HIV seropositivity and sexuality: cessation of sexual relations among men and women living with HIV in five countries

Factors associated with sexual quality of life among men living with HIV

INTRODUCTION

This study aims to assess the prevalence of sexual difficulties and identify factors associated with the Sexual Quality of Life (SQoL) among people living with HIV (PLWHA).

METHODS

The study included 107 heterosexual men and 474 men who have sex with men (MSM) from five countries. Participants self-reported variables related to physical and mental health, as well as HIV-related parameters. Erectile or ejaculation difficulty, as well as low sexual desire, were investigated. SQoL was measured using the PROQOL-SexLife questionnaire.

RESULTS

Most of participants reported low sexual desire, predominantly among MSM. Among MSM, living with a partner and healthcare satisfaction were associated with SQoL scores in POP dimension, while consistent condom use, cardiovascular complications, and being single were associated with SQoL scores in STI dimension. Viagra use, anti-cholesterol treatment, and living with a partner were associated with SQoL scores in DIS dimension. Among heterosexual men, employment and African origin were associated with SQoL scores in the POP dimension. Alcohol consumption was associated with SQoL scores in STI dimension.

CONCLUSION

This study underscores the importance of non-clinical determinants when assessing SQoL among PLWHA, emphasizing psychological factors and the perceived quality of healthcare. Tailored interventions should incorporate these findings to enhance overall SQoL outcomes.

Conceptions of sexual health by gay men living with HIV in serodifferent couples in Montreal, Canada: results from a qualitative analysis

BACKGROUND

Gay, bisexual, and other men (GBM) who have sex with men living with HIV in serodifferent couples (one partner living with HIV, the other HIV-negative) may encounter unique sexual health challenges. This study aimed to explore their definition of sexual health that could improve service provision.

METHODS

We interviewed 10 gay-identified men living with HIV from 2017 to 2019 as part of CTNPT013, a study on the sexual health of HIV serodifferent GBM couples conducted at two HIV-specialised clinics in Montreal, Canada. Participants partook in semi-structured interviews on the meaning of sexual health. We performed a content analysis of interview transcripts, coding them according to the 10 dimensions of Robinson's Sexual Health Model.

RESULTS

Mean age of interviewees was 35.4years (s.d.,10.2; range, 20-53). Every dimension of Robinson's model was spontaneously evoked, except for body image and spirituality. All men indicated intimacy/relationships (e.g. sexual agreements) and sexual health care/safer sex (e.g. HIV management, risk behaviours) as relevant aspects of sexual health. Other dimensions included: positive sexuality (n =7), such as pleasure and enjoyment during sex; talking about sex (n =5), which mainly concerned HIV disclosure; sexual functioning (n =4); challenges to sexual health (n =3), including substance abuse; and culture/sexual identity (n =3). Two participants (n =2) cited masturbation/fantasy.

CONCLUSIONS

This study emphasises the multi-faceted nature of sexual health for gay men with HIV in serodifferent couples and the pivotal roles of relationships, HIV, risk management (e.g. via health care, knowledge), and positive sexual experiences. These dimensions could be considered in sexual health promotion interventions targeting this population.

Divergent Perspectives of Filipino PLWH, Their Partners, and Care Providers on Sexuality After an HIV Diagnosis: A Q-Methodological Analysis

ABSTRACT

This study explores the perspectives that Filipinos with professional and personal experience with people living with HIV hold about sexuality after an HIV diagnosis. Twenty people living with HIV (PLWH), 11 partners of PLWH, and 10 HIV care professionals in the Philippines were asked to rank-order 54 statements about sexuality post-HIV diagnosis. They shared the reasoning behind their rankings on an online survey platform. By-person factor analysis was done, with factors extracted based on principal component analysis followed by varimax rotation. The analysis yielded six factors with 22 males' and 3 females' Q-sorts exemplifying the views regarding sexuality post-HIV diagnosis: to be human, is to be sexual; information is power; fear of being othered; partnership for enhanced sexuality; disclosure and trust; and communication is foundational. This study revealed diverse viewpoints about sexuality after an HIV diagnosis. HIV care professionals play a decisive role in addressing concerns relating to the sexual health and well-being of newly diagnosed PLWH.

Factors associated with the reproductive health of women living with HIV in Iran

Background

Insight on reproductive health status in women living with HIV is associated with improved psychological well-being, health behaviors, and physical wellness. The overall aim of this paper is to gain insight into the reproductive health of women living with HIV and related factors.

