shutterstock_3103435The term “women who have sex with women” (WSW), according to the UNAIDS Terminology Guidelines, “includes not only women who self-identify as lesbian or homosexual and have sex only with other women but also bisexual women as well as women who self-identify as heterosexual but have sex with other women.” “WSW” is a public health research category that defines itself based on behaviour rather than identity, acknowledging that what one does does not always map on exactly to how one sees or identifies oneself. The terms “lesbian” and “bisexual,” on the other hand, refer to women who self-identify as being sexually, emotionally, romantically, or otherwise attracted to women.

Research in South Africa, Zimbabwe, Namibia, and Botswana places the self-reported rate of HIV infection among WSW at 9.6%. A study of a South African sample found self-reported HIV prevalence among black and white WSW to be 9% and 5%, respectively. These studies, because they rely on self-reporting, likely underestimate the true prevalence. WSW have been largely overlooked in the HIV response. As a result, there is a dearth of information about WSW health in South Africa.

The lack of attention to WSW in the national response to HIV, AIDS, STIs, and TB contributes to the idea that WSW sex cannot be risky, despite the fact that a host of STIs—including HIV, human papilloma virus, syphilis, trichomoniasis, herpes simplex virus, and bacterial vaginosis—can be contracted through same-sex sexual activity between women. Research has shown that WSW tend to internalise the programmatic neglect of same-sex sexual activity among women as an attitude that this kind of sex is unrisky, and thus few WSW use prevention methods such as dental dams and finger cots.

WSW are made more vulnerable by the alarming rate of sexual violence perpetrated against them, not only exposing them to HIV and STIs but also gravely violating their human rights. The stigma and discrimination attached to WSW not only manifests in sexual violence, but also in discrimination within the healthcare system, police services, and other government services. This happens despite protection under the Constitution and a remarkably progressive legal environment.

More research needs to be conducted on WSW, and there is a pressing need for more messaging on WSW health. It is imperative as well that we address the violence, stigma, and discrimination that violate the rights of WSW and prevent them from accessing government and other services.