Lesbians in Spain have a complicated history with AIDS. For the most part, it has not impacted our community in the same way it impacted other members of the rainbow. At the same time, the virus did impact our relationship with other members of the rainbow and organizations that represented us. Like the events around Pride happening parallel to the HIV / AIDS epidemic, it strengthened some lesbians relationships with the LGBT community, pushed some Spanish lesbians more towards queer activism and pushed some of us further away from gay men. History is always messy, and lesbians rarely act in concert together as we represent a diverse and amazing bunch of women.
While the early history of the virus does not deal with lesbians directly, it does set the scene for later lesbian interactions both with the virus and HIV / AIDS activism around the virus.
AIDS first appeared in Spain in October 1981 at Hospital Vall d’Hebron de Barcelona in a 35-year-old-man. This was a mere four months after the first five cases had been described by doctors in Los Angeles, California. The name AIDS, SIDA in Spanish, would first be applied to the disease in 1982. At that time, almost nothing was known about it. The case was discovered after the man had arrived at the hospital with Kaposi sarcoma, headaches, weight loss, appetite loss, hemiplegia and recovering from gonorrhea. Doctors performed a CT scan on the patient, discovered a 3-centimeter mass in his head and performed surgery to remove it. The patient died four days later. Dr. Carmen Navarro, a tissue analyst at the hospital, wanted to examine a sample from the surgery as she had detected granulomatous toxoplasmosis, a parasitic infection, that she had never seen present with someone with Kaposi sarcoma before. This opportunistic infection was what caused them to link their case with those in Los Angeles. When doctors looked more closely at the case and compared it to those in the United States, they found the man had had several sexual encounters with men in New York City in 1974 and Turkey in 1980. At the time of his death, he had been in a steady relationship.
AIDS immediately became associated with homosexuality, and specifically male homosexuality and the perceived way of life that came with being a gay man, because the first discovered case was in a gay man and because the first cases discovered in the United States were found in a cluster of gay men. This association stuck even as AIDS cases were discovered a wider population, including in pediatric cases in late 1982 and early 1983, along with the discovery that AIDS could be transmitted from mother to fetus. It would be from these other types of cases that the first AIDS activists in Spain would emerge. One of the earliest would be an organization supporting children who contracted AIDS, offering them activities and supporting them in the face of social exclusion. By 1983, HIV was discovered to be a virus, along with the knowledge that it was transmitted through sexual penetration and sharing of needles during illicit drug use. It was finally given the name HIV in 1986. Early patients had short life expectancies, most not living more than a few years after contracting the virus. Within a few years of the virus being discovered, Spanish health authorities realized that the biggest cause of its transmission was not, like the United States and other places, unprotested sex but shared needles from intravenous drug use. Despite this, the AIDS crisis in Spain led to heavy stigmatization against homosexuals, more so than other nearby countries like France or the United Kingdom.
By 1986, the epidemic had begun to hit the rest of Spain all at once. In Madrid, one of the hospitals at ground zero was Hospital Universitario 12 de Octubre. It soon filled up hospital beds across the country. It was at this point, almost five years after AIDS was first confirmed as arriving in the country that activism around AIDS slowly began to build. This activism though was not from within the homosexual rights community that had achieved a number of successes in the past few years, including decriminalizing of homosexuality. The homosexual rights community of the 1980s wanted to avoid the stigma of being attached to AIDS and the discrimination faced by people with AIDS despite the homophobia AIDS was generating inside the country. The detachment also continued even as many gay men in Spain died from the disease, especially in cities like Sevilla. This pattern of detachment continued into the early 1990s.
During the late 1980s, as the homosexual rights movement began to start mobilizing more towards fighting for AIDS, lesbian feminists made a collective decision to more or less sit out that battle as they did not consider AIDS to be an issue that impacted women, and they did not work on efforts to prevent the transmission of sexually transmitted infections, including AIDS, between women.
Despite the resistance of some homosexual activists and in line with what was occurring in other countries, some of the fractured alliances between gays and lesbians began to heal in a number of larger cities across Spain as a result of the continuing AIDS crisis. This was felt locally in how some Orgullo events began to be organize. This was not always the case though in all places, and in many cases was confined only to specific HIV and AIDS activism.
