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Question

LHRC,

Can lesbians pass HIV/AIDS to each other via sex? Is there any studies that prove it has been past from one woman to the next through oral sex or sex with toys?

Thanks,
Just Wondering


Answer by Amy V. Kindrick, M.D., M.P.H.

Hello,

I am an Infectious Diseases doctor and a lesbian here in San Francisco. In short, we don't know much about how likely it is that an HIV-infected woman would transmit virus to another woman.

The virus certainly is present in the genital secretions of infected women, as well as in blood (including menses). However, the concentration of virus in vaginal secretions probably is not high enough to constitute an infectious inoculum in the context of most mucous membrane exposures. The Center for Disease Control (CDC) has been unable to confirm any cases in which a woman has acquired HIV via sexual exposure to another woman, although their method for gathering risk behavior information could very well miss cases that are actually there. I'm aware of 4 reported cases in which woman to woman sexual transmission was highly likely, and I'm sure that it has occurred; there is absolutely no reason to assume that it's impossible.

Nevertheless, transmission risks via oral-genital contact or genital-genital contact via hands or toys (in the absence of visible blood) are probably exceedingly small -- certainly less than 0.05% per exposure, assuming a known infected source. Based on what we know about transmission between men and women and between men, the presence of blood, oral or genital lesions, HCV co-infection, or concomitant sexually transmitted infections (including BV) in either partner may enhance transmission risk, but there are no direct data to support or refute this in the context of sexual contact between women.

Fortunately, a study is currently underway that will attempt to answer some of these important questions more definitively. It's called "Fem to Fem" and is sponsored by the CDC. Unfortunately, it will probably be several more years before we know more. In the meantime, I counsel lesbians that although sexual transmission risks (excluding blood to blood contact) are probably very low, they are not 0. Latex is a very effective barrier, and should be used when a partner's status is unknown or known to be positive. When faced with transmission risk estimates in the neighborhood of 0.05% or lower, some women choose to forgo barrier protection.

If a woman chooses not to use protection, it's important for her to realize that she is taking a risk in doing so.


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