HIV associated with poorer sexual function for women

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Sexual function is poorer in HIV-positive women than in women who are HIV-negative, US investigators report in a study published in the online edition of the Journal of Acquired Immune Deficiency Syndromes.

For women with HIV, increasing age and a lower CD4 cell count were associated with lower sexual functioning.

“Our analysis reveals that the burden of sexual problems is significantly higher among women with HIV infection compared with HIV-uninfected women”, write the investigators.



The presence of one or more additional health conditions at the same time as a primary condition (such as HIV).

body mass index (BMI)

Body mass index, or BMI, is a measure of body size. It combines a person's weight with their height. The BMI gives an idea of whether a person has the correct weight for their height. Below 18.5 is considered underweight; between 18.5 and 25 is normal; between 25 and 30 is overweight; and over 30 is obese. Many BMI calculators can be found on the internet.


A group of diseases characterized by high levels of blood sugar (glucose). Type 1 diabetes occurs when the body fails to produce insulin, which is a hormone that regulates blood sugar. Type 2 diabetes occurs when the body either does not produce enough insulin or does not use insulin normally (insulin resistance). Common symptoms of diabetes include frequent urination, unusual thirst and extreme hunger. Some antiretroviral drugs may increase the risk of type 2 diabetes.


Confounding exists if the true association between one factor (Factor A) and an outcome is obscured because there is a second factor (Factor B) which is associated with both Factor A and the outcome. Confounding is often a problem in observational studies when the characteristics of people in one group differ from the characteristics of people in another group. When confounding factors are known they can be measured and controlled for (see ‘multivariable analysis’), but some confounding factors are likely to be unknown or unmeasured. This can lead to biased results. Confounding is not usually a problem in randomised controlled trials. 

cross-sectional study

A ‘snapshot’ study in which information is collected on people at one point in time. See also ‘longitudinal’.

Thanks to antiretroviral therapy, many women with HIV can expect to live a long and healthy life. The majority of HIV-positive women remain sexually active after their diagnosis, and given the efficacy of antiretroviral therapy it is likely that a large proportion will remain so for several decades.

There has been little research into sexual function and satisfaction amongst women with HIV. Nevertheless, there are good reasons to believe that sexual problems occur more frequently in HIV-positive women than in those who are HIV-negative. Other chronic illnesses have been associated with reduced sexual satisfaction and functioning, as have the use of illicit drugs and alcohol. In addition, it is also possible that antiretroviral treatment may have a detrimental impact on sexual function.

Investigators from the Women’s Interagency HIV Study (WIHS) therefore conducted a cross-sectional study including 1279 HIV-positive and 526 HIV-negative women that enquired about sexual function and satisfaction. The study was conducted between 2006 and 2007.

All the women completed an established questionnaire (Female Sexual Function Index) that was used to assess several areas of sexual satisfaction and function including arousal, desire, lubrication, orgasm and pain during intercourse. Higher scores (maximum, 36), were associated with better sexual function, and lower scores with poorer function.

Information was also obtained on age, menopausal status, mental health history, co-morbidities, CD4 cell count, viral load, the use of antiretroviral therapy and HIV treatment side-effects to see if any of these factors had an independent association with sexual function.

Overall, the women with HIV had significantly lower sexual satisfaction scores than did the HIV-negative women (mean, 13.8 vs 18, p < 0.001).

Amongst both HIV-positive and HIV-negative women, higher sexual satisfaction scores were seen in women who were younger and who were married or living with a regular partner.

Poorer scores were recorded for both HIV-positive and HIV-negative women who were menopausal, had diabetes, were depressed, or who were taking medication to treat seizures, high blood pressure, or heart disease.

Amongst the women with HIV, lower sexual functioning scores were observed in those whose body mass index was in the underweight range.

Statistical analysis that controlled for potentially confounding factors showed that HIV infection (p < 0.001), not being in a relationship (p < 0.001), being menopausal (p < 0.001), and depression (p < 0.001) were all significantly associated with a poorer sexual function score.

Next the investigators looked at the relationship between sexual functioning scores and reported sexual behaviour. This suggested that higher levels of sexual function were associated with a more active sex life, with women with higher reported levels of sexual function and satisfaction reporting greater numbers of sexual partners.

Finally, the researchers restricted their analysis to the HIV-positive women to see if any HIV-related factors were connected with sexual function.

Their first statistical analysis showed that the presence of lipodystrophy (p = 0.003), and a lower CD4 cell count, below 500 cells/mm3 (p = 0.005), were both significantly associated with poorer sexual function scores.

However, a subsequent model that included age as a variable showed that only CD4 cell count (p = 0.02) and increasing age were significant (p < 0.001).

“Our study shows a clear link between HIV infection and sexual problems among women”, comment the investigators.

They believe that their research has implications for the routine care of women with HIV and suggest “there is a role for assessment of sexual problems in overall care of women with HIV infection, particularly those classified as having AIDS.”


Wilson TE et al. HIV infection and women’s sexual functioning. J Acquire Immune Defic Synr (online edition), 2010.