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

Carter, Allison; Greene, Saara; Money, Deborah; Sánchez, Margarite; Webster, Kath; Nicholson, Valerie; Whitbread, Jessica; Salters, Kate; Patterson, Sophie; Loutfy, Mona; Pick, Neora; Brotto, Lori A.; Hankins, Catherine; Kaida, Angela

doi:10.1007/s11199-017-0826-z

Cited by 20 publications

(33 citation statements)

References 199 publications

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“…Our data, from the contemporary antiretroviral therapy era, suggest that the impact of HIV diagnosis on sexual function endures longer than previously described. We found no association between sexual function and nadir CD4 count, current CD4 count or HIV viral load, in keeping with other studies (Carter et al, 2017). It is therefore likely that multidimensional contextual factors play an important role in sexual well-being including the emotional impact of HIV diagnosis, experiences of trauma and violence, age, HIV-related stigma, and concerns about HIV transmission (Carter et al, 2017), many of which we did not measure in the PRIME Study.…”

Section: Discussionsupporting

confidence: 86%

“…It is unsurprising that women living with HIV are more likely to seek help within sexual health services as in many parts of the UK, HIV and sexual health services are provided within the same department affording women the opportunity to have sexual health issues addressed. The effects of living with HIV on women's sexual well-being are widely recognised (Carter et al, 2017). We found an association between lower sexual function and having been diagnosed with HIV for ≥20 years.…”

Section: Discussionmentioning

confidence: 59%

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Association of HIV status with sexual function in women aged 45–60 in England: results from two national surveys

et al. 2019

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Increasing numbers of women living with HIV are reaching their midlife. We explore the association of HIV status with sexual function (SF) in women aged 45-60 using two national cross-sectional surveys: the third British National Survey of Sexual Attitudes and Lifestyles ("Natsal-3") and "PRIME", a survey of women living with HIV attending HIV clinics across England. Both studies asked the same questions about SF that take account not only sexual difficulties but also the relationship context and overall level of satisfaction, which collectively allowed an overall SF score to be derived. We undertook analyses of sexually-active women aged 45-60 from Natsal-3 (N = 1228, presumed HIV-negative given the low estimated prevalence of HIV in Britain) and PRIME (N = 386 women living with HIV). Women living with HIV were compared to Natsal-3 participants using multivariable logistic regression (adjusting for key confounders identified a priori: ethnicity, ongoing relationship status, depression and number of chronic conditions) and propensity scoring. Relative to Natsal-3 participants, women living with HIV were more likely to: have low overall SF (adjusted odds ratio (AOR) 3.75 [2.15-6.56]), report ≥1 sexual problem(s) lasting ≥3 months (AOR 2.44 [1.49-4.00]), and report almost all 8 sexual problems asked about (AORs all ≥2.30). The association between HIV status and low SF remained statistically significant when using propensity scoring ). Among women living with HIV (only), low SF was more common in those who were postmenopausal vs. Premenopausal (55.6% vs. 40.4%). This study suggests a negative association between HIV status and sexual function in women aged 45-60. We recommend routine assessment of SF in women living with HIV.

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Section: Discussionsupporting

confidence: 86%

Section: Discussionmentioning

confidence: 59%

Association of HIV status with sexual function in women aged 45–60 in England: results from two national surveys

et al. 2019

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“…Although there has been increased access to ART, studies examining sexuality and reproduction for women living with HIV still show that HIV impacts sexuality and reproduction negatively (Carter et al, 2017a; Greene, Ion, Kwaramba, Smith, & Loutfy, 2015; Rahangdale et al, 2014). Women with HIV therefore face unique challenges, such as in partner relationships, sexual satisfaction and childbearing (Bharat & Mahendra, 2007; Carter et al, 2013; Florence et al, 2004).…”

Section: Introductionmentioning

confidence: 99%

“…In 2017, a Swedish inductive interview study examining seven HIV-positive women’s sexuality showed that fear of transmitting HIV to one’s partner is highly present (Norwald, Holmström, & Plantin, 2017). In order to support the health and well-being of women living with HIV, health care professionals need access to a solid knowledge base about issues related to HIV, sexuality and childbearing (Carter et al, 2017a; Shapiro & Ray, 2007). There is still insufficient knowledge regarding what sexuality and childbearing means to women living with HIV in a Swedish context.…”

