Sex and Relationships for HIV Positive Women Since HAART: a Quantitative Study S Lambert, a Keegan, J Petrak
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333 Sex Transm Infect: first published as 10.1136/sti.2004.013516 on 1 August 2005. Downloaded from HIV Sex and relationships for HIV positive women since HAART: a quantitative study S Lambert, A Keegan, J Petrak ............................................................................................................................... Sex Transm Infect 2005;81:333–337. doi: 10.1136/sti.2004.013516 Objective: To investigate current levels of sexual activity, enjoyment, condom use, and other factors affecting sexual behaviour in a sample of women living with HIV. Method: Participants were self selected. A cross sectional design using semi-structured questionnaires was employed. 82 HIV positive women completed questionnaires asking about demographics, relationships, sexual behaviour, and safer sex practices. The Hospital Anxiety and Depression Scale (HADS) and Golombok-Rust Inventory of Sexual Satisfaction (GRISS) were administered. See end of article for Results: 28% of women had had no sexual partners since diagnosis. Mean time diagnosed was authors’ affiliations 69 months, range 4–191 months. Time since diagnosis was not associated with having had a sexual ....................... partner. 59% of women had a current sexual partner, half reporting intercourse in the past month. Correspondence to: Infrequent sex (84%), avoidance (84%), non-communication (69%), and dysfunction (60%) were among Dr Sarah Lambert, the most prevalent sexual difficulties. Endorsement of HIV impaired sexual enjoyment was associated with Department of Medical reduced sexual frequency (p = 0.006) and sexual dysfunction (p = 0.042). Sexual dissatisfaction was Psychology, Essex County associated with infrequency of sex (p = 0.037), avoidance (p = 0.02), and non-communication (p = 0.032). Hospital, Lexden Road, Colchester CO3 3NB, UK; Clinically significant levels of anxiety and depression were reported in 60% and 38% of cases, respectively. sarahannlambert@ Depression was associated with avoidance of sex and higher total GRISS scores (p = 0.006 and hotmail.com p = 0.042). 60% of respondents stated that they ‘‘always’’ used condoms; a trend was observed between Accepted for publication reduced condom use and higher levels of depression and anxiety (p = 0.09 and p = 0.06, respectively). 3 November 2004 Conclusion: Sexual difficulties, including abstinence, were prevalent in this sample indicating the potential ....................... for interventions addressing the psychosexual needs of HIV positive women and their partners. here are few studies examining sexual and relationship United Kingdom, making it difficult to generalise findings. In difficulties among HIV positive women since the advent the United Kingdom, 61% of the estimated 10 052 women of antiretroviral medication although increased longevity known to be infected are black African, having acquired HIV T 8 may renew interest in this aspect of quality of life. Early via heterosexual sex, in Africa. IDU accounts for only 8% of 9 studies in US samples suggest high rates of reduced sexual infections in women. The aims of this study were (1) to http://sti.bmj.com/ drive and frequency of sexual activity in women since HIV investigate current levels of sexual activity in a sample of HIV seroconversion,12 with rates of persistent hypoactive sexual positive women in the United Kingdom; (2) to examine safe desire reported to be 60% in women with HIV infection.3 sex practices, and (3) to investigate associations between Other studies suggest a majority of HIV positive women psychological variables, disease variables, sexual functioning, remain sexually active.45Among a mixed Canadian sample of and condom use. injecting drug users (IDU) and non-IDU of Haitian, African, and white background, 68% of women had been sexually on September 28, 2021 by guest. Protected copyright. active since diagnosis. Sexual activity since diagnosis and in METHOD the past month was associated with self reported CD4 count.4 Design A recent US study of 101 HIV positive women reported that The study employed a cross sectional design using quantita- higher levels of sexual functioning were associated with tive and qualitative methods to investigate sexual behaviour fewer HIV related symptoms, better mental health, and never and relationships in a sample of women living with HIV. The having used injecting drugs.5 quantitative data only are presented here. There is mixed evidence that decreased sexual interest may be associated with antiretroviral medication, particularly Participants protease inhibitors (PI), in both men and women.6 The same Women were recruited from HIV clinics on two hospital sites study also found that symptomatic HIV