COGAM was the largest homosexual rights organization in Madrid in the late 1980s, having been founded in following a meeting of Coordinadora de Frentes de Liberación Homosexual del Estado Español (COFLHEE) in 1985. The group strived more towards moderation, and away from radical liberation philosophies characterized by a number of other homosexual rights activist groups in Madrid at the time. By the early 1990s, lesbians were much more engaged with the organization than they had been with other homosexual rights groups in the past as they once again found common ground on issues like securing social support services. Among the lesbians involved with COGAM around this time were Mili Hernández and Beatriz Gimeno Reinoso.
The fight against AIDS in Spain emerged in the early 1990s not from lesbian activist circles or gay rights activist but from a new activist group identified as queer activities, which grew out of anarchist culture and the newly emerging transgender culture that was replacing transexual culture in Spain. These newly emerging queer organizations challenged the more conservative and homosexual organizations that already existed, such as Col·lectiu Lambda, Coordinadora Gay y Lesbiana (CGL) and the Colectivo de Lesbianas y Gais de Madrid (COGAM) who were perceived as not capable of taking direction on the street to effect social change in the face of blatant homophobia. Queer activist groups challenged existing lesbian and gay men activist groups by demanding acceptance for who they were, without the need to conform to heterosexual norms as a means of being acceptable to society, culture and the legal system.
Two problems emerged for COGAM in the very early 1990s. The first was that a number of their members wanted to engage more fully with liberation politics. The second was that institutionally, COGAM appeared unable and unwilling to act to combat the AIDS epidemic and its impact on gay men in the city. COGAM split with COFLHEE in 1991 over the liberation politics issue. It was for the AIDS reason though that Las Radical Gai (LGR) also split from the organization in 1991. They, along with Lesbianas Sin Duda (LSD), would become the two major homosexual militancy groups in Madrid and in Spain as a result of COGAM’s inaction on the AIDS issue.
Lesbianas Sin Duda and La Radical Gai were soon at the forefront of the battle against AIDS and HIV in the city of Madrid in the early 1990s. They would play key roles in turning the body into a dimension of space from which sexuality and gender would then be used to exercise resistance against the state.
Lesbianas Sin Duda were created in Lavapies in February 1993 from a network of friends. The women came from different backgrounds. Some had been active in homosexual rights activism during the 1980s, some came from feminist groups, and some came from left wing extra-parliamentary groups. Lesbianas Sin Duda working to erase the AIDS stigma would focus not just on lesbians and bisexual women, but also on other groups including female drug addicts, prostitutes and those who had passively contracted the virus but were not part of marginalized classes.
The group Radical Morals, which emerged from the gay rights group La Radical Gai founded in Lavapiés in 1991, opposed the inclusion of lesbians in literature on the prevention of AID/HIV during the 1990s because, according to one of their proposals, lesbians do not fuck and cannot pass on the virus as a result, the media does not discuss lesbians getting AIDS/HIV, lesbians cannot enter hospitals and, anyway, lesbians do not exist.
During 1993 and continuing into the next few years, LSD worked on drawing attention to the impact of HIV and AIDS on women and on lesbians through art. They teamed up with a number of other organizations as part of these efforts, including ACT UP (France) and La Radical. They held photography exhibits, designed posters and created fanzines inspired by Barbara Kruguer as part of these efforts. One of their goals was to stop allowing others in the broader AIDS and HIV activist community to represent lesbians and lesbian sexual activities, and to give lesbians their own voice in describing their sexual practices as it related to AIDS and HIV.
III Jornadas Feministas Estatales. Juntas y a por todo took place in Madrid in 1993. Lesbianas Sin Duda held a workshop at the jornada called “Sexo seguro y bollero”. On 1 December 1993, Lesbianas Sin Duda held a protest outside the Ministerio de Sanidad, located at Paseo del Prado, 18, to protest their policies related to HIV and AIDS. The group was one of the only ones in Spain to trying to actively draw attention to women and lesbians, and their needs as it related HIV and AIDS, both in treatment and in terms of health-related policies. Fefa Vila was a member of LSD involved in these efforts. On International Day of the Fight against AIDS that took place on 1 December 1996, Lesbianas Sin Duda protested on the street in front of the Ministerio de Sanidad, demanding intervention to combat the AIDS epidemic taking place in the country.