Method

An analytical cross-sectional study was carried on women living with HIV (N = 112) attending high-risk behavior consultation centers in Rasht and Tehran, Iran. The sampling of respondents was in the form of consecutive and available. The data gathering including questionnaires that were divided into three parts: sociodemographic and health characteristics, reproductive behaviors information, and reproductive health assessment tool for women living with HIV.

Result

The sub-dimension of responsible behavior received the highest total mean score (54.27 ± 22.18). The mean scores in the sub-dimension of coping with the diagnosis, life instability, disease disclosure, disease-related concerns, and support needs for self-care were 50.14, 49.23, 44.27, 40.08, 38.25, and 33.25 respectively.

Conclusion

The results clearly showed that the reproductive health situation of women living with HIV needs particular attention. Strategic planning and context-specific interventions are needed to improve women’s access and utilization of reproductive health services.

Exploring Intimate Partner Relationships before and after HIV Diagnosis among Minority Older Women

OBJECTIVES

Literature shows that sexual activity remains important at older age and is a valued part of life. However, little is known about the intimate partner relationships (IPR) among minority older women living with Human Immunodeficiency Virus (HIV). The purpose of this study is to explore the effect HIV diagnosis had on the intimate partner relationships (IPR) among minority older women living with HIV (MOWH).

METHODS

Qualitative descriptive study. A total of 28 MOWH (Black and Latinas) aged 50 years and older participated in face to face semi-structured in-depth interviews. Interviews were analyzed using content analysis.

RESULTS

Three themes emerged from the analysis: (a)"Intimate partner relationships before HIV diagnosis" that revealed sexual practices increasing the risk for HIV in their intimate relationships; (b)"Facing relationship consequences of HIV disclosure after diagnosis" explored the consequences of HIV disclosure, and how disclosure determined the future of their intimate relationships; and (c) "Intimate partner relationships after HIV diagnosis" described the quality of intimate partner relationships and changes after HIV diagnosis.

CONCLUSIONS

Results from this study contribute to understanding and increasing awareness of the effect of HIV on the intimacy of MOWH.

CLINICAL IMPLICATIONS

Education provided by health care workers and interventions targeting MOWH should address the effect of HIV in IPR, address MOWH's concerns about it, and help them to improve their overall health.

Sexual and reproductive health of women living with HIV in Muslim-majority countries: a systematic mixed studies review

Background

The number of women living with the human immunodeficiency virus (WLHIV) in Muslim-majority countries has increased significantly in the last decade. These women are often marginalized and face insecure sexual and reproductive health (SRH) needs and rights. However, little is known about the multi-faceted factors influencing these women’s fertility, contraceptive, and perinatal decisions and sexual life. This systematic mixed studies review aimed to synthesize the empirical evidence on social, cultural, and structural factors influencing the SRH of WLHIV in Muslim-majority countries.

Methods

This review provides a synthesis of quantitative, qualitative and mixed-method research findings searched from PubMed, EMBASE, Scopus, CINAHL and Cochrane databases. We screened 3452 SRH studies involving WLHIV. The studies, published in English between 2008 and 2017, were from 20 Muslim-majority countries with increased numbers of WLHIV. The quality of eligible studies was appraised using a mixed-methods appraisal tool (MMAT) version 2011. Findings were thematically analysed by a hybrid deductive-inductive approach. Two independent reviewers were involved in the study selection, data extraction, quality appraisal, and data synthesis.

Results

We included 13 SRH-related studies involving 1748 WLHIV in eight Muslim-majority countries. Most of these studies explored fertility desire and sexual health, while only a small proportion related to contraceptive use and the perinatal-care experience. We identified that WLHIV faced neglect of their SRH rights. These rights were predominantly affected by the socio-cultural, religious and health-services context of the women’s lives, which directed them to unsafe sex practices and stressful perinatal experiences.

Conclusions

This study points to the need for SRH laws, policies, and interventions which stop WLHIV experiencing SRH discrimination violence and achieving their SRH rights.

