HIV-related research on WSW, regardless of sexual orientation, has been scarce yet notable for its unexpected findings:

  • higher HIV seroprevalence rates among women who have sex with both women and men (i.e., behaviorally bisexual women) compared to their exclusively homosexual or heterosexual counterparts;
  • high levels of risk for HIV infection through unprotected sex with men and through injection drug use; and
  • risk for HIV infection of unknown magnitude owing to unprotected sex with women and artificial insemination with unscreened semen.

Although estimates vary, numerous studies have reported HIV positivity among WSW. A study conducted in San Francisco reported a 1% HIV seroprevalence rate in a sample of 498 self-identified lesbian and bisexual women, higher than that reported for childbearing women in California (0.2%) or for women sampled from a San Francisco population-based household survey (0.4%) (Lemp et al., 1995). Behaviorally bisexual women from a predominantly African-American STD clinic population in New York City were reported to have an 18% HIV seroprevalence rate compared to 11% among exclusively heterosexual women (Bevier et al., 1995). Also, a study of injection drug-using women in drug treatment in King County, Washington, reported that women who identified as lesbian or bisexual had 8% HIV seroprevalence rates compared to 1.5% among heterosexual women (Harris et al., 1993). Several other studies corroborate the findings that WSW, specifically behaviorally bisexual and drug-injecting WSW, seem to have higher HIV seroprevalence rates than exclusively heterosexual women (Cheng et al., 1997; Cohen et al., 1993; Ehrhardt et al., 1995; Jose et al., 1993; Ross et al., 1992; Weiss, 1993; Williams et al., 1996; Young et al., 1992).

Because WSW have been ignored in most HIV prevention efforts they may perceive their risk of HIV exposure to be lower than it actually is. In a survey of 1,086 WSW, risk perception for HIV acquisition was not as high as would have been expected given the proportion of risk behaviors reported: only 43% of the women with a history of a clear HIV risk factor perceived themselves to be at risk for HIV infection (Einhorn and



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