The Instituto de la Mujer prepared a report for the first time on women with HIV / AIDS in 1992. Instituto de la Mujer had been founded on 24 October 1983 and attached to the Ministerio de Igualdad to promote equality between the sexes, and to encourage the participation of women in political, cultural, economic and social life. At the time the document was released, the institute was between plans with the first plan having been focused on six areas, one of which was women’s health, and a second of which was family and social protection. The document then takes a heterocentric perspective to advice regarding the prevention of transmission. Lesbians and women who had sex with other women were not mentioned.
Despite an awareness for a number of years that AIDS could be transmitted from a mother to a fetus, it was only in 1993 that the clinical definition of AIDS changed in Spain to allow for the possibility that women could contract the virus. For some feminists in Spain, this was viewed as another type of violence enacted upon women’s bodies as the medical establishment, aware of the virus since 1981, had not bothered to verify its transmissibility to women.
One of the results of the AIDS pandemic in Spain by this point in the 1990s, according to a paper by Ricardo Llamas, was that in the mind of the public, AIDS had often rendered gay men to little more than bodies and lesbians to a place where they did not even exist because of a lack of visibility as a result of the media attention given to their male counterparts. Male homosexuals became defined almost solely by their sexual practices, and the contagion they could get from them.
Despite the literature produced by the Instituto de la Mujer, organs of the Spanish state continued to focus mostly on gay men when it came to trying to prevent the spread of AIDS in the mid to late-1990s. One example is from Coordinadora gai-lesbiana, stop sida who produced a pamphlet in collaboration with the Ministerio de Sanidad y Consumo in 1997 titled, “Estás Cambiando la Historia” about the history of HIV and AIDS in the gay collective. It featured a shirtless man on the front, talked about safe sex, condom usage and lubricant. It did mention that women, bisexuals and heterosexuals could get HIV, and that HIV could be transmitted from vaginal fluid. Despite being produced by an organization based in Barcelona by a gay and lesbian organization intended for national distribution, the word lesbian never appeared in connection to getting the virus.
LGBT organizations often were the same when it came to lesbians and AIDS prevention. CGL launched a major AIDS prevention campaign in 1995 called “Cuídate 95” at bars, saunas and clubs frequented by gay men. Twenty different LGBT organizations from 14 of Spain’s 17 regions participated. Lesbians were deliberately left out as CGL and participating LGBT organizations did not believe AIDS and STI prevention among lesbians was worth diverting resources to at that moment.
The AIDS epidemic created renewed interest in LGTB organizations in Madrid and nationally. Most of this interest came from gay men, with organizations seeing their membership increase exponentially by this group. This at times further pushed lesbian and transsexuals’ interests in these groups to the margins. Increased membership by gay men also sometimes resulted in fewer representations of women and women’s sexual health in campaigns run by these organizations, with almost none mentioning the prevention of AIDS via vaginal prevention, cleaning of sex toys or using vaginal prophylactics.
There were exceptions though. COGAM ran a campaign saying lesbians were not immune to AIDS in 1996. Unlike their campaigns aimed at men, they did not use photographs of women but instead used ballpoint pen sketches. The advice focused on oral practices like cunninglus and through penetrative practices using toys or fingers.
Lesbians continued to rarely ever the target of general campaigns in Spain to combat HIV and AIDS in the late 1990s and all the way into the early 2010s. One of the first such general campaigns not aimed explicitly at gay men was launched in 1999 for World AIDS Day, and was about the use of condoms in AIDS prevention. General campaigns in 2000, 2001, 2002, 2003, 2004, 2005, 2006, 2007, 2008, 2009, 2010, 2011, 2012, 2013, 2014, 2015, 2016 and 2017 also failed to address women who had sex with women. The government did have specific campaigns for men who had sex with men in 2008, 2009, 2010, 2011, 2014 and 2017. The government also had campaigns aimed at young people, for which women who had sex with women were not mentioned in their campaigns in 1998, 1999, 2000, 2001, 2002, 2003, 2004, 2005, 2006, 2007, 2008, 2009 and 2012. Among 38 campaigns to fight AIDS and HIV by the government between 1998 and 2012, only two even featured any pictures of women having sex with women, but the text and surrounding discussion made clear that these images were not designed to educate lesbians on safe sex practices but instead intended to capture heterosexual male audiences to educate them.
Beyond the lack of educational materials available for lesbians, there was also a lack of research done in Spain in the period between 1998 and 2012 on the sexual behavior of lesbians and other women who had sex with women, or statistics on prevalence inside this group for any sexually transmitted disease. Scholars have attributed the lack of research in this area to machoism and sexism in general, and as a result of pressure from the LGBT community who do not view lesbians as as important as they are viewed as lower risk for contracting AIDS with the belief that resources should not be diverted away from gay men and transwomen towards lesbians.
