Washington Blade - July 14, 2006
Elizabeth A. Perry

"We are not aware of any confirmed cases," said Dr. Patrick Sullivan, acting deputy director for science with the CDC's Division of AIDS Prevention.

But that fact comes with a few caveats: Women who have sex with HIV-positive men or share intravenous drug needles with a person with AIDS are engaging in high-risk activities. Blood transfusions and artificial insemination also can raise the stakes.

"But over the last couple of decades there has been a sustained systematic effort to understand the transmission risk of women having sex with other women," Sullivan said. "If the CDC becomes aware of HIV-infected women who have sex with other women, the health department will try to understand how the transmission occurred."

It's still theoretically possible for women to contract the disease from each other, according to unpublished statistical data included in the CDC's updated fact sheet "HIV/AIDS among women who have sex with women."

Public health officials use the term "women who have sex with women" instead of "lesbian" because they said sexual practices and sexual identity mean different things to different people.

Statistics for the fact sheet were gathered by studying 246,461 women who were diagnosed with HIV as of December 2004. Of that number, 7,381 said they had sex with women, but had other risk factors, including injection drug use, sexual contact with infected men or a blood transfusion. Some 534 women who were sexually active exclusively with other women were diagnosed with HIV, but had another risk factor like intravenous drug use.

In an update to the 2004 figures, Dr. Kathleen McDavid, an epidemiologist with the CDC, said as of December 2005, more than 250,000 women had been diagnosed with HIV since the beginning of the AIDS epidemic.

"Through December 2005 there were fewer than 50 cases of women who had sex with other women, with no other risk factors," she said. "These are the ones that were followed up on with the health department. Ninety percent of those [50] cases were found to have another risk factor."

Sullivan said the most common means of transmission for women is intravenous drug use and sex with HIV-infected men. He said that AIDS counselors do the best they can with the information they are given at the time to identify risk factors, even if some of them do not emerge until a follow up visit.

"When a woman has just received a diagnosis, she might not be willing to talk about all the risk factors that might be present," he said. "We know from initial reports that women who were diagnosed injected drugs or had sex with a male partner."

Ryland Roane, supervisor of the Virginia Department of Health HIV/STD/Viral Hepatitis Hotline, said the CDC tries to track individual HIV cases of women who have had sex with men all the way back to 1978.

"But there doesn't have to be a man somewhere," he said. "It could be intravenous drug use."

Lesbians not exempt from sexual precautions

Beth Marschak, a health educator with the HIV/STD/Viral Hepatitis Hotline, said some women who identify as lesbian may have had sexual contact with men at some point in their lives, even if it was only once. Others have never been with men, but they might be surprised by some of the ways they can still be at risk.

Dr. Philippe Chiliade, medical director of the Whitman-Walker Clinic in metropolitan Washington, D.C., said he has only heard of one anecdotal case of an HIV-infected woman who had sex with another woman, but had no risk factors. He said the risk of HIV transmission between women is "extremely low," however the theoretical possibility of transmission is greater during the first few months after a woman is infected.

"If one partner has a high viral load in her vaginal secretions she is a lot more contagious," he said.

Chiliade said lesbians are not exempt from sexual precautions because there are many other STDs that are a lot easier for them to get, including chlamydia, gonorrhea, pelvic inflammatory disease, herpes and human papillomavirus.

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