Thanks to the benefit of anti-HIV therapy, women in high-income countries are living longer. Surveys in the United States have found that most women remain sexually active after a diagnosis of HIV infection. Most research on the sexual behaviour of HIV-positive women is focused on assessing the risk of HIV transmission. However, issues related to other aspects of women’s sexual health—such as those listed below—in the context of HIV infection have received comparatively little attention:
- loss of sexual interest
- difficulties with desire
- problems achieving arousal and orgasm
- pain during sex
Some researchers suspect that sexual problems may be more common in some HIV-positive women than in their HIV-negative sisters. In part, this suspicion arises because certain chronic health conditions that are associated with sexual dysfunction may be more common among HIV-positive women, including the following:
- cardiovascular disease
- diabetes
- mental health issues
- substance abuse
It is also possible that the use of anti-HIV agents may negatively impact sexual health.
Researchers across the United States undertook a study to collect information from HIV-positive women and women at high risk for HIV infection about their sexual functioning. They found that HIV-positive women reported more sexual problems than HIV-negative women.
Study details
Researchers with the Women’s Interagency HIV Study (WIHS) in the following U.S. cities have been collecting health-related information from HIV-positive women and women at high risk for HIV infection:
- Chicago
- Honolulu
- Los Angeles
- New York
- San Francisco
- Washington, DC
The study team began recruiting women in 1994. Participants are regularly interviewed, have medical exams and blood drawn for analysis.
In 2006 and 2007, WIHS surveys included questions about sexual functioning using the Female Sexual Function Index (FSFI). This survey asks questions about a range of sexual functions from orgasm to overall sex life to relationships.
In total, 1,279 HIV-positive women and 526 HIV-negative women completed the sexual function survey.
Results
In general, the researchers found that women who were younger and who were married or living with a partner tended to report better sexual functioning.
Women who tended to have greater levels of sexual problems generally had the following:
- diabetes
- symptoms of depression
- used medications to treat mental health issues, seizures, high blood pressure or heart disease
As much as 32% of survey participants reported having no sexual activity with another person in the past six months. The WIHS survey did not investigate whether this reflected a lack of available partners, a decision to abstain from sex or other factors.
HAART
About 66% of HIV-positive women were taking highly active antiretroviral therapy (HAART) at the time of the sexual function survey. Among these women there was no link between specific classes of anti-HIV medicines such as protease inhibitors or non-nukes (NNRTIs) and the presence of sexual dysfunction.
Among women who had less than 200 CD4+ cells, decreased sexual function was common.
What’s next?
Overall, the WIHS survey revealed a greater burden of sexual function problems among HIV-positive women.
Bear in mind that the WIHS study design is that of a cross-sectional study, analogous to a snapshot at one particular time. Cross-sectional studies are often cheaper and simpler than studies of a more robust design, such as longitudinal studies.
The findings from the WIHS survey can serve as a foundation for conducting future in-depth research with HIV-positive women to gain a more sophisticated understanding of sexual function issues and its relationship to many aspects of these women’s lives and health.
—Sean R. Hosein
REFERENCE:
- Wilson TE, Jean-Louis G, Schwartz R, et al. HIV infection and women’s sexual functioning. Journal of Acquired Immune Deficiency Syndromes. 2010; in press.