The situation for lesbians as it related to the AIDS crisis remained much the same for the 2000s with the exception that medical advances during the late 1990s had begun to make AIDS a less deadly. This included the approval of a protease inhibitor, highly active antiretroviral therapy, and new methods of HIV testing. AIDS deaths for women had peaked for women in 1996 with 1,137 deaths but were 555 in 1997 and in the 300s until 2002 when they dipped below that number for the first time since 1990. Similar patterns in AIDS related deaths played out for Spanish men. By the end of the decade, there would be only 207 AIDS related deaths for women.
The Instituto de la Mujer prepared a second edition in 2007 of their women with HIV / AIDS report. The only time lesbians were mentioned were in the name of a national organization to contact that supports women with HIV / AIDS. Bisexual women were not mentioned at all. The report said that most cases of HIV / AIDS in Spain impacted men, that heterosexual transmission accounted for 60.3% of all cases in 2006. The Instituto de la Mujer estimated that there were 120,000 to 150,000 people who had HIV / AIDS in Spain, with 20 to 25% being women. Of the women a quarter did not know how they were infected. The document then takes a heterocentric perspective to advice regarding the prevention of transmission.
LGBT activists continued to have problems with how to address lesbian visibility, which had already been lacking but had decreased even more because of the AIDS crisis, and the AIDS crisis. The 2008 Festival de Cultura Gay y Lésbica de Madrid, organized by COGAM and FELGTB, included an exhibition at the Círculo de Bellas Artes. The 2008 Pride focused on lesbian visibility, which the organizers said they wanted to draw attention to, but the organizers also wanted to draw attention to HIV / AIDS. The exhibition on HIV / AIDS focused mostly on gay men. The experiences and contributions of lesbians during the worst of the 1990s was obscured.
After many years of being omitted from HIV/AIDS prevention literature by the Ministerio de Sanidad y Política, lesbians reappeared in 2009 with a picture of the lips of two women kissing outdoors with the phrase, “Si me besas, te transmitiré ternura”, meaning, “If you kiss me, I will convey tenderness.” The material is designed for a broader audience, and removes all idea of women and lesbian sexuality as it goes on to suggest the only sexual activity lesbians engage in is kissing on the lips in a maternal way. This was far removed from the AIDS prevention material of the 1990s created by Lesbianas Sin Dudas (LSD) that featured overt female reproductive genitalia when all the institutional materials only featured references to male genitalia and condoms.
Mortality for AIDS continued to decline during the 2010s. In 2011, 197 women in Spain had died as a result of AIDS. By the end of 2019, this number had dropped to 80 women, the lowest number since 1987 when 85 women had died of AIDS, a huge spike on 1986 when 37 women had died of AIDS.
COGAM was the organization in Madrid for lesbians to seek help from if they had AIDS or HIV in the 2010s. COGAM’s website in 2010 featured their lesbian section, but it made no mention of women’s sexual health. Their HIV page referenced that they held two workshops a year on sexual health for lesbians and bisexual women, and also contained a brochure about lesbian sexual health. By 2012, their website no longer offered these workshops and instead offered a number of workshops aimed at transwomen and male sex workers. These services were also not offered by the lesbian group inside COGAM on their website. The situation from 2012 was repeated in 2014, with the only image of a woman appearing on the page being a single generic form as one of many in the rainbow. There was however imagery of nearly nude men. 2016 was the same as 2014 but with an image high heels encouraging transwomen and male sex workers to get tested. Sexual health was mentioned only once on the lesbian page and that was as an interest for which they provided no additional information. Their NEXUS group on HIV and AIDS also made no mention of lesbian or bisexual women sexual health needs. 2018 had no improvement on COGAM’s website when it came to information about and services offered to lesbians and bisexual women on their sexual health.
