Love with HIV: A Latent Class Analysis of Sexual and Intimate Relationship Experiences Among Women Living with HIV in Canada
Love remains hidden in HIV research in favor of a focus on risk. Among 1424 women living with HIV in Canada, we explored (1) whether eight facets of sex and intimacy (marital status, sexual activity, physical intimacy, emotional closeness, power equity, sexual exclusivity, relationship duration, and couple HIV serostatus) may coalesce into distinct relationship types, and (2) how these relationship types may be linked to love as well as various social, psychological, and structural factors. Five latent classes were identified: no relationship (46.5%), relationships without sex (8.6%), and three types of sexual relationships—short term (15.4%), long term/unhappy (6.4%), and long term/happy (23.2%, characterized by equitable power, high levels of physical and emotional closeness, and mainly HIV-negative partners). While women in long-term/happy relationships were most likely to report feeling love for and wanted by someone “all of the time,” love was not exclusive to sexual or romantic partners and a sizeable proportion of women reported affection across latent classes. Factors independently associated with latent class membership included age, children living at home, sexism/genderism, income, sex work, violence, trauma, depression, HIV treatment, awareness of treatment’s prevention benefits, and HIV-related stigma. Findings reveal the diversity of women’s experiences with respect to love, sex, and relationships and draw attention to the sociostructural factors shaping intimate partnering in the context of HIV. A nuanced focus on promoting healthy relationships and supportive social environments may offer a more comprehensive approach to supporting women’s overall sexual health and well-being than programs focused solely on sexual risk reduction.
KeywordsLove Sex Relationships Power Feminism Women HIV
The Canadian HIV Women’s Sexual and Reproductive Health Cohort Study (CHIWOS) is funded by the Canadian Institutes of Health Research (CIHR, MOP111041); the CIHR Canadian HIV Trials Network (CTN 262); the Ontario HIV Treatment Network; and the Academic Health Science Centres Alternative Funding Plans Innovation Fund. AC and KS received support through a Doctoral Research Award from the CIHR HIV/AIDS Research Initiative and the Canadian Association for HIV Research. NO and AdP received support from Fonds de Recherche du Quebéc—Santé. AK received salary support through a Tier 2 Canada Research Chair in Global Perspectives on HIV and Sexual and Reproductive Health. The CHIWOS Research Team would like to especially thank all of the women living with HIV who participate in this research. We also thank the entire national team of Co-Investigators, Collaborators, and Peer Research Associates. We would like to acknowledge the national Steering Committee, the three provincial Community Advisory Boards, the national CHIWOS Aboriginal Advisory Board, and our partnering organizations for supporting the study, especially those who provide interview space and support to our Peer Research Associates. We also thank Dr. Robert S. Hogg for his involvement as Doctoral Supervisor. Listed here are all the CHIWOS Research Team members and affiliated institutions: Rahma Abdul-Noor (Women’s College Research Institute), Aranka Anema (Harvard Medical School), Jonathan Angel (Ottawa Hospital Research Institute), Dada Mamvula Bakombo (McGill University Health Centre), Fatimatou Barry (Women’s College Research Institute), Greta Bauer (University of Western Ontario), Kerrigan Beaver (Women’s College Research Institute), Marc Boucher (CHU Ste-Justine), Isabelle Boucoiran (CHU Ste-Justine), Jason Brophy (Children’s