By Carmen Logie
Lesbian, bisexual and queer women are rarely included in HIV research. Women who have sex with women, and their HIV infection rates, are not captured anywhere because women cannot report having a woman as a sexual partner in Canada’s HIV statistics. The current record only allows women to report HIV exposure either through injection drug use or heterosexual sex. This contributes to the erasure of women’s sexual and gender diversity and fluidity in HIV research. Queer* women are ignored in HIV research: this is a problem and here is why it matters.
- Queer women have a range of sexual practices and partners: There is a sexual and gender fluidity that is missed by current epidemiological categories, and subsequently in the majority of HIV research. People’s sexual identities may not always reflect standard understandings of sexual practices. For example, persons identifying as lesbians may have sex with cisgender or transgender men. Lesbian, bisexual and queer women may use drugs and may share needles; some research indicates that women who are queer and use drugs may in fact have elevated rates of exposure to HIV. We know homophobia can contribute to poverty, social exclusion and mental health challenges, including substance use, so keeping our mind open to the fact that queer women may use drugs to cope with homophobia can allow us to move beyond the assumption that all women who use drugs are straight. Queer women can also be transgender, and transphobia has negative impacts on wellbeing.
- Queer women experience stigma, discrimination and are more likely to report sexual violence: For the last five years there is an increasing focus on social drivers of HIV, in particular stigma, discrimination and violence. There is emerging literature, from South Africa and in forthcoming data from a national Canadian study conducted by the Canadian HIV Women’s Sexual and Reproductive Health Cohort Study (CHIWOS), that demonstrates forced sex as a risk factor for HIV transmission among women, and among queer women in particular. Homophobic rape, often known as ‘corrective rape,’ targets queer women across the globe. Categorizing HIV transmission from homophobic rape as ‘heterosexual sex’ misses the point that it was violent and homophobic. It misses the point that queer women can be at risk for HIV just for being who they are. Applying a lens that looks at the intersection of stigma and discrimination based on sexuality, race, gender identity, class, and nationality, among others, shows the complexity that needs to be considered when we think of the lived realities of queer women.
- Queer women have the same—or higher—rates of other sexually transmitted infections: There is an abundance of research that shows queer women have the same, and sometimes even higher, rates of other sexually transmitted infections (STIs) than heterosexual women. There are also differences in STI risks between women who have sex with women, with several studies showing women who report having cis men as sex partners having higher rates of STIs. Despite these STI risks, queer women have a low perception of risk, and limited uptake of safer sex strategies. Research that I conducted shows linkages between a lifetime history of STIs among queer women and sexual stigma, forced sex, and women believing that their healthcare provider was uncomfortable with their sexual orientation. My forthcoming research also shows that homophobia reduces safer sex practices among queer women with low social support and low coping skills. We know having another STI elevates HIV infection risks, so this is another reason to include women’s sexual identity and partners in our research.
The solution is quite simple. Why don’t we just ask women about their own, and their sex partners’ sexual and gender identities?
* I use ‘queer’ to convey asserted, non-heterosexual identities and affiliations claimed by women across multiple contexts/interactions
Carmen Logie is an assistant professor in the Factor-Inwentash Faculty of Social Work at the University of Toronto. She is also the adjunct scientist for Women’s College Research Institute at Women’s College Hospital in Toronto.