Safe sex practices among women who have sex with women in Tanzania: implications for HIV and STIs control among this group

Abstract

ABSTRACT Background: Women who have sex with women (WSW) are at an increased risk of sexually transmitted infections (STIs) due to engagement in high-risk sexual behaviors. Safe sex practice is hence critical for the WSW. The aim of the study was to assess safe sex health behaviors and practices among WSW to inform sexual and reproductive interventions targeting this group in Tanzania. Methods: This study was cross-sectional descriptive and retrospective conducted in Dar-es-Salaam region, the largest commercial city in Tanzania. Study population included WSW aged 18 years and above who met inclusion criteria. Data was collected using focus group discussions, in-depth interviews, key informant interviews and life stories. Data analysis applied thematic analysis. Results: Few WSW reported practicing safe sex. WSW used condoms only when engaging in sex with men. Some WSW lacked information on availability of protective devices; while some WSW did not use protection despite having information on availability of protective devices. Majority of WSW used good hygiene practice (cleaning body, vagina, mouth, and sex toys) before and after sex to prevent transmission of infections; and some WSW used pre- and post- exposure prophylaxes. Low access and high cost of protective devices, being in a monogamous relationship, low health risk perception, fear of developing cancer from using lubricants, and advise from health worker against using lubricants, were reasons given by WSW for not practicing safe sex. Conclusions: Given the current evidence of overlap between the homosexual and heterosexual populations in STI transmission, comprehensive education on potential routes of STI transmission among WSW is critical. Keywords: Women who have sex with women, Safe sex, Sexually transmitted infections, Sexuality, HIV, Tanzania