disease and older age of an inner London NHS Trust and from voluntary organisa- were also associated with decreased sexual interest.6 In a tions. For clinic attendees, the investigators compiled a list of recent European study, the same authors evaluated sexual all women registered on the HIV clinic databases on both dysfunction in HIV positive women using the female sexual sites. For voluntary organisations, two investigators (AK and function index and concluded that psychological factors SL) attended two evening meetings, one a women’s support (depression, irritability, anxiety) and the HIV diagnosis itself group and one a mixed sex group for refugees and people were more likely to be the main drivers of sexual difficulties seeking asylum. An advertisement was placed in Positively and not necessarily the commencement of antiretroviral Women magazine, a monthly publication distributed through- treatment.7 out the United Kingdom. There is little published work on the sexual functioning of seropositive women living in England. The ethnic and Abbreviations: GRISS, Golombok-Rust Inventory of Sexual Satisfaction; cultural backgrounds and route of acquisition of HIV for HADS, Hospital Anxiety and Depression Scale; IDU, injecting drug women in the US samples differs from those of women in the users; PI, protease inhibitors www.stijournal.com 334 Lambert, Keegan, Petrak Sex Transm Infect: first published as 10.1136/sti.2004.013516 on 1 August 2005. Downloaded from Table 1 CD4 count and viral loads (n = 81) CD4 count Viral load (6106/l) No % (/ml) No % ,100 5 6 Undetectable 30 37 101–200 10 12 ,10 000 12 14 201–300 16 20 10 000–100 000 3 4 301–500 27 34 .100 000 5 6 . 500 10 12 ‘‘Don’t know’’ 32 39 ‘‘Don’t know’’ 13 16 – – – Procedure problem. The measure has demonstrated acceptable levels of Hospital questionnaire distribution occurred on a weekly reliability and validity.11 basis. Investigators placed a questionnaire, information Data were analysed using Statistical Package for Social sheet, and consent form in the patient’s medical notes before Sciences (SPSS) version 11.0. the consultation. At the voluntary organisations, attendees were given a brief explanation of the study and invited to RESULTS participate by completing a questionnaire. In response to the Sample characteristics Positively Women advertisement, a group from Manchester Eighty two women completed questionnaires: 59 (72%) were expressed interest and 25 questionnaires were sent for recruited through HIV clinics and 23 (28%) through distribution to their members. Questionnaire distribution voluntary organisations. The mean age of participants was took place between January and December 2002. 37.9 years, range 20–64 years; 75% of the women identified The East London and City Health Authority research ethics themselves as ‘‘black African,’’ with 6% identifying as ‘‘white committee approved this study. UK,’’ 6% ‘‘European,’’ and 13% ‘‘other’’ (black Caribbean, black UK, Pakistan, Irish). Fifty two (63%) women were Measures unemployed, 23 (28%) were employed, and seven (9%) were Semi-structured questionnaire students. Over three quarters had attended college or A semi-structured questionnaire was developed from themes university. that emerged in earlier interviews with 20 clinic attendees. Information on the following areas was gathered: demo- graphics, social support, health and risk issues, treatment, HIV diagnosis and treatment family issues, sexual history and behaviour, safe sex Mean time since HIV diagnosis was 68 months, range 4– practices, history of abuse, and mental health. 191 months; 59% of the 80 women who responded to the questions about diagnosis and treatment were on antiretro- The Hospital Anxiety and Depression Scale (HADS)10 viral therapy, mean time on therapy 33 months (range 3– The HADS is a self report, widely used measure of anxiety 95 months). Table 1 shows the CD4 and viral loads for and depression comprising seven items in each of the women in the sample. 39% of women were unable to report depression and anxiety subscales. Cut-off scores determine their viral load. severity of depression and anxiety. Within medical samples, http://sti.bmj.com/ the HADS has demonstrated acceptable internal consistency, Past and current relationships concurrent and construct validity. Women were asked about number of sexual partners since diagnosis. Of the 76 women who responded, 21 (28%) had Golombok-Rust Inventory of Sexual Satisfaction not had any partners; 27 (36%) and 10 (13%) reported one (GRISS)11 and two partners, respectively; 12 (16%) had between three The GRISS is a validated measure for individuals in and five sexual partners and only six (8%) had more than heterosexual relationships, consisting of 28 self report items five. on September 28, 2021 by guest. Protected copyright. designed to assess the quality of relationships