Intimacy versus Isolation: A Qualitative Study of Sexual Practices among Sexually Active HIV-Infected Patients in HIV Care in Brazil, Thailand, and Zambia

Abstract

The success of global treatment as prevention (TasP) efforts for individuals living with HIV/AIDS (PLWHA) is dependent on successful implementation, and therefore the appropriate contribution of social and behavioral science to these efforts. Understanding the psychosocial context of condomless sex among PLWHA could shed light on effective points of intervention. HPTN 063 was an observational mixed-methods study of sexually active, in-care PLWHA in Thailand, Zambia, and Brazil as a foundation for integrating secondary HIV prevention into HIV treatment. From 2010–2012, 80 qualitative interviews were conducted with PLWHA receiving HIV care and reported recent sexual risk. Thirty men who have sex with women (MSW) and 30 women who have sex with men (WSM) participated in equal numbers across the sites. Thailand and Brazil also enrolled 20 biologically-born men who have sex with men (MSM). Part of the interview focused on the impact of HIV on sexual practices and relationships. Interviews were recorded, transcribed, translated into English and examined using qualitative descriptive analysis. The mean age was 25 (SD = 3.2). There were numerous similarities in experiences and attitudes between MSM, MSW and WSM across the three settings. Participants had a high degree of HIV transmission risk awareness and practiced some protective sexual behaviors such as reduced sexual activity, increased use of condoms, and external ejaculation. Themes related to risk behavior can be categorized according to struggles for intimacy and fears of isolation, including: fear of infecting a sex partner, guilt about sex, sexual communication difficulty, HIV-stigma, and worry about sexual partnerships. Emphasizing sexual health, intimacy and protective practices as components of nonjudgmental sex-positive secondary HIV prevention interventions is recommended. For in-care PLWHA, this approach has the potential to support TasP. The overlap of themes across groups and countries indicates that similar intervention content may be effective for a range of settings.

Sexual and reproductive health of women living with HIV in Muslim-majority countries: a systematic mixed studies review

“…Fear of transmitting HIV, becoming pregnancy and a loss of sexual desire were also identified as barriers to sexual satisfaction for WLHIV post-HIV diagnosis [44,49,51]. These findings are supported by the results of recent studies conducted in African, European, South American, and Asian countries [80,81] that reported a lack of communication between WLHIV with their partner regarding safer and satisfying sexual practices led to sexual inactivity and dissatisfaction.…”

“I Wasn’t in My Right Mind”: Qualitative Findings on the Impact of Alcohol on Condom Use in Patients Living with HIV/AIDS in Brazil, Thailand, and Zambia (HPTN 063)

“…A total of 80 participants were included in the qualitative portion of the study [21] and included mixed sexual orientation and gender identity (see Table 1). Recruitment for this qualitative portion of HPTN 063 was voluntary.…”

“…Sample characteristics of the current sample (who commented on the role of alcohol) compared to the total qualitative sample are presented in Table 1. Additional information and procedures regarding the qualitative parent study are reported elsewhere [21].…”

Addressing gender inequalities to improve the sexual and reproductive health and wellbeing of women living with HIV

“…This potential consequence is likely not only to affect women's willingness to disclose their HIV status, but also to compromise their safety due to threats or experience of violence. Some women living with HIV report rejection of sexual relations by their partners or inability to find sexual partners because of their HIV status [ 18 , 71 ]. Women living with HIV may also experience internalized stigma that includes fear and anxiety that partners may not find them attractive [ 70 , 72 , 73 ].…”