The impacts of depression and anxiety on quality of life among patients with HIV/AIDS and their spouses: testing dyadic dynamics using the actor-partner interdependence model

HIV/AIDS not only affects the patients, but also their entire family. This study aimed to assess the impacts of the patients' and their spouses' anxiety and depression on their quality of life (QoL) at the dyadic level. A total of 120 serodiscordant husband-wife dyads from the voluntary counselling and testing center in Shiraz, Iran, were involved in this study from February to June 2015. The WHOQOL-BREEF, CESD-10, and Beck Anxiety Inventory instruments were used, respectively, to assess the QoL, depression, and anxiety scores of the participants. The actor-partner interdependence model (APIM) was used to estimate the effects of depression and anxiety of both the people living with HIV/AIDS (PLWHA) and their spouses on their own QoL (actor effect) as well as their partners' (partner effect). The APIM analysis revealed that both PLWHAs' and their spouses' depression and anxiety showed actor effects on their own QoL. Furthermore, spouses' depression showed a significant partner effect on PLWHAs' QoL and PLWHAs' anxiety had significant partner effects on spouses' QoL. Accordingly, this data can be used to develop targeted interventions aimed at guidance and assistance of PLWHAs and their spouses to find coping strategies that improve their own QoL as well as their partners'.

Changes in sexual behaviors following diagnosis with HIV: patterns and correlates among people living with HIV (PLHIV) in China

Effective secondary prevention of HIV infections requires knowledge about changes in sexual behaviors after diagnosis among people living with HIV (PLHIV), yet there is a dearth of literature assessing gender-specific patterns and correlates of such changes among heterosexual PLHIV in China. Data used in the current study were derived from a cross-sectional survey conducted from 2012 to 2013 among 1212 heterosexual sexually active PLHIV in Guangxi, China. Most participants reduced sexual frequency (71.2%), reduced or maintained the same number of sexual partners (96.6%), and increased or maintained same frequencies of condom use (80.6%). Gender difference was found in changes in sexual frequency, but not in the number of sexual partners or condom use. For males, decrease in sexual frequency was associated with having no desire to have children (OR = 2.03, 95% CI 1.20, 3.44), being virally suppressed (OR = 0.27, 95% CI 0.079, 0.94), and social support (OR = 1.44, 95% CI 1.06, 1.96). Health promoting behaviors in condom use (i.e., increased or maintained same frequencies of condom use) for males was associated with being 45 years of age or older (OR = 0.35, 95% CI 0.21, 0.61), having an HIV-negative main partner (OR = 1.80, 95% CI 1.11, 2.92), and physical health-related quality of life (OR = 1.02, 95% CI 1.00, 1.04). For females, decrease in sexual frequency was associated with having no desire to have children (OR = 1.58, 95% CI 1.01, 2.47). Health promoting behaviors in condom use for females was associated with having an HIV-negative main partner (OR = 3.24, 95% CI 1.63, 6.45) and social support (OR = 0.75, 95% CI 0.57, 0.99). Future intervention efforts need to target PLHIV who need extra support in making health-improvement efforts and to facilitate gender-specific behavioral changes in sexual risk reduction after HIV diagnosis.

Health-related quality of life assessment among people living with HIV in Rio de Janeiro, Brazil: a cross-sectional study

PURPOSE

To assess health-related quality of life (HRQoL) and its associated factors among people living with HIV/AIDS (PLWHA) in Rio de Janeiro, Brazil.

METHODS

A cross-sectional study including PLWHA receiving usual HIV-care at Instituto Nacional de Infectologia Evandro Chagas (INI/Fiocruz) was conducted between 2014 and 2016 in Rio de Janeiro, Brazil. The EQ-5D-3L assessed HRQoL; PHQ-2 and ASSIST were used for screening depression and substance use, respectively. Clinical variables were obtained from the INI/Fiocruz cohort database, and structured questions evaluated intimate partner violence, sexual abstinence and relationship status. Data were analysed using multivariable Tobit regression model.

RESULTS

A total of 1480 PLWHA were included: 64.7% were male at birth (38.4% men who have sex with men [MSM], 24.3% heterosexual men and 2% transgender women [TGW]); median age was 43.1 years, and 95.8% were receiving antiretroviral therapy. The median EQ-5D-3L utility score was 0.801. Results showed that the following factors: MSM and women; older age; lower educational level; no engagement in a relationship; depression screening positive; polysubstance use; and, detectable viral load were independently associated with worse HRQoL.

CONCLUSIONS

PLWHA under care at INI/Fiocruz presented good HRQoL. Polysubstance use, depression and lower educational level were among the factors negatively associated with HRQoL. This was the first time that the EQ-5D-3L utility scores were calculated for a considerable number of PLWHA in Brazil, which is a fundamental piece of information for future cost-effectiveness analysis.