One of the big accomplishments of the decade was for the first time, a national health or LGBT organization specifically examined the risks of lesbians for catching AIDS or other STIs. The organization to do this was FELGTB in 2011. That year, the organization had the slogan “2011 en Positivo, + salud, + solidaridad” as part of their efforts to talk about the HIV / AIDS crisis in the LGBT community in Spain. They said one of the reasons for this was the disease primarily affected men who slept with other men, bisexual men, women transexuals and male sex workers. They also produced a report on the sexual health of lesbians, bisexual women and other women who had sex with women in order to assist LGBT organizations and activist across the country in assisting this group as there was an identified issued of inequality in care when it came to women in the LGBT community. Issues they identified among healthcare workers when dealing with women was they mistook women who had sex with women as lesbians, they assumed that lesbians and bisexual women had lower rates of STIs than heterosexual women, that sex practices between women do not constitute intercourse, an assumption that all women are automatically heterosexual which requires patients to out themselves to receive better information, and a lack of a specific profile for women who sleep with women to offer healthcare professionals to assess risks of STIs. For scientists studying women having sex with women, they frequently confuse identity with practice which means important information may be omitted, and they ignore risky sexual practices between women. For women who have sex with women, the information they receive is systematically assuming they have sex with men, assumes that even if they are lesbians they had sex with men at some point as some research indicates up to 80% of lesbians had had sex with men, and also confuse identity with practice as heterosexual identifying women who occasionally have sex with women do not find information about safe sex practices between women relevant.
Their review of existing research on lesbians found that heterosexual women and lesbians are both 10 to 20% likely to have an STI during their lifetime with Trichomonas vaginalis the most common STI reported at 6%, followed by HPV at 4.8%, Chlamydia at 4.6%, herpes at 3.3%, pelvic inflammatory disease at 2%, gonorrhea at 1.6%, syphilis at 0.3% and HIV at 0.1%. Almost all of this data was from research done in the United States. They also said that HIV / AIDS was exceedingly rare among lesbians, with no confirmed transmission cases between women having sex with women in the United States as of 2006. That was against a backdrop of US CDC data that said there were 7,381 cases of HIV among women who had sex with women, but they had other risk factors such as intravenous drug use, occasional sex with infected men or blood transfusions. Of those 7,381 cases, only 534 said they had sex exclusively with men, 486 had other risk factors for HIV while 48 did not and still contracted AIDS. While the US CDC said they had no data on transmission of cases of HIV between women, they did acknowledge that cases of transmission had been reported and the Atlanta office of the CDC published case studies about specific women who had contracted HIV after sex with other women.
Other data out of the United States shared by FELGTB said that women who had sex with women felt a lack of vulnerability to STIs and were more willing to engage in risky sexual practices than their heterosexual or bisexual counterparts. The higher the number of partners women had, the more likely women were to contract an STI. These in turn would filter down to women who only had one sexual partner. An Australian study cited by FELGTB found that 16.6% of self-identified heterosexual women had STIs, while 23.4% of self-identified lesbians had STIs and 37.9% of bisexual women had STIs. The authors attributed to the higher rates to the higher number of sexual partners had by lesbian and bisexual women, and that heterosexual women were more likely to use some form of birth control like a condom compared to lesbians.
FELGTB concluded that medical practitioners needed to be educated more on the topic, that heterocentrism and homophobia resulted in prejudice when it came to care of lesbians getting treatment for STIs, and that more specific training was needed to better identify profiles of lesbians and bisexual women likely to contract STIS. They also concluded there was a lack of political, academic and health system will to do more research specific to lesbian needs and to try to improve their specific sexual health, that there was a lack of systematic campaigns aimed at lesbians and bisexual women that left them more vulnerable. They estimated that based on global surveys, it seemed likely that between 10 and 20% of lesbians and bisexual women in Spain had an STI at some point in their life, and that for some STIs, women who have sex with women are more vulnerable than women who have sex with men. They also concluded that it is not true that women who have sex with women have a zero percent risk of contracting HIV / AIDS.
FELGTB denounced the ignorance and repression of research done into the STIs among lesbians, bisexual women and other women who have sex with women in Spain. They demanded greater media attention to this health issue for women and to not make these health issues invisible. They also requested greater involvement by universities and research training centers in studying sexual health of lesbians, bisexual women and other women who have sex with women in Spain. They asked the government to reduce the price of access to preventative materials for HIV and other STIs such as condoms, lubricants, and latex dials, and to remove the VAT from these items. They asked that the feminist movement incorporate a gender perspective in their work spaces to better include the needs of lesbians, bisexual women and other women who have sex with women in order to empower these groups to improve their sexual health. They asked that government campaigns stop using a androcentrism and cishomonormatividad perspective in trying to reach out to LGBT communities when addressing sexual health. FELGTB also said that LGBT association needed to improve their political and technical training when it came to addressing the sexual health needs of cis women, and that LGBT associations include information on female sexual health and safe sex practices.
