HIV Risk Behaviors Among Women Who Have Sex with Women (WSWs) Enrolled in a High-Risk US Cohort

Objectives: To determine the percentage of women who have sex with women (WSWs) in a high risk cohort and to describe HIV risk behaviors among WSWs.

Methods: Between March and October 1995, we enrolled 865 HIV-seronegative women with histories of HIV risks in New York City, Chicago, Providence, and Philadelphia. 511 reported heterosexual risk (in the absence of drug injection) and 354 reported drug injection (+/- heterosexual risk). 55% were African- American, 29% white, non-Hispanic, and 16% Latina. Members of the cohort were re-assessed every 6 months for 24 months.

Results: 88 (10.2%) of the women indicated a history of sex with women during the 6 months prior to enrollment. 78.4% of these WSWs reported > 1 male sexual partner. The percentage of WSWs was higher among African-American/ non-Hispanics (12.4%) than among white/non-Hispanics (8.4%) or "others" (5.8%); and was inversely associated with age. The number of recent residential moves was greater among WSWs than among non-WSWs (p=0.001), and more WSWs than non-WSWs believed they had been exposed to HIV in the 6 months prior to enrollment (p = 0.004). WSWs also were more likely to report having had sex with bisexual men (p=0.03). Multivariate analysis showed WSWs to be significantly more likely than non-WSWs to have exchanged sex for money or drugs (OR = 3.2, 95% CI = 1.6, 6.2) and to have used crack (OR = 2.4, 95% CI = 1.3, 4.3) after adjustment for potential confounders. The HIV-seroconversion rate was higher, but not significantly so, among WSWs (2 HIV-seroconversions, rate = 1.42/100 person years at risk [pyar], 95% CI = 0.4, 5.7) than among non-WSWs (13 HIV-seroconversions, rate=1.04/100 pyar, 95% CI = 0.6, 1.8).

Conclusions: In the present cohort of women at high risk of HIV infection, those who reported engaging in sex with women appeared to be at equal or greater risk of HIV infection than other women. Health care providers need to address HIV risks in females who report sex with women and should not assume negligible HIV risk if women self-identify as lesbians. Future HIV prevention interventions in development need to address risk behaviors and psychosocial cofactors of risk in women who have sex with women.

Michael Marmor
New York Univ. School of Medicine
341 E. 25th St, 2nd Floor
New York, NY 10010