasized that the survey was a sample of women who go to gay bars and not one that represents the entire lesbian and bisexual community. “You have to remember that a lot of bisexual and lesbian women don’t go to bars,” she said. “Many are still closeted and wouldn’t go to a public place, such as a gay bar, where they could be recognized.”

In addition, she noted that the women’s sexual orientation is flexible, rather than dichotomous, and this has major implications in designing HIV prevention programs.

“Sexual orientation among lesbian and bisexual women is very complex and shifts take place between sexual orientation and sexual behavior. There were a number of (more) women who said they were exclusively heterosexual or homosexual despite also saying they had other types of relationships.

“People working in HIV prevention should not make assumptions of sexual behavior on the basis of a person’s stated sexual orientation. Our inability as a society to speak openly about our sexual behavior gets in the way of dealing with prevention effectively,” Norman said.

Co-authors of the study are Roger Roffman, UW professor of social work; and Melissa Perry, an assistant professor, Yvonne Stevenson, a researcher, and Jeffrey Kelly, a professor, at the Medical College of Wisconsin’s Center for Aids Intervention Research.

For more information, contact Norman at (206) 543-7511 or via e-mail at duecy@u.washington.edu or Perry at (414) 765-8820 or at mperry@post.its.mcw.edu.