Sexual problems common in HIV-positive gay men

Just under half of gay men with HIV have multiple sexual problems, Australian investigators report in the May edition of the Journal of Sexual Medicine. HIV-positive gay men were significantly more likely to report sexual difficulties than HIV-negative gay men, with the causes differing according to the men’s HIV status.

Sexual expression can affect physical, mental and social wellbeing. There is, however, little information about sexual dysfunction in gay men. The few studies that have been conducted in this population suggest that sexual problems in gay men can have a number of causes. These include social factors, such as age and employment status; physical health factors, related to HIV infection and other chronic illnesses; psychological issues, for example depression and internalised homophobia; and behavioural factors, including recreational drug and alcohol use.

Furthermore, studies to date have only focused on two measures of sexual dysfunction: erectile problems and problems with ejaculation. Nor has earlier research explicitly examined the association between poor sexual function in HIV-positive gay men and mental health. What’s more, the existing research has not examined if the sexual problems experienced by HIV-positive gay men are different to those encountered by HIV-negative gay men.

Investigators from Australia therefore conducted a study involving 542 gay men who were recruited from general practices that have a large number of HIV-positive patients. A total of 217 men (40%) included in the study were HIV-positive.

The men were asked if they had experienced any of seven sexual problems lasting for at least four weeks in the previous twelve months.

HIV-positive men were more likely than HIV-negative men to have experienced each of these measures of sexual dysfunction: erectile problems (52% vs 39%); difficulty ejaculating (31% vs 22%); premature ejaculation (21% vs 17%); loss of libido (60% vs 40%); lack of pleasure from sex (32% vs 26%); anxiety over sexual performance (47% vs 42%); and pain during sex (8% vs 7%).

Not only were HIV-positive men significantly more likely than HIV-negative men to report a single sexual problem (81% vs 67%, p < 0.001), they were also more likely to have experienced multiple problems (48% vs 35%, p = 0.002).

Next the investigators examined the causes of multiple sexual problems for HIV-positive and HIV-negative men.

For both HIV-positive and HIV-negative men, major depression was significantly associated with sexual problems (HIV-positive men, p < 0.05; HIV-negative men, p < 0.001).

However, other factors differed according to the men’s HIV status. For HIV-positive men, treatment with antidepressants (p < 0.05), poor coping strategies (p < 0.003) and unprotected anal intercourse with a casual partner in the previous six months (p < 0.001) were all significant. For HIV-negative men the significant factors were poor general health (p < 0.05), and lack of social support (p < 0.01).

“Rates of self-reported sexual problems are high among gay men in Australia”, write the investigators. They add, “Gay men with HIV are more likely to experience sexual problems than those without HIV. With the exception of major depression, factors associated with multiple sexual problems differ between the two groups.”

The investigators draw attention to their finding that sexual dysfunction in HIV-positive men is associated with unprotected anal sex with casual partners. They conclude this “needs to be a priority issue for future HIV prevention education.”