Abstract
Earlier research reports lower sexual satisfaction among people living with HIV (PLHIV) compared to HIV-negative persons. A number of psychosocial factors directly associated with sexual dissatisfaction have been identified. Little is known about sexual satisfaction and their contributors among PLHIV in Sweden. The aim of this study was to examine direct and indirect effects of variables within sociodemographic, clinical HIV-related, psychological, and sexual domains on sexual (dis)satisfaction among PLHIV in Sweden. Data for this study were derived from a nationally representative, anonymous survey among PLHIV conducted in 2014 (n = 1096). Statistical analysis included four steps: descriptive analyses, identification of variables associated with sexual (dis)satisfaction, identification of variables associated with those contributors of sexual (dis)satisfaction, and a path model integrating all these analyses. A total of 49% of participants reported being sexually dissatisfied, and no significant differences were observed when non-heterosexual men, heterosexual men, and women were compared. Among women, a negative change in sex life after HIV diagnosis and distress with orgasmic difficulties was directly associated with sexual dissatisfaction. For men, hopelessness, high HIV stigma, sexual inactivity in the last 6 months, and a negative change in sex life after HIV diagnosis were directly associated with sexual dissatisfaction. Path analyses showed in both men and women significant indirect associations between not being involved in an intimate relationship, lower self-reported CD4 cell counts, and perceiving obligation to disclose HIV status to sexual partners as a barrier to look for a long-term partner and sexual dissatisfaction. Our results show that despite good treatment outcomes, the HIV diagnosis has a negative bearing on sexual satisfaction. The need for gender-tailored interventions and clinical implications of these findings are discussed.
Highlights
With advancements in antiretroviral therapy (ART), people living with HIV (PLHIV) in countries with general access to such treatment can live long and productive lives
The present study focused on two dimensions of HIV stigma, negative self-image/internalized stigma (3 items: I feel guilty about having HIV; The attitudes of others about HIV make me think less of myself; and Having HIV makes me feel inferior to others) and one aspect of anticipated HIV stigma, Concerns about public attitudes toward PLHIV (3 items: People with HIV are treated like lepers; Most people think that someone with HIV is dirty; and Most people I know feel uncomfortable being around someone who has HIV)
Erectile difficulties Never or rarely Sometimes, often, or always Distress with erectile difficulties No distress Minor or major distress Orgasmic difficulties Never or rarely Sometimes, often, or always Distress with orgasmic difficulties No distress Minor or major distress Ejaculatory difficulties Never or rarely Sometimes, often, or always Distress with ejaculatory difficulties No distress Minor or major distress HIV changed sex life Positive change No change Negative change Obligation to disclose HIV status an obstacle to look for a long-term partner Definitely or to a certain extent Not at all OR odds ratio, CI confidence interval, ART antiretroviral therapy, PLHIV people living with HIV, Post-traumatic stress disorder (PTSD) symptoms post-traumatic stress disorder symptoms
Summary
With advancements in antiretroviral therapy (ART), people living with HIV (PLHIV) in countries with general access to such treatment can live long and productive lives. Increased life expectancy of PLHIV and the transformation of HIV into a chronic condition call for the assessment of factors that are important for the quality of life in this group. Organization, 2013), PLHIV may still fear both transmitting HIV to an intimate partner and being turned down sexually when disclosing their HIV status (Driskell, Salomon, Mayer, Capistrant, & Safren, 2008; Galletly & Dickson-Gomez, 2009). Another challenge is potential side-effects on sexual functioning due to ART (Asboeetal.,2007;Moreno-Perezetal.,2010).Legalsurveillance is a further potential challenge. Canadian qualitative studies (Kapiriri,Tharao,Muchenje, Masinde,& Ongoiba, 2016; Mykhalovskiy, 2011) have found that as a consequence of Canadian criminalization of HIV non-disclosure to sexual partners, some PLHIV withdraw from sexual activity due to fear of HIV transmission, anxiety, uncertainty, fear of abandonment, and loss of ability to engage in fulfilling sexual relationships
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