Section: Introductionmentioning

confidence: 99%

Sexuality and childbearing as it is experienced by women living with HIV in Sweden: a lifeworld phenomenological study

Carlsson-Lalloo

Berg

Mellgren

et al. 2018

International Journal of Qualitative Studies on Health and Well

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The effectiveness of antiretroviral treatment has reduced sexual HIV transmission and mother-to-child-transmission. To optimally support women living with HIV, health care providers need deepened knowledge about HIV, sexuality and childbearing. The aim of this study was to describe the phenomenon sexuality and childbearing as experienced by women living with HIV in Sweden. Data were collected by phenomenon-oriented interviews with 18 HIV-positive women. A reflective lifeworld analysis based on phenomenological philosophy was conducted, describing the meaning structure of the phenomenon. The essence of the phenomenon is that perceptions about HIV and its contagiousness profoundly influence sexual habits and considerations in relation to pregnancy and childbearing. These perceptions are formed in combination with knowledge and interpretations about HIV by the women themselves and by their environments. The essence is further described by its constituents: Risk of transmission imposes demands on responsibility; The contagiousness of HIV limits sexuality and childbearing; Knowledge about HIV transmission provides confident choices and decisions; and To re-create sexuality and childbearing. Although HIV has a low risk of transmission if being well treated, our study shows that HIV-positive women feel more or less contagious, which influences sexuality and decision-making in relation to become pregnant and give birth.

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“…Coupled with the increasing use of pre-exposure prophylaxis (PrEP) by HIV negative sexual partners of PLWH [9][10][11], these developments mean that earlier research on the impact on sexual functioning and adjustment following HIV diagnosis may no longer be applicable. Feminist and sexual rights perspectives have been applied to theorise ways to promote the sexual well-being of women with HIV [12]. Yet, there is currently no model of factors which promote sexual adjustment to HIV to guide further research and intervention into this important aspect of quality of life for PLWH.…”

Section: Introductionmentioning

confidence: 99%

A new grounded theory model of sexual adjustment to HIV: facilitators of sexual adjustment and recommendations for clinical practice

et al. 2020

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Background: Life expectancy of people living with HIV (PLWH) is increasing. Effective biomedical prevention methods (treatment as prevention and preexposure prophylaxis) are being widely implemented in high-income nations. Therefore, research into quality of life, including sexual adjustment, is of increasing importance to HIV care. Yet, sexual adjustment of PLWH has been neglected in past research. We propose a new model of sexual adjustment to HIV which explores the dynamic process, facilitators and barriers characterising sexual life of PLWH overtime.Method: Thirty PLWH (19 male, 11 female) recruited from two HIV treatment centres as well as community groups, completed semi-structured interviews which were audio-recorded and transcribed verbatim for analysis using grounded theory.Results: The model of sexual adjustment to HIV is the first to establish how undue fears of transmission of HIV during sex and/or fear of rejection by sexual partners determine initial sexual behaviour after diagnosis and also sexual adjustment over time. Within the model, sexual adjustment to HIV is facilitated by factors which assist PLWH to overcome such fears, including: partner acceptance, peer, community and health professional support, and accurate knowledge of risk of transmission including of undetectable viral load and pre-exposure prophylaxis. Adjustment is inhibited when undue fears of transmission and of rejection persist long term, resulting in maladaptive behaviours to cope with such fears including avoidance of sex and problematic drug and alcohol use. Conclusion: This model offers clear directions for promoting sexual adjustment to HIV. Health professionals should: (a) assess and intervene for sexual quality of life (not just risk) among PLWH; (b) be aware that serosorting facilitates adjustment in the short to medium term, but may interfere with adjustment long-term, (c) promote opportunities for positive connection between PLWH, and (d) intervene directly with PLWH and HIV negative sexual partners to promote accurate risk of transmission knowledge, including how this applies to their own sexual practices, and whether they are experiencing undue fear of transmission over time.

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

Cited by 20 publications

References 199 publications

Association of HIV status with sexual function in women aged 45–60 in England: results from two national surveys

Association of HIV status with sexual function in women aged 45–60 in England: results from two national surveys

Sexuality and childbearing as it is experienced by women living with HIV in Sweden: a lifeworld phenomenological study

A new grounded theory model of sexual adjustment to HIV: facilitators of sexual adjustment and recommendations for clinical practice

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