Southern African Lesbian and Bisexual Women Responses to Symptoms of Sexually Transmitted Infections

  • Radhika M. Wikramanayake
  • Margaret M. Paschen-Wolff
  • Zethu Matebeni
  • Vasu Reddy
  • Ian Southey-Swartz
  • Theo G. M. SandfortEmail author
Original Paper


Sexually transmitted infection (STI) in lesbian and bisexual women is a relatively unexplored topic, particularly for women from low- and middle-income countries. Despite perceptions that women who have sex with women (WSW) are at negligible risk of contracting STI, existing research demonstrates that WSW do become infected with STI. Given the opposition between assumptions of invulnerability and the observed risks, we explored how WSW would respond to symptoms of STI (i.e., wait until symptoms passed, see a medical doctor, and inform sexual partners). We used data collected as part of a collaboration between academic researchers and community-based LGBTQ organizations in Botswana, Namibia, South Africa, and Zimbabwe. Chi-squared tests were used to test whether participants’ responses to hypothetical STI symptoms varied in relation to several intrapersonal, interpersonal, and structural factors. Multivariable logistic regression (backward) was used to assess whether these variables were independently associated with women’s responses. Most women would be proactive in response to potential STI symptoms and would see a medical doctor. However, most women would not inform their sexual partner of symptoms of STI. Findings demonstrate several intrapersonal, interpersonal, and structural factors that influence WSW’s health agency, and show a clustering of high-risk factors among women who would not be proactive about their health. Our findings suggest the need for improved health and health care of WSW in Southern Africa.


Lesbian and bisexual women Sexually transmitted infections Healthcare behavior Southern Africa Sexual orientation 



This research project was designed and implemented in collaboration with the following community organizations: Behind the Mask SA, Durban Lesbian and Gay Community and Health Centre SA, Forum for the Empowerment of Women SA, Gays and Lesbians of Zimbabwe, LeGaBiBo (Lesbians, Gays and Bisexuals of Botswana), OUT LGBT Well-Being SA, Out-Right Namibia, and Triangle Project SA. The project was funded by the Open Society Initiative for Southern Africa (PI: Vasu Reddy, Ph.D.), with additional support from the United Nations Development Programme, and Open Society Foundations; these organizations also participated in the study. Additional support came from a NIMH center Grant (P30-MH43520; PI: Robert Remien, Ph.D.) and a NIMH training Grant (T32-MH19139; PI: Theo Sandfort, Ph.D.). We thank all women who participated in the study.

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2020

Authors and Affiliations

  1. 1.HIV Center for Clinical and Behavioral StudiesNew York State Psychiatric Institute and Columbia UniversityNew YorkUSA
  2. 2.Department of Psychiatry, Division on Substance Use DisordersNew York State Psychiatric Institute, Columbia University Irving Medical CenterNew YorkUSA
  3. 3.Department of SociologyUniversity of the Western CapeCape TownSouth Africa
  4. 4.Faculty of the HumanitiesUniversity of PretoriaPretoriaSouth Africa
  5. 5.Open Society Initiative for Southern AfricaJohannesburgSouth Africa
  6. 6.Department of PsychologyUniversity of PretoriaPretoriaSouth Africa

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