The issues surrounding lesbianism and HIV/AIDS are far more complicated than how to properly use a dental dam or clean a sex toy. Many lesbians believe that HIV transmission is impossible or at least less frequent than transmission between heterosexual partners or homosexual men (Rieder, 129). While sexual acts between two women tend to be less risky as far as infection is concerned, there is still a definite risk that health workers, policy makers, and lesbians themselves must understand in order to live healthy, happy lives. My arguments are focused almost entirely on information obtained within the US in the past few decades since the outbreak, although I will draw on history of women loving women throughout history and geography to make the occasional point. While systems of prevention cannot simply be “transplanted” from place to place, the experiences of American lesbian women with HIV are important in the ongoing discussion regarding prevention and treatment.
The first reported case of lesbian to lesbian transmission of the virus occurred in 2003, but advocates insist that it is a first only in name. “The woman in question is simply the first to fit into a certain set of parameters set by the CDC and accepted by most researchers. Women who may have contracted HIV from their female partners in the past and who had any other risk factors have traditionally been classified either under those risk factors or as ‘undetermined’” (Hawkins). The Guidelines themselves seemingly disqualify lesbian activity as any sort of risk factor: heterosexual sex is not a risk only if a woman had sexual contact with a man prior to 1978. This means a woman could have thousands of female partners, but one protected male partner in 1979 would be listed as the site of transmission (Hawkins). Women in general have been left out of the AIDS discussion since the early days of hysteria, seeing as it was the “gay man’s disease.” “It took ten years for the CDC to expand it’s definition of HIV to include female-specific opportunistic infections” and there is still very little known about how AIDS medications affect women” (Hawkins). The lack of information on symptoms affecting only women allowed many women to grow terminally ill and die of AIDS before they could even be diagnosed (Densham 136). The change in guidelines was due to the ongoing efforts of lesbian AIDS activists (Densham 136). The CDC did fund a few small-scale studies regarding lesbians and AIDS transmission, however, the data was lost in the World Trade Center attack on 9/11/01 (Hawkins). There has also been remarkably little information on infection via artificial insemination, particularly in the early days of infection, which put lesbians trying to conceive at risk (Pies 140).
The myth of HIV-free lesbian communities has a lot of resonance, but does not stand up against the facts. The Lesbian AIDS Project in NYC counsels over a thousands lesbians that have tested positive (Hawkins). Although infection may take many routes, the presence of HIV-positive sapphists cannot be ignored. Many infected women never tell their doctors about their sexual endeavors with other women, either for fear of stigma, or it is simply never asked (Hawkins). Lesbians have often missed the memo on HIV prevention simply because the messages are not directed to them because of the long-standing idea that lesbian sex is not “real sex” and thus not risky (Hawkins). “Popular representations of HIV/AIDS have had a major impact on which communities gain access to awareness programs and effective treatments” (Kaplan 4). Because the infection was believed to be isolated to gay men and “deviant sexuality,” “rising rates of the disease among heterosexual men and heterosexual and lesbian women in the West” was ignored (Kaplan 4). It is important to note the racial inequities in awareness: white gay men worked very hard to educate one another on the disease and how to combat it, while gay men were often left in the dark. “A study of approximately 5,700 gay men in six major US citicies reports that the rates of unawareness among Black gay ménages fifteen to twenty nine ‘staggeringly high’” and that of “those found to have HIV, 90% of Blacks said that they did not know they were infected” (Collins 291).
There’s a lot more to the issue than the debates about transmission. Lesbian communities are not like the imagined Amazon territories: free of men and heterosexuality (Rupp). “If lesbian communities were closed and static havens then the point [of transmissibility]would be valid” (Adams 133). But they are not. Lesbians come in all colors and predispositions. They are mothers, lovers, sex workers, drug users, and come in thousands of flavors, so to speak. It should be noted that prostitution and “sapphism” has gone hand in hand in public imagination for centuries now. The ancient Greek term, hetairistria, connotes both same sex female desire and prostitution, and in later centuries, pioneering sexologist Alexandre-Jean-Baptiste Parent-Duchalet concluded that many prostitutes had sex with other women, in 1836 (Rupp 111). A madam in the 1940’s declared “just about all prostitutes are lesbians and tribades” and courtesans in 1970’s India often confirmed this statement, claiming that their “most satisfying physical relationships” and “closest emotional connections” were with other women (Rupp 113). IV drug use and prostitution are frequently acknowledged as transmission sites, but to equate these issues with lesbianism takes a different kind of outreach. There is a definite population of lesbian-identified women who turn tricks to survive, which usually means having sexual relations with men. Lea Sanchez’s work with the Lesbian AIDS Project has taken her into the intersection of race, sexuality, identity and drug use, where she has discovered many cracks in society that AIDS prevention is simply not reaching (Sanchez 151). Addiction to IV drugs has further complicated the already heady notion of lesbians who prostitute to men. “If you are a junkie, lesbian or not, turning tricks is often necessary to get your fixes” (Sanchez 151). Many of addicted women end up sharing needles with high-risk people, following the hierarchy of gender and class established by the circle of users (Sanchez 151). While sex workers are overly represented in prevention methods geared towards women, how to protect their female partners goes unannounced. Informal sex-for-money situations form similar risks, which is one reason HIV spread so quickly through poor, black women along the Mississippi Delta between 1990 and 2000 (Collins 291). These sex-for-money informal, unnegotiated relationships grew out of women’s need to provide for their families. Although women knew of HIV/AIDS, they felt powerless to protect themselves from the spreading wildfire of infection (Collins 291). “Like every other epidemic, AIDS develops in the cracks and crevasses of society’s inequalities…We cannot face the epidemic if we try to hide the contradictions and conflicts which it exposes” (Coravano 138). In short, it’s beyond time for a new, honest discussion to take place.