FELGTB finished off with specific advice for lesbians, bisexual women and other women who had sex with women. That included to enjoy their sexuality, to talk freely about their sexuality, to inform themselves about real and potential risks of contracting HIV and other STIs, and to encourage them to speak up inside the LGBT and feminist movement to make sure their voices were heard on the issue of their own sexual health.
FELGTB was not alone in addressing lesbian sexual health needs in 2011. Fundación Triángulo created a guide on the sexual health for women who have sex with women in 2011. This guide was updated in 2017. It was created by Grupo de Mujeres de Fundación Triángulo who were based at branches of Fundación Triángulo in Madrid, Coslada and San Fernando de Henares. The document was the first of its kind in the Comunidad de Madrid.
A UNAIDS Under Global AIDS Response Progress Reporting Guidelines, 2011–2013 found a prevalence rate of 12.9% among women who used illicit drugs intravenously and contracting AIDS. This data is some of the only available data about HIV and AIDS among Spanish women from that period. While transgender women were mentioned in the study, mentioning that as many as 30% of transgender women in Spain may use illicit drugs intravenously, no specific mention was made regarding lesbian drug use.
Slightly more data and casual observation about Spanish lesbian AIDS risks became available in 2014. That year, Jorge del Romero, Director of the Centro Sandoval de Madrid, said that 95% of the AIDS cases the clinic had treated in lesbian women were ones where the lesbian or bisexual woman had acquired the virus after sexual context with male. Because of the low rate of sexual transmission of HIV / AIDS between women having sex with women, there was still no official guidance on what sort of prophylaxis usage safe sex practices were most effective in preventing the transmission of the virus between women in 2014. Because of this and a lack of general education, pre-exposure prophylaxis as a means of safe sex practice between lesbians had not really taken hold in Madrid by 2014. At the time, despite its efficacy in other countries at being a greater preventer of AIDS than a condom, it still had not received approval in Spain for medical use either.
A world first happened in 2014 related to lesbians and AIDS risks. The Morbidity and Mortality Weekly Report, a publication by the United States Center for Disease Control and Prevention, documented one its first likely confirmed cases of women-to-woman transmission of AIDS in 2014. The publication was important because back in 1981, it was the first to document the existence of AIDS. In the case discussed, one partner had contacted the virus from a previous heterosexual relationship, and likely given it to her partner after they both stopped taking antivirals, stopped being tracked by a sexual health program and then had unprotected sex while the partner who had AIDS was menstruating. The virus was 98% genetically similar between the two women.
Discrimination against lesbians continued by state organs when it came to the production of sexual health materials for the prevention of HIV and AIDS. A 2018 booklet by stop sida, coordinadora gai-lesbiana done in collaboration with the Ministerio de Sanidad y Consumo only mentioned lesbians in organization names. All the pictures used were of men. The descriptions used the masculine gender. Condoms are mentioned. The word hombres is used eight times while mujer is never used. The booklet was published in Barcelona but intended for national distribution.
Lesbians were aware that their sexual health was being ignored, though most that spoke out on the issue only did so from CRECUL president Elena de León said in 2018 that lesbians were forgotten in official campaigns by the local government in Madrid during the AIDS epidemic as the only tool the Comunidad de Madrid subsidized to fight AIDS transmission was a condom and women having sex with women were never featured in any awareness campaigns.
The pandemic period brought little change to the status quo when it came to lesbians and HIV / AIDS. Almost all activism around the issue had died a number of years back. Lesbians, bisexual women and women who had sex with women were largely ignored by general efforts to reduce HIV / AIDS. LGBT organizations were more miss in a hit or miss situation of if they provided information for women’s sexual health, instead extending almost all their resources on sexual health to gay men, transwomen and male sex workers.
In 2021, FELGTB had a section on their website dedicated to sexual health, with a section related to the sexual health needs of transwomen and male sex workers. There was no section dedicated to cis women, and their sexual health needs.
Triángulo Castilla y León y la Diputación de Valladolid published a guide in 2021 about sexuality among older people. This guide did reference lesbians and provide explicit written information about female biology, and how it could be used for sexual pleasure. The guide was shared nationally by Fundación Triángulo.