Few cases of HIV transmission between women who have sex with women (WSW) have been reported in the United States, but these cases still can and do occur. Studies have shown that HIV can be transmitted by female-to-female sexual contact with unprotected exposure to vaginal or other bodily fluids and to blood from menstruation. Historically, confirming HIV transmission during female-to-female sexual contact has been difficult because other risk factors are almost always present or cannot be ruled out. “It can be difficult to determine if HIV was transmitted by female-to-female sex or other more common modes of transmission, such as injection drug use and heterosexual sex,” says Amy Lansky, PhD, MPH.
A Case Report
According to a report published in the Morbidity & Mortality Weekly Report, the Houston Department of Health contacted the CDC in August 2012 regarding a rare transmission of HIV that likely resulted from sexual contact between HIV-discordant partners. The women involved reported having unprotected sex during a 6-month monogamous relationship. The woman with newly acquired HIV did not report any other recognized risk factors for HIV infection. The other partner was previously diagnosed with HIV and had stopped receiving antiretroviral treatment in 2010.
In this case, laboratory tests confirmed that the woman with newly diagnosed HIV had a virus that was virtually identical to that of her partner. “This case was unique because the CDC was able to use both phylogenetic and epidemiologic data in the investigation,” Dr. Lansky says. The viruses infecting the two women had a 98% or higher sequence identity in three genes. The couple had not received any preventive counseling before the woman who had previously tested negative for HIV acquired the virus.
The case report highlights the importance for all individuals to know their HIV status and the associated transmission risk factors, Dr. Lansky says. “HIV-discordant couples need to receive education and counseling services, especially for safer sex practices,” she says. “Anyone who is identified as HIV-positive should be linked to care, and efforts should be made to retain them in care. Suppressing HIV viral loads by taking antiretroviral therapies as prescribed can result in better health outcomes and reduce the possibility of transmitting HIV to others.”
According to the CDC, clinicians should inquire about risky behaviors with all patients infected with HIV to reduce risks for spreading the infection. “Specifically for WSW,” says Dr. Lansky, “clinicians should encourage those infected with HIV to adhere to treatment regimens and educate all WSW about how the infection can be transmitted through open wounds, bodily fluids, and other more common methods of transmission. I know the STD testing near me is very thorough but that’s not to say all centers are as diligent.”
Readings & Resources (click to view)
Chan SK, Thornton LR, Chronister KJ, et al. Likely female-to-female sexual transmission of HIV—Texas, 2012. MMWR Morb Mortal Wkly Rep. 2014;63:209-212. Available at: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6310a1.htm?s_cid=mm6310a1_w.
Kwakwa HA, Ghobrial MW. Female-to-female transmission of human immunodeficiency virus. Clin Infect Dis. 2003;36:e40-e41.
Raiteri R, Fora R, Gioannini P, et al. Seroprevalence, risk factors and attitude to HIV-1 in a representative sample of lesbians in Turin. Genitourin Med 1994;70:200–5.
McCombs SB, McCray E, Wendell DA, Sweeney PA, Onorato IM. Epidemiology of HIV-1 infection in bisexual women. J Acquir Immune Defic Syndr. 1992;5:850-852.
Petersen LR, Doll L, White C, Chu S. No evidence for female-to-female HIV transmission among 960,000 female blood donors. The HIV Blood Donor Study Group. J Acquir Immune Defic Syndr. 1992;5:853-855.
Cohen C, Marmor M, Wolfe H, Ribble D. Risk assessment of HIV transmission among lesbians. J Acquir Immune Defic Syndr. 1993;6:1173-1174.
Chu SY, Buehler JW, Fleming PL, Berkelman RL. Epidemiology of reported cases of AIDS in lesbians, United States 1980-89. Am J Public Health. 1990;80:1380-1381.