Women who have sex with women (WSW) and women who have sex with women and men (WSWM) receive less medical attention than the rest of the population [1]. It is due to structural factors (such as socio-economic and political context, social structure), negative attitudes of professionals, and a lack of published data about the health problems that affect these women [2].

Some diseases are more prevalent among lesbian and bisexual women than in the general population [3], because of discrimination based on affective-sexual orientation. This is one of the Public Health challenges, and determines the health of lesbian, gay, trans, bisexual and intersex people [4].

We analyze the HIV prevention campaigns in Spain, to assess the degree of inclusion of WSW and WSWM in them. The period of time includes from 1999 to 2017, with material available online.

A total of 38 campaigns, 7 intended for young people, 6 for men who have sex with men (MSM) and 25 for the general population. Of these 25, 18 are published on the World AIDS Day. None one of the campaigns there were information about WSW/WSWM. Since 2015, the general population campaigns include specific messages against discrimination, stigma, and words like respect. There were 6 campaigns aimed at MSM, using iconography, advertising spots and showing public personalities. 4 of these campaigns have access to videos, spots created ad hoc, and links to epidemiological data. Table 1.

The messages of the general campaigns for the prevention of HIV in Spain, present a total exclusion of WSW/WSWM. These results are agreed with other studies that point out the lack of studies, or population data that explores sexually transmitted infections (STIs) in the WSW/WSWM [5]. There are also few studies analyze the sexual behaviors of these collective of women [6]. Therefore, the risks associated with certain sexual practices cannot be defined, and it cannot plan specific, adapted and effective prevention campaigns destined to WSW/WSWM.

The unequal inclusion of WSW and WSWM in campaigns puts them in a situation of vulnerability. The design of the campaigns assumes a heteronormative model of attention to women's health, and this is one of the reasons for the invisibility of WSW/WSWM in them [7]. Under a perspective of affective-sexual diversity, the Spanish campaigns to prevent HIV transmission responded to the increase in MSM with specific interventions, with an attractive design, positive references, public figures and non-stigmatizing messages. However, there has not been the same sensitivity towards the WSW/WSWM. The lack of information about HIV prevention in this group of women makes them vulnerable [8], leading them to the erroneous perception of an absence of risk [9] and a scarce or null adoption of preventive measures to reduce the risk of HIV transmission [6].

This group of women has not deserved enough interest and nor has there been concern to implement specific preventive measures. Among the reasons could be the machismo, -also by the collective of lesbian, gay, trans, bisexual and intersex (LGTBI)-, the homophobia and the lesbophobia. It has opted for the invisibility of these realities, instead of investigate into their own sexuality and habits that facilitate the transmission of HIV and other STIs.

The inclusion of the WSW/WSWM in the prevention campaigns would help to break their invisibility, to reduce inequalities due to sexual-affective diversity, as well as to ensure equitable health care for all people in the LGTBI collective [4].