Satisfaction with sexual life in people living with HIV/AIDS: the persistent weight of the fear of transmission

Sexual life is an important dimension of quality of life, which may be affected by the fear of transmission in people living with HIV/AIDS (PLWHA), despite the fact that antiretroviral therapy prevents person-to-person transmission. We, therefore, aimed to explore the sexual life satisfaction of PLWHA and its correlation with their fear of HIV transmission and self-esteem. Consecutive adult PLWHA from seven HIV care facilities in the Rhone-Alpes region, France, were asked to complete a self-administered, anonymous questionnaire concerning sociological and medical data, satisfaction with sexual life (18 questions), and self-esteem (Rosenberg score). Overall, 690 PLWHA answered the questionnaire (mean age 49.2 ± 11 years); 74.9% were men, of which 75.1% had sex with men. Overall, 68.0% of respondents feared transmitting HIV (a lot/a bit). A lower satisfaction with sexual life was significantly associated with being female, not having a stable sexual partner, being unemployed, having a low income, experiencing a fear of HIV transmission, having lower self-esteem, and not reporting an excellent/very good health status. These results strongly suggest that the information concerning the antiretroviral-induced suppression of infectivity should be widely diffused, as this may enhance the quality of sexual life in PLWHA.

Drivers of Sexual Inactivity Among Women Living with HIV and AIDS: Findings of the GENIH Study in São Paulo, Brazil

The advances on HIV/AIDS diagnosis and treatment have enabled people living with HIV/AIDS (PLHA) better quality of life. However, the persistence of HIV-related stigma and discrimination, and the risks triggered by HIV disclosure, may be a barrier to the sexual exercise of PLHA. We investigated the prevalence of sexual inactivity and the reasons given for it among a representative sample of women of reproductive age living with HIV/AIDS (WLWHA) in the municipality of São Paulo, Brazil. We surveyed 918 WLWHA with probability proportional to average number of visits in each of the 18 referral HIV/AIDS services. Sexual inactivity was defined as not having had vaginal sexual intercourse in the year prior to research. Statistical modeling of the factors associated with sexual inactivity was carried out by way of bivariate and multivariate analysis. In all, 22.2% (n = 200) of the women did not have sexual relations in the year prior to the interview. The majority reported a reduction in desire (64.5%) and sexual activity (68%). Among the women not in a relationship, the predictors of sexual inactivity were: being older (35-49) (ORa = 2.25); not being Catholic (ORa = 2.91); having kept the diagnosis secret from their partner (ORa = 2.45); having had up to five sexual partners throughout life (ORa = 3.81). The diagnosis of HIV seems to have more of an effect on the desire for and frequency of sexual activity than on its interruption. Sexual inactivity was influenced by the stigma of HIV/AIDS, by age, and by moral-religious values.

Sexual (Dis)satisfaction and Its Contributors Among People Living with HIV Infection in Sweden

Earlier research reports lower sexual satisfaction among people living with HIV (PLHIV) compared to HIV-negative persons. A number of psychosocial factors directly associated with sexual dissatisfaction have been identified. Little is known about sexual satisfaction and their contributors among PLHIV in Sweden. The aim of this study was to examine direct and indirect effects of variables within sociodemographic, clinical HIV-related, psychological, and sexual domains on sexual (dis)satisfaction among PLHIV in Sweden. Data for this study were derived from a nationally representative, anonymous survey among PLHIV conducted in 2014 (n = 1096). Statistical analysis included four steps: descriptive analyses, identification of variables associated with sexual (dis)satisfaction, identification of variables associated with those contributors of sexual (dis)satisfaction, and a path model integrating all these analyses. A total of 49% of participants reported being sexually dissatisfied, and no significant differences were observed when non-heterosexual men, heterosexual men, and women were compared. Among women, a negative change in sex life after HIV diagnosis and distress with orgasmic difficulties was directly associated with sexual dissatisfaction. For men, hopelessness, high HIV stigma, sexual inactivity in the last 6 months, and a negative change in sex life after HIV diagnosis were directly associated with sexual dissatisfaction. Path analyses showed in both men and women significant indirect associations between not being involved in an intimate relationship, lower self-reported CD4 cell counts, and perceiving obligation to disclose HIV status to sexual partners as a barrier to look for a long-term partner and sexual dissatisfaction. Our results show that despite good treatment outcomes, the HIV diagnosis has a negative bearing on sexual satisfaction. The need for gender-tailored interventions and clinical implications of these findings are discussed.