Patricia Hill Collins work reflects the need for a redefinition and reconception of Black sexual politics, but some of the lessons are just as valid for the lesbian community. Her concept of “honest bodies” that celebrate their sexuality and are honest with their partners speaks directly to the issue (Collins 287). While gayness (and thus HIV/AIDS) are often pathologized as being a white man’s disease, the effect it is having upon the black community is particularly devastating. In the year 2001, two thirds of the women found to be HIV positive were black (Collins 292). The secret “Down Low” culture of black gay and bisexual men only exacerbates the issue, because it is so secretive and often practices unprotected sex (Collins 291). The issue of non-acceptance and homophobia within a large amount of black culture facilitates Patricia Hill Collins desire for the black community to “ready up for some honesty,” but the same could be said of lesbians and the AIDS phenomenon (Collins 290). She says “When individual African American women and men strive to develop honest bodies and to reclaim the erotic as a site of freedom, and love as a source of affirmation for self and others, they challenge the spread of HIV/AIDS” (Collins 290). The same could be said of lesbians who refuse to use protection. When a woman asked lesbian AIDS activist, Mary Louise Adams, if she knew anyone who practiced safe (lesbian) sex, she offered herself as an example. The woman appeared horrified, and assumed that Adams was infected herself (Adams 132). She found many lesbians unwilling to use protection because it required planning and there is an element of spontaneity that eclipses many lesbians view of “how sex happens” (Adams 132). Adams advocates honest discussion in workshops and “frank talk about what we do in bed” (Adams 130). One workshop she attended with straight and bisexual women was particularly liberating because women were obliged “to talk about sex, graphically [and]non judgementally” (Adams 131). Through these talks, Adams learned that “the task is not so much to expand constantly upon what is safe…but rather to expand on what is sexual” in essence, to eroticize safeness. The advocated “honest talk” within and between and including communities that are becoming increasingly affected by HIV/AIDS is important if we are going to get anywhere in preventing, and hopefully eradicating the disease.
HIV is a contentious issue, particularly because it is bound up in sex, sexuality and identity. The lesbian community must stand up and take notice of the threat of HIV transmission and begin to have honest, straight forward conversations with one another about how they can protect themselves and each other. It is time to move out of fear and darkness and into understanding and advocacy. With such efforts, HIV can be reduced and, hopefully one day, eradicated completely.
Adams, Mary Louise. All That Rubber, All That Talk. “AIDS: The Women.” Edited by Ines Rieder and Patricia Ruppelt. Cleiss Press, San Francisco, 1988.
Collins, Patricia Hill. Black Sexual Politics. Routledge, NY & London, 2004.
Densham, Andrea. CDC, NIH, ACS, FDA—Alphabet City. “An Introduction to Women’s Studies: Gender in a Transnational World” editor: Caren Kaplan. McGraw Hill, Higher Eduction, 2006.
Hawkins, Karen. Lesbians and HIV? Curve magazine. Volume 13 #4. http://backup.curvemag.com/Detailed/375.html. Accessed 4/14/11.
Kaplan, Caren. “An Introduction to Women’s Studies: Gender in a Transnational World” editor: Caren Kaplan. McGraw Hill, Higher Eduction, 2006.
Pies, Cheri. Insemination: Something New To Consider. “AIDS: The Women.” Edited by Ines Rieder and Patricia Ruppelt. Cleiss Press, San Francisco, 1988.
Rupp, Leila J. Sapphistries: A Global History of Love Between Women. New York University Press, NY. 2009.
Sanchez, Lea. You Have To Know Street Talk. “AIDS: The Women.” Edited by Ines Rieder and Patricia Ruppelt. Cleiss Press, San Francisco, 1988.