Being HIV positive is associated with lower sexual function and a higher prevalence of sexual problems, according to research involving middle-aged women conducted in England and published in AIDS Care. Almost twice as many women living with HIV reported low sexual function, with two-thirds of women with HIV also reporting at least one sexual problem in the previous year. Postmenopausal status was associated with sexual dysfunction in women with HIV, an association that was not observed in HIV-negative women.
“Our analysis shows that sexual function problems among sexually-active women aged 45-60 are more common among women living with HIV, compared to a presumed HIV-negative group of women of a similar age,” comment the authors. “Our study addresses a significant evidence gap on the sexual wellbeing of midlife women living with HIV and is one of very few comparing sexual function in women with and without HIV.” The authors recommend that assessment of sexual function should be incorporated into the routine care of all women with HIV.
In 2016, an estimated 10,500 potentially menopausal women (aged 45 to 60) were living with HIV in the UK, a fivefold increase over ten years. Understanding the effects of menopause on women living with HIV is therefore an increasingly important aspect of HIV care.
Research conducted in Australia, Europe and the United States has shown that the menopause can affect sexual function in middle-aged HIV-positive women, and that sexual problems including pain, vaginal dryness and lack of desire and satisfaction are common.
Aware that an increasing number of HIV-positive women are menopausal, a team of investigators led by Nasreen Toorabally at University College London, designed a study comparing levels of sexual satisfaction and prevalence of sexual problems between middle-aged women with and without HIV.
Data for the HIV-negative women were obtained from the British National Survey of Sexual Attitudes and Lifestyles (Natsal-3), which was conducted between 2010 and 2012. HIV-prevalence in the general population is low so all were assumed to be HIV negative. The HIV-positive sample was recruited from the PRIME (Positive TRansItions through MEnopause) Study, conducted at HIV clinics across England between 2016 and 2017.
All participants included in the study (1228 HIV negative; 386 HIV positive) were sexually active and were asked the same questions about sexual function and experience of sexual problems.
Sexual function was assessed using a 17-measure questionnaire, covering specific sexual problems (including lack of interest in sex, lack of enjoyment, anxiety, pain, not reaching orgasm and vaginal dryness), issues with a partner (including feeling emotionally close during sex and sharing sexual likes and dislikes), self-appraisal of sexual satisfaction, and whether they had sought help/advice about their sex life.
There were significant differences between the HIV-positive and -negative groups. Almost three-quarters of the HIV-positive group were black African (70%), whereas 88% of the HIV-negative sample were white British. The HIV-positive participants were slightly younger (49 vs 51 years). In terms of menopausal status, 56% of HIV-negative and 28% of HIV-positive women were postmenopausal. Regardless of HIV status, almost all identified as heterosexual and over 85% of both groups reporting being in a relationship.
The overall sexual function score was significantly lower for women with HIV compared to HIV-negative women (median 8.44 vs 11.59, p < 0.001). Moreover, 45% of HIV-positive women, but only 23% of HIV-negative participants, met the cut-off for low sexual function. After adjustment to take into account demographic differences between the two groups, the association between HIV and low sexual satisfaction remained significant (AOR = 2.43; 95% CI, 1.68-3.51).
Among women with HIV, being diagnosed for 20 or more years was associated with low sexual satisfaction. There was no association with current or nadir CD4 cell count or viral suppression.
The most common sexual problems reported by women with HIV were lack of interest in sex (48%), lack of enjoyment (32%), no orgasm or delayed orgasm (31%), and lack of excitement or arousal (29%).
Women with HIV were more likely to report at least one sexual problem than HIV-negative women (69% vs 54%). Indeed, each of the eight sexual problems included in the survey were more common in the HIV-positive group. In particular, women with HIV were especially likely to report lack of excitement or arousal (29% vs 13%) and anxiety (16% vs 4%).
There was a significant association between menopausal status and sexual function among the women with HIV. Over half (53%) of post-menopausal women, compared to 38% of pre-menopausal individuals, reported low sexual function. This difference was not observed in the HIV-negative group.
Overall, of the women experiencing sexual problems, those with HIV were more likely to seek help than HIV-negative women (32% vs 17%, p < 0.001). Sources of help also differed, with the HIV-positive women turning to friends, family and sexual health/HIV clinics, whereas the HIV-negative women turned to their GPs.
“Our study addresses a significant evidence gap on the sexual well-being of midlife women living with HIV,” comment the authors. “We advocate that assessment of sexual function be incorporated into routine HIV clinical care provided to women living with HIV of all ages.”
Toorabally N et al. Association of HIV status with sexual function in women aged 45-60 in England: results from two national surveys. AIDS Care, online edition, https://doi.org/10/1080/09540121.2019.1653436.