Sexual behaviors among women living with HIV in Ontario, Canada

Abstract

Understanding the sexual activities and partnerships of women living with human immunodeficiency virus (HIV) remains important to promote healthy sexuality and to reduce the transmission of HIV and other sexually transmitted infections. We described sexual behaviors of women living with HIV enrolled in an ongoing study in Ontario, Canada. Data were available from 582 women who self-completed a sexual behavior questionnaire between 2010 and 2012. Nearly half (46.1%) of women reported a sexual partner in the preceding three months; women less likely to be sexually active were older, Black/African, separated, divorced, widowed, single, and unemployed. Most sexually active women had one partner (76.4%), a regular partner (75.9%), male (96.2%) partner(s), and partners who were HIV-negative or unknown HIV status (75.2%). Women were more likely to use a condom with HIV-negative/status unknown partners (81.3%) than with HIV-positive partners (58.6%; p = .008). Only 8.0% of sexually active women reported condomless sex with a discordant HIV-negative/status unknown partner when their viral load was detectable. Overall, most women living with HIV were sexually inactive or engaged in sexual activities that were low risk for HIV transmission.

The Problematization of Sexuality among Women Living with HIV and a New Feminist Approach for Understanding and Enhancing Women’s Sexual Lives

“…In total, 32 quantitative studies involving 11,552 women living with HIV were included in our review (Agaba et al, 2017;Bernier et al, 2016;Bogart et al, 2006;Bouhnik et al, 2008;Castro, Le Gall, Andreo, & Spire, 2010;Florence et al, 2004;Kaida et al, 2015;Luzi et al, 2009;Robinson et al, 2017;Schrooten et al, 2001;Taylor et al, 2015;Trotta et al, 2008;Valadares et al, 2014;Wessman et al, 2015;Wilson et al, 2010;Zierler et al, 1999). Henceforth, for clarity, we have identified them by their alphabetically assigned number in the reference list.…”

“…In much of the literature, investigators provided no definition of sexual activity at all, leading readers to assume that it meant heterosexual (penile-vaginal) intercourse. When definitions were provided, they were most often restricted to interpersonal sex involving vaginal and anal intercourse (3,22,27), and, in two cases, oral sex as well (16,24). Two studies also counted caressing and foreplay (10,31) and just one reported on self-pleasure among women (14).…”

“…Sexual activity. Most studies tended to conclude that the "majority of women" (14, p. 267) living with HIV are sexually active, although one report suggested the exact opposite (24).…”

“…In terms of recent sexual experience (i.e., past month to past year), studies most often indicate about two-thirds to three-fourths of women engage in intercourse (4,5,6,7,8,10,11,13,14,18,19,22,23,27,30,31,32), although estimates range considerably by sociodemographic, economic, and cultural factors, from as low as 14% among 59 Nigerian women aged 50 and over (versus 50% of Nigerian men) (20), to 44-49% with 1795 Canadian women reporting high stigma (16,24), to as high as 93% in 43 Italian women engaged in care (23).…”

“…In spite of these realities, less than half of reviewed studies (i.e., n = 15 of 32, or 47%) considered how acute and chronic stressors may impact HIV-positive women's sexuality, with most focusing on emotional health (5,7,8,12,13,15,16,18,(20)(21)(22)(23)(24)31) and just four studying violence (5,7,18,29). In particular, depression and anxiety were linked to lower sexual desire (13), activity (8,16), and function (5,12,18,31).…”