Sexual Inactivity & Sexual Satisfaction among Women Living with HIV in Canada in the Context of Growing Social, Legal & Public Health Surveillance
INTRODUCTION:
Women
represent nearly one-quarter of the 71,300 people living with HIV in Canada.
Within a context of widespread HIV-related stigma and discrimination and
on-going risks to HIV disclosure, little is known about the influence of
growing social, legal and public health surveillance of HIV on sexual activity
and satisfaction of women living with HIV (WLWH).
METHODS:
We
analyzed baseline cross-sectional survey data for WLWH (≥16 years,
self-identifying as women) enrolled in the Canadian HIV Women's Sexual and
Reproductive Health Cohort Study (CHIWOS), a multisite, longitudinal,
community-based research study in British Columbia (BC), Ontario (ON) and
Quebec (QC). Sexual inactivity was defined as no consensual sex (oral or
penetrative) in the prior six months, excluding recently postpartum women (≤6
months). Satisfaction was assessed using an item from the Sexual Satisfaction
Scale for Women. Multivariable logistic regression analysis examined
independent correlates of sexual inactivity.
RESULTS:
Of 1213
participants (26% BC, 50% ON, 24% QC), median age was 43 years (IQR: 35, 50).
23% identified as Aboriginal, 28% as African, Caribbean and Black, 41% as White
and 8% as other ethnicities. Heterosexual orientation was reported by 87% of
participants and LGBTQ by 13%. In total, 82% were currently taking
antiretroviral therapy (ART), and 77% reported an undetectable viral load
(VL<40 copies/mL). Overall, 49% were sexually inactive and 64% reported
being satisfied with their current sex lives, including 49% of sexually
inactive and 79% of sexually active women (p<0.001). Sexually inactive women
had significantly higher odds of being older, not being in a marital or committed relationship, having an annual household income below $20,000 CAD, and reporting high (vs. low) HIV-related stigma. No independent association was found with ART use or undetectable
VL.
CONCLUSIONS:
Approximately
half of WLWH in this study reported being sexually inactive. Associations with
sexual dissatisfaction and high HIV-related stigma suggest that WLWH face
challenges navigating healthy and satisfying sexual lives, despite good HIV
treatment outcomes. As half of sexually inactive women reported being satisfied
with their sex lives, additional research is required to determine whether WLWH
are deliberately choosing abstinence as a means of resisting surveillance and
disclosure expectations associated with sexual activity. Findings underscore a
need for interventions to de-stigmatize HIV, support safe disclosure and
re-appropriate the sexual rights of WLWH.
By: Kaida A1, Carter A2,3, de Pokomandy A4,5, Patterson S2,3, Proulx-Boucher K4, Nohpal A3, Sereda P3, Colley G3, O'Brien N4,5, Thomas-Pavanel J6, Beaver K6,Nicholson VJ2, Tharao W7, Fernet M8, Otis J8, Hogg RS2,3, Loutfy M6,9; CHIWOS Research Team.
- 1Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada; kangela@sfu.ca.
- 2Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada.
- 3British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada.
- 4Chronic Viral Illness Service, McGill University Health Centre, Montreal, Quebec, Canada.
- 5Department of Family Medicine, McGill University, Montreal, Quebec, Canada.
- 6Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.
- 7Women's Health in Women's Hands Community Health Centre, Toronto, Ontario, Canada.
- 8Département de Sexologie, Université du Québec à Montréal, Montréal, Quebec, Canada.
- 9Department of Medicine and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
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