HIV-positive women in the UK report high levels of sexual abstinence and psychological distress

Increased life expectancy with the advent of antiretroviral therapies should increase the opportunity for HIV-positive women to develop sexual relationships. In spite of the availability of HAART, sexual and relationship difficulties appear to be unchanged.

Previous studies have suggested that HIV-positive women may experience changes in sexual desire, arousal and orgasmic functioning and low rates of condom use. To date, there has been little published work about the sexual functioning of HIV-positive women in the UK.

At the 9th Annual Conference of the British HIV Association (BHIVA), held in Manchester last weekend, researchers from the Infection and Immunity Department at St Bart’s and the London NHS Trust, presented new research which explores current sexual activity and enjoyment, safer sex practices and women’s perceived barriers to condom use as well as the effects of psychological distress on sexual behaviour and satisfaction.

The researchers interviewed 82 HIV-positive women recruited from two inner London HIV clinics and voluntary organisations. The mean age of participants was 37.9 years, 75% of women were black Africa, a total of 19% had a CD4 count below 200 cells/mm3, 37% of the women had an undetectable viral load and the mean length of time since HIV diagnosis was 68.5 months.

Almost one third of women (28%) reported no male sexual partners since diagnosis. Just over one third (36%) reported having had one partner since diagnosis.

An alarming 41% of women reported a history of sexual abuse and one third (34%) reported past physical abuse, a smaller proportion (6%) reported current physical abuse.

Overall 54% and 35% of women reported clinically significant levels of anxiety and depression respectively. Among the sexually active, depression was associated with avoidance of sex and the researchers also identified a significant association between reduced condom use and higher levels of depression and anxiety.

Over half of the women reported currently being in a relationship and three quarters of these women reported being currently sexually active. Of the sexually active women, over half stated that they always or usually used condoms. Psychological distress had a negative impact upon condom use.

The researchers suggested that in view of these findings, in particular the high levels of abstinence reported by HIV-positive women in the UK, psychosexual interventions should be aimed at addressing psychological distress and sexual attitudes. In view of the fact that an ever-increasing proportion of HIV-positive women in the UK are of black African ethnicity, such interventions will need to be culturally appropriate.