Hospital of Eastern Ontario), Lori Brotto (University of British Columbia), Ann Burchell (St, Michael’s Hospital), Claudette Cardinal (Simon Fraser University), Allison Carter (Kirby Institute), Lynne Cioppa (Women’s College Research Institute), Tracey Conway (Women’s College Research Institute), José Côté (Centre Hospitalier de l’Université de Montréal), Jasmine Cotnam (Canadian Aboriginal AIDS Network), Cori d’Ambrumenil (AIDS Vancouver Island), Janice Dayle, (McGill University Health Centre), Erin Ding (British Columbia Centre for Excellence in HIV/AIDS), Danièle Dubuc, (McGill University Health Centre), Janice Duddy (Pacific AIDS Network), Mylène Fernet (Université du Québec à Montréal), Annette Fraleigh (Women’s College Research Institute), Peggy Frank (Simon Fraser University), Brenda Gagnier (Women’s College Research Institute), Marilou Gagnon (University of Victoria), Jacqueline Gahagan (Dalhousie University), Claudine Gasingirwa (Women’s College Research Institute), Nada Gataric (British Columbia Centre for Excellence in HIV/AIDS), Rebecca Gormley (British Columbia Centre for Excellence in HIV/AIDS), Saara Greene (McMaster University), Danielle Groleau (McGill University), Charlotte Guerlotté (COCQ-SIDA), Trevor Hart (Ryerson University), Catherine Hankins (McGill University), Roula Hawa (Women’s College Research Institute), Emily Heer (Alberta Health Services), Robert S. Hogg (British Columbia Centre for Excellence in HIV/AIDS and Simon Fraser University), Terry Howard (Glasshouse Consultants), Shazia Islam (Women’s College Research Institute), Joseph Jean-Gilles (GAP-VIES), Hermione Jefferis (AIDS Vancouver Island), Evin Jones (Pacific AIDS Network), Charu Kaushic (McMaster University), Mina Kazemi (Women’s College Research Institute), Mary Kestler (Oak Tree Clinic, BC Women’s Hospital and Health Centre), Maxime Kiboyogo (McGill University Health Centre), Marina Klein (McGill University Health Centre), Nadine Kronfli (McGill University Health Center), Gladys Kwaramba (Women’s College Research Institute), Gary Lacasse (Canadian AIDS Society), Ashley Lacombe-Duncan (University of Michigan), Melanie Lee (Simon Fraser University), Rebecca Lee (CIHR Canadian HIV Trials Network), Jenny Li (British Columbia Centre for Excellence in HIV/AIDS), Viviane Lima (British Columbia Centre for Excellence in HIV/AIDS), Elisa Lloyd-Smith (Vancouver General Hospital), Carmen Logie (University of Toronto), Evelyn Maan (Oak Tree Clinic), Valérie Martel-Lafrenière (Centre Hospitalier de l’Université de Montréal), Carrie Martin (Canadian Aboriginal AIDS Network), Renee Masching (Canadian Aboriginal AIDS Network), Lyne Massie (Université du Québec à Montréal), Melissa Medjuck (formerly of the Positive Women’s Network), Brigitte Ménard, (McGill University Health Centre), Cari L. Miller (formerly of Simon Fraser University), Judy Mitchell (Positive Living North), Gerardo Mondragon (British Columbia Centre for Excellence), Deborah Money (Women’s Health Research Institute and Faculty of Medicine at UBC), Ken Monteith (COCQ-SIDA), Marvelous Muchenje (Women’s Health in Women’s Hands CHC), Florida Mukandamutsa (CASM), Mary Ndung’u (African Partnership Against AIDS), Valerie Nicholson (Simon Fraser University), Kelly O’Brien (University of Toronto), Nadia O’Brien (McGill University Health Centre and McGill University), Gina Ogilvie (University of British Columbia, Women’s Health Research Institute), Susanna Ogunnaike-Cooke (Public Health Agency of Canada), Joanne Otis (Université du Québec à Montréal), Rebeccah Parry (Simon Fraser University), Sophie Patterson (Simon Fraser University), Angela Paul (Positive Living North), Doris Peltier (Canadian Aboriginal AIDS Network), Neora Pick (Oak Tree Clinic, BC Women’s Hospital and