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Sexual and loving relationships are not just confined to one-to-one monogamous relationships
Sexuality or sexual identity can be difficult to define. The social norm is that we should feel attracted to and love people of the opposite sex, and many of us may be in such a relationship, which is known as a heterosexual relationship.
Some of us may have a more fluid attitude towards sexuality and relationships. We may have very close and intimate relationship which are also sexual with female friends for certain periods of our lives, and also have relationships and sex with male partners. This kind of relationship may be defined by some as bisexual – though some women in these relationships may prefer to have no label at all.
Some women prefer to have a sexual relationship only with another woman. This kind of relationship is called lesbian. Within the SHE programme, we recognise the difficulties of labelling anybody’s sexuality so we use the term “women who have sex with women”, since this term is not concerned with our identity, but concerns specific actions which are of particular relevance to HIV.
Moreover, some people prefer to have a sexual relationship with more than one person at a time. And others prefer to have no sexual relationships at all.
Regardless of our partner’s gender, we are all at risk for HIV transmission
Women who have sex with women and transgender women living with HIV often experience high levels of isolation and invisibility because they are assumed not to be at high risk of HIV. It is important to remember that the fact that some of us are transgender, or love and have sex with other women, does not exclude us from STIs, including HIV.
It is possible for women, even those of us who identify as lesbians and have sex and relationships exclusively with other women, to have had other risk behaviours such as unprotected sex with male partners with HIV; or to have shared needles when using drugs; or perhaps to have inseminated with untested sperm.
Some women who have sex with women may have acquired HIV at birth. So no matter if we are having sex with a man, a woman or a transgender person, we should try to have safer sex.
Many women who have sex with women do not discuss their sexual relationships with healthcare providers or even within their HIV support groups because they fear judgement and discrimination.
It is important that peer support group facilitators address the needs of women who have sex with women and do not make the assumption that relationships will be heterosexual.
For transgender women, sex and relationships may often be very challenging. Many of us who are transgender may be pushed into sex work and drug use by difficult socio-economic circumstances.
Technically, safe sex and harm reduction recommendations are not different for those of us in this group, and focus on avoiding exchanges of body fluids by using condoms and clean needles. However, it is important to acknowledge that the social stigma directed to those of us who are transgender can limit the ability to put those recommendations into practice.
There is little research on transgender women with HIV. However, recent studies in the U.S. have shown that male-to-female transgender women are particularly vulnerable to HIV and may find it very difficult to access support once diagnosed.[i] It is important that we discuss this in our peer support groups, as many people are not be familiar with the issues, needs and rights of those of us who are transgender.
Having an honest disclosure with multiple partners in one group
Polyamorous relationships are loving or sexual relationships which include more than two people, such as two women and a man or two men and a woman, or other numbers of people and combinations.
If a woman living with HIV is in such a relationship, disclosure may be even more complicated because it will involve more than one person at a time. However, this makes it even more important that every effort is made to ensure all partners in the relationship are taking measures to engage in safe sex practices, such as using a new condom every time you have sex and making efforts to not exchange fluids. Each polyamorous group will agree upon and negotiate levels of openness and risks they feel comfortable with. It is important as facilitators to be aware that sexual and loving relationships are not just confined to one-to-one monogamous relationships.
[i] Reiner, S. and others, “HIV risk and social networks among male-to-female transgender sex workers in Boston, Massachusetts”. Journal of the Association of Nurses in AIDS Care 20(5):373–86. September/October 2009
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