It is well known that women are more vulnerable to HIV infection, both due to physiological reasons, as well as social. Gender-based violence and discrimination disempower many women across the globe in terms of their ability to negotiate safer sex. Women who have sex with women (WSW), lesbian and bisexual women face additional discrimination, both from society as well as in the health care environment. Moreover homo-phobic or more correctly les-phobic rape increases these women’s risk to a far greater degree.

Additionally, because sex between women is seldom understood in its detail, most believe that it carries a zero risk of HIV transmission. This in turn has led to the almost universal exclusion of WSW in HIV prevention efforts and research. Thus it is fair to say that the level of knowledge around HIV of WSW has never been prioritized even though they are a sexually active group and engaging in both same and heterosexual sex. Discrimination leads many of these women to lead a stealth lifestyle which means they engage in heterosexual sex and they need to be empowered to negotiate for that to be safer too. These realities are often considered unimportant by many in the field of HIV, using the excuse that this being a numerically small group of the population and thus not worth the focus.

This marginalization of WSW is evident not only in governments’ actions, but in the development sector too. There needs to be a demand for greater inclusion of funding, research, behavior change communication and understanding of the experiences of WSW with regard to HIV. In 2011 we are seeing this become a reality but the focus needs to grow and continue for years to come.

Regarding the UNGASS reporting process, the total lack of indicators on these women reflects the current mainstream opinion that these women do not merit inclusion in a global M&E system.

Thus a content analysis was done on the country narrative reports in lieu of the lack of indicators that capture WSW. As a means to measure if any countries are doing work on improving the HIV knowledge levels of WSW.

In our content analysis (methodology available in the Framework Report available on the AAI website) we found only 4 references to WSW and HIV knowledge in three country reports (excluding NCPIs).

Thus in 2010, Norway (1 reference), Sri Lanka (1 reference), and Venezuela (2 references) made mention of WSW and knowledge in their country reports.

Case Studies

Norway

Closer inspection of the three countries reveals that Norway’s health directorate works very closely with Gay and Lesbian Health Norway, providing funding (one of the two biggest recipients of funds from the directorate), coordinating training with nurses on LGBT and HIV issues, and otherwise implementing the over 60 measures identified in the action plan "Bedre livskvalitet for lesbiske, homofile, bifile og transpersoner2009-2012" (Better quality of life for lesbian, gay, bi-sexual and transpersons 2009-2012). [i]

Sri Lanka

In the 2010 Country report Sri Lanka deals with MSM, beach boys and LGBT. This recognition of the differences is a step in the right direction. The report states that The AIDS Foundation is supporting a CSO called Equal ground in their work, “which is involved with these groups to carry out awareness programmes, debates on their sexual and reproductive needs and rights. In 2009, they were able to cover 63 direct beneficiaries, 18 organizations in 20 regions of the country.

Knowledge on basic facts of HIV has increased from 26.2% to 58.4% at post intervention. A telephone hotline was established and members were trained to provide information for the inquiries. Around 2096 people have been indirect beneficiaries of these programmes although most of them do not belong to this sub population.”[ii]

Venezuela

Venezuela also notes that there needs to be the realization of research studies on the risk factors related to human rights violations of LGBT people, the creation of specific health systems and the extension of health systems in general for TG, lesbians and bisexual women and gay and bisexual men. Additionally the report adds that there needs to be an expansion of information campaigns for the prevention of HIV transmission for LGBT people, including other vulnerable groups and gender diverse people.[iii]

Importantly, the report also calls for the recognition of sexual orientations and gender identities or expressions in the technical descriptors in the guidelines developed by UNAIDS, to ensure the inclusion of gender diversity in the UNGASS country reports to ensure universal access.[iv]

Venezuelan leadership should be lauded for this stance and their leadership and accountability to LGBT acknowledged and praised.

The lack of information on HIV Knowledge of WSW is testimony to the widespread neglect of this group of individuals and requires urgent attention on an international scale.

Currently there is no data on the vulnerability of post-op transgender women who have sex with cis-gendered women (women whose gender identity matches their sex at birth, unlike transgender people). These women are particularly vulnerable as they face several dimensions of discrimination, including from other WSW.