One third of people with HIV attending French hospitals experience sexual difficulties, most often associated with treatment side-effects and the psychological impact of HIV, report researchers in the July 2008 edition of AIDS and Behavior.
People with HIV commonly report sexual difficulties, including loss of desire, difficulties in maintaining partnerships and erectile dysfunction. Such problems are often described as “sexual dysfunction”, and possible causes include psychological issues, the use of drugs (both prescribed and recreational), other medical conditions such as diabetes, and hormonal abnormalities. Most of the research into the issue has involved men, and there is little information on the prevalence and causes of sexual dysfunction in women.
The VESPA study was a cross-sectional survey of a random sample of HIV-positive outpatients attending 102 French hospitals in 2003. Patients completed a standardised face-to-face interview that covered a range of aspects of daily life. Other findings from VESPA have already been reported on aidsmap.com, including a fuller description of the research methodology.
This analysis included the 1812 people who reported at least one sexual partner in the previous year. Forty per cent of the sample were gay men; 23% were heterosexual men; 12% men infected through drug use; 20% heterosexual women; and 4% women infected through drug use. Compared to UK samples of people with HIV, a smaller proportion of the heterosexuals were migrants.
Sixty eight per cent of respondents had a steady partner and 48% reported casual partners. In terms of health, 95% were on HIV treatment, and 90% had a CD4 cell count above 200 cells/mm3.
A total of 33.3% of the sample reported having experienced “sexual problems” or “sexual difficulties” in the previous four weeks. Nonetheless the researchers note that this is not a clinical measure of sexual dysfunction but a suggestive appreciation by the individual.
The study aimed to understand the factors associated with sexual difficulties. In univariate analysis, these included: not being employed, using anti-depressant and anti-anxiety drugs, having sex relatively few times in the last month, and being diagnosed with HIV for longer. Gay men, female injecting drug users and female migrants were more likely to experience sexual difficulties than other groups.
Moreover, those who believed that HIV treatments were very effective were less likely to have sexual difficulties. This was also the case for respondents who had both a steady partner and casual partners in the past year.
A number of factors were examined and found not to be associated with dissatisfaction: age, gender, level of education, CD4 cell counts, viral load results, CDC disease stage, taking treatment, and treatment regimen.
Furthermore, in multivariate analysis, the factors that remained significantly and independently associated with sexual difficulties were associated with discrimination, knowing other people with HIV, and treatment side-effects.
Almost 20% of respondents had felt discriminated against by relatives, friends, healthcare workers, at work, or by others in the past year. Compared to those not experiencing discrimination, those suffering discrimination from one group were twice as likely to have had sexual difficulties (Adjusted odds ratio [AOR]: 2.1; 95% confidence interval [CI] 1.6-2.7). Moreover, those who experienced discrimination from three or more of these groups were more than four times more likely to say that they had sexual difficulties (AOR: 4.4; 95% CI 1.9-10.3).
Knowing at least four people living with HIV was also independently associated with sexual difficulties (AOR 1.3; 95% CI 1.1-1.7). Moreover, in the univariate analysis, having known more than four people who died from AIDS and having experienced the death of a sexual partner had also been associated with sexual difficulties.
The authors say that although social networks can be supportive, other studies have shown higher levels of perceived HIV-related difficulties in people who know other people with HIV. They hypothesise that social networks can help people be more aware that “sexual difficulties can occur with illness”.
Experience of treatment side-effects was also associated with sexual difficulties. Those who perceived side-effects to be disturbing were twice as likely to have sexual difficulties (AOR 2.2; 95% CI 1.8-2.8).
More specifically, people experiencing lipodystrophy experienced more distress (AOR 1.3; 95% CI 1.0-1.6). The authors note that some, but not all, previous studies have found a link between lipodystrophy and sexual dysfunction, which may be explained by a feeling of being less sexually attractive.
The authors comment that the sexual transmission of HIV “can give rise to psychological complications that non-sexually transmitted diseases do not share”. They draw attention to their finding that CD4 counts, viral load results and disease stage were not associated with sexual difficulties, which highlights “the predominant role of the psychological impact of HIV experience on sexual difficulties.”
Bouhnik AD et al. Sexual difficulties in people living with HIV in France—results from a large representative sample of outpatients attending French hospitals (ANRS-EN12-VESPA). AIDS and Behavior 12: 670-676, 2008.