A mark that is no mark? Queer women and violence in HIV discourse

Abstract

Lesbian, bisexual and queer women are invisible and ignored in HIV discourse, as epidemiological classifications result in their institutionalised exclusion from risk categories. Simultaneously, these women live with HIV, often in situations of societal exclusion and under threat of violence. In this paper, we consider the connections between discourse and violence to examine how both are reproduced through, applied to and dependent upon people. The ways lesbian, bisexual and queer women do (or do not) appear in HIV discourse tells us much about how people and categories operate in the global pandemic. The fault-lines of lesbian, bisexual and queer women's constrained visibility in HIV discourse can be seen in situations where they are exposed to HIV transmission through homophobic sexual assault. In dominant HIV discursive practices, such homophobic assault leaves Judith Butler's 'mark that is no mark', recording neither its violence nor its 'non-heterosexuality'. Structural violence theory offers a means to understand direct and indirect violence as it pertains to HIV and lesbian, bisexual and queer women. We call for forms of modified structural violence theory that better attend to the ways in which discourse connects with material realities. Our theoretical and epidemiological lens must be broadened to examine how anti-lesbian, bisexual and queer-women bias affects transnational understandings of human worth.

A Pilot Study of a Group-Based HIV and STI Prevention Intervention for Lesbian, Bisexual, Queer, and Other Women Who Have Sex with Women in Canada

“…QWC is a theory-driven intervention based on the Modified Social Ecological Model (MSEM) framework 30 and social and structural drivers of HIV and STI. 11,17 This study provides evidence for future randomized control trials to address multi-level dimensions associated with HIV and STI vulnerability, including individual (safer sex practices, STI knowledge, safer sex selfefficacy) and structural (sexual stigma) factors. Including participants from geographically diverse regions of Canada (Calgary and Toronto) shows promise with regards to translating our study findings other urban Canadian centres.…”

“…Given findings from the current and prior studies 7,11,12 that approximately 20% of LBQ and WSW report a lifetime history of STI, it is critical to understand how to tailor multi-level strategies that reduce STI vulnerability among this population of women overlooked in most STI prevention research. 17,62 …”

“…7,15,16 Perceptions that LBQ women are at low risk for STI acquisition contribute to a scarcity of research on effective strategies to reduce STI vulnerability among this population. 12,13,15,[17][18][19] Despite similar STI infection risks, LBQ women in high income countries access sexual health services, including routine gynecologist appointments 15 and STI testing, 12 at lower rates than heterosexual women. Canadian data indicate that lesbians reported significantly lower rates of Papanicolaou testing than heterosexual or bisexual women, lesbians and bisexual women had higher odds of not having a regular doctor than heterosexual women, and bisexual women had higher reported unmet healthcare needs than lesbian and heterosexual women.…”

“…11 It is particularly important to account for sexual and ethnoracial differences within populations of LBQ women. 17,[25][26][27][28] To illustrate, a recent study reported a prevalence of herpes simplex virus (HSV) type 2 of 26% among African American WSW and 54% among African American women who have sex with women and men (WSWM), indicating significant differences in STI prevalence between sexual orientations. 29 A cross-sectional study of WSW in Toronto, Canada, indicated that women identifying as bisexual had higher selfreported lifetime STI history rates than lesbian or queer identified women.…”

Sexual practices, identities and health among women who have sex with women in Lesotho – a mixed-methods study

“…While access to testing for sexually transmitted infections (STIs) is low, 4% of adults in Lesotho report diagnosis with an STI and 15% of adult women report symptoms of an STI (MOHSW and ICF Macro 2010). Despite the disproportionate burden of HIV/STIs among women in Africa, women who have sex with women are often assumed to be 'low risk' and have historically been excluded from public health discourse on HIV and STIs (Dworkin 2005;Logie et al 2012;Logie and Gibson 2013;Power, McNair, and Carr 2009;Richardson 2000).…”