HIV and sexually transmitted infection knowledge among women who have sex with women in four Southern African countries

Abstract

Women who have sex with women in Southern Africa, where HIV prevalence is high, are often presumed to have minimal risk for sexually transmitted infections (STI) and HIV despite research documenting female-to-female transmission. This study examined the demographic and social factors contributing to female-to-female STI/HIV transmission knowledge among Southern African women who have sex with women using an integrated model of health literacy. In collaboration with community-based organisations in Botswana, Namibia, South Africa and Zimbabwe, data were collected through anonymous surveys (N = 591). Multivariable stepwise forward logistic regression assessed independent associations between participant characteristics and high vs. low knowledge using five items. Overall, 64.4% (n = 362) of women had high knowledge; 35.6% (n = 200) had low knowledge. Higher education (adjusted odds ratio [aOR]: 2.24, 95% confidence interval [CI]: 1.48, 3.40), regular income (aOR: 2.14, 95% CI: 1.43, 3.21), residence in Botswana (aOR: 3.12, 95% CI: 1.15, 8.48) and having ever received tailored STI/HIV information (aOR: 2.17, 95% CI: 1.41, 3.32) predicted significantly higher odds of high knowledge in the final multivariable model. Results suggest opportunities for peer-led sexual health programming and expanded HIV prevention campaigns addressing women who have sex with women.

Keywords:

• Health literacy
• sexually transmitted infections
• HIV
• women who have sex with women
• Southern Africa

Acknowledgements

This research project was designed and implemented in collaboration with Behind the Mask, Durban Lesbian and Gay Community & Health Centre, the Forum for the Empowerment of Women, OUT LGBT Well-Being, the Triangle Project (South Africa); Gays and Lesbians of Zimbabwe; LeGaBiBo (Botswana); and OutRight Namibia. We thank all participants and the Southern African Lesbian and Bisexual Women Research Team for their contributions.

Declaration of interest

No potential conflict of interest was reported by the authors.

Funding

The project was funded by the Open Society Initiative for Southern Africa (PI: Vasu Reddy), with additional support from the United Nations Development Programme and the Open Society Foundations who also participated in the study. Margaret Paschen-Wolff was supported by a training grant (T32 MH019139; PI: Theodorus Sandfort) from the US National Institute of Mental Health at the HIV Center for Clinical and Behavioral Studies at the NY State Psychiatric Institute and Columbia University (P30-MH43520; PI: Robert Remien).