Lesbians: the forgotten sexual minority in the HIV response

In Kenya, lesbians, are marginalised and often lack access to sexual health and HIV services. When Brenda was raped to ‘cure’ her of being lesbian, she was left with HIV which she passed on to her female partner.

In Kenya, where same sex relationships are illegal, sexual minorities, especially lesbians, are marginalised and often lack access to HIV prevention programmes.

“It’s as if we don’t exist!” laments Brenda, 23, who is a lesbian living with HIV. “There’s no data or specialized HIV programs that address lesbians which has led to our receiving poor HIV health care services.”

Take a moment to consider this fact: currently there are five million young people (15-24) living with HIV, the majority of whom live in sub-Saharan Africa.

But so far, the global response to HIV has largely neglected young marginalised populations, which includes those from sexual minorities, as well as those who sell sex or inject drugs.

In Kenya, health workers are often particularly insensitive and ill-equipped to serve lesbians, lacking the knowledge on how to prevent HIV transmission between two women.

“We are told that women cannot infect each other and sometimes they even ask us about our male sexual partners,” Brenda adds.

Stigma and discrimination

“Unfortunately our society defines us and our roles from the day we are born and we are raised to actively live up to those roles or face being ostracized,” says Brenda.

The stigma and criminalisation that comes with being a sexual minority in Kenya prevents many young women from seeking sexual and reproductive health advice and services.

“After high school I was admitted at a local university and that came with freedom. I was now able to be me. My attraction to women persisted and though I was discreet about my orientation, a male student who had in vain tried to be with me caught me with another lady in our hostel.

“He ganged up with his friends and they raped and sodomized us, all the while telling us that we should learn to be women. It was a painful experience, what was I to do? Do I go to the police or hospital? What was I going to tell them? That I have been gang raped for being a lesbian?”

Regardless of sexual orientation, around the world one in three girls and women will be beaten, coerced into sex or abused in their lifetime. Research indicates that vulnerability to HIV among women who have experienced sexual violence may be up to three times higher than among those who have not.

It’s critically important that governments act to improve access to comprehensive health services for women who have experienced sexual violence, including sexual and reproductive health services such as emergency contraception, safe abortion care, HIV prevention and treatment, and psychosocial support.

Access to sexual health services

Many women who have sex with women believe they are not at risk of HIV, STIs or unintended pregnancy so they do not access information about safer sex.

Brenda says: “I tried to come to terms with life after my ordeal; little did I know that my fear to go to hospital during that experience would cost me. I didn’t know that if I had acted on time I would have been given PEP [post-exposure prophylaxis].

“Two years later I became sick with TB and as is the norm I was tested for HIV and was found to be positive.

“I had also ignorantly and unintentionally passed it to my partner who has never been with a man. I thought lesbians could not infect each other with HIV and this made us less careful in our intimacy. We didn’t practice safe sex, we didn’t know how.”

Understanding HIV risk factors

Earlier this year, the Centers for Disease Control and Prevention (CDC) reported in Morbidity and Mortality Weekly Report that female-to-female transmission of HIV is possible especially if there is exposure to vaginal or other body fluids, blood from menstruation, or blood from damage sustained during rougher sex.

However the risk of HIV transmission between women who have sex with women is minimal and they are far more at risk of HIV from rape aimed at ‘correcting’ lesbian behavior, or unprotected sex with men due to their preference or due to pressure to conform to gender norms and expectations to have children.

Currently they are a population group that remain particularly underserved in HIV programmes, with many barriers preventing them from accessing sexual and reproductive health services. There needs to be a concerted effort to train medical staff to be non-discriminatory and to take a sexual history without making assumptions about identity or sexual behaviour.

Governments, international agencies and donors have failed to adequately fund research, prevention, treatment and care for young lesbians, and other sexual minorities. This needs to change if the UN mantra to see ‘no-one left behind’ in the post 2015 development framework is to have any credence.

This story was first published on Gay Star News

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