Health Centre), Alie Pierre (McGill University Health Centre), Jeff Powis (Michael Garron Hospital), Karène Proulx-Boucher (McGill University Health Centre), Corinna Quan (Windsor Regional Hospital), Jesleen Rana (Women’s Health in Women’s Hands CHC), Eric Roth (University of Victoria), Danielle Rouleau (Centre Hospitalier de l’Université de Montréal), Geneviève Rouleau (Centre Hospitalier de l’Université de Montréal), Sergio Rueda (Centre for Addiction and Metal Health), Kate Salters (Simon Fraser University, British Columbia Centre for Excellence in HIV/AIDS), Margarite Sanchez (ViVA, Southern Gulf Islands AIDS Society, Simon Fraser University), Roger Sandre (Haven Clinic), Jacquie Sas (CIHR Canadian HIV Trials Network), Édénia Savoie (McGill University Health Centre), Paul Sereda (British Columbia Centre for Excellence in HIV/AIDS), Stephanie Smith (Women’s College Research Institute), Marcie Summers (formerly of the Positive Women’s Network), Wangari Tharao (Women’s Health in Women’s Hands CHC), Christina Tom (Simon Fraser University), Cécile Tremblay (Centre Hospitalier de l’Université de Montréal), Jason Trigg (British Columbia Centre for Excellence in HIV/AIDS), Sylvie Trottier (Centre Hospitalier Universitaire de Québec), Angela Underhill (Women’s College Research Institute), Anne Wagner (Ryerson University), Sharon Walmsley (University Health Network), Clara Wang (British Columbia Centre for Excellence), Kath Webster (Simon Fraser University), Wendy Wobeser (Queen’s University), Denise Wozniak (Positive Living Society of British Columbia), Mark Yudin (St. Michael’s Hospital), Wendy Zhang (British Columbia Centre for Excellence in HIV/AIDS), Julia Zhu (British Columbia Centre for Excellence in HIV/AIDS). All other CHIWOS Research Team Members who wish to remain anonymous.
- Abelsohn, K., Benoit, A. C., Conway, T., Cioppa, L., Smith, S., Kwaramba, G., … CHIWOS Research Team. (2014). “Hear(ing) new voices”: Peer reflections from community based survey development with women living with HIV. Progress in Community Health Partnerships: Research Education and Action, 9(4), 561–569. https://doi.org/10.1353/cpr.2015.0079.CrossRefGoogle Scholar
- AIDES. (2016). #Révélation. Retrieved February 20, 2019 from http://www.aides.org/campagne/revelation.
- Bair-Merritt, M. H., Lewis-O’Connor, A., Goel, S., Amato, P., Ismailji, T., Jelley, M., … Cronholm, P. (2014). Primary care-based interventions for intimate partner violence: A systematic review. American Journal of Preventive Medicine, 46(2), 188–194. https://doi.org/10.1016/j.amepre.2013.10.001.CrossRefPubMedGoogle Scholar
- Balaile, G., Laisser, R., Ransjo-Arvidson, A. B., & Hojer, B. (2007). Poverty and devastation of intimate relations: Tanzanian women’s experience of living with HIV/AIDS. Journal of the Association of Nurses in AIDS Care, 18(5), 6–16. https://doi.org/10.1016/j.jana.2007.07.005.CrossRefPubMedGoogle Scholar
- Becker D. (2014). The dating game: Accepting the past and living in the present. Positive Living Newsletter: Girl Talk, 6–7. http://positivelivingbc.org/wp-content/uploads/2015/2003/issue2091_lowres.pdf.
- Bowleg, L., Lucas, K. J., & Tschann, J. M. (2004). “The ball was always in his court”: An exploratory analysis of relationship scripts, sexual scripts, and condom use among African American women. Psychology of Women Quarterly, 28(1), 70–82. https://doi.org/10.1111/j.1471-6402.2004.00124.x.CrossRefGoogle Scholar
- Brizay, U., Golob, L., Globerman, J., Gogolishvili, D., Bird, M., Rios-Ellis, B., … Heidari, S. (2015). Community-academic partnerships in HIV-related research: A systematic literature review of theory and practice. Journal of the International AIDS Society, 18(1), 19354. https://doi.org/10.7448/IAS.18.1.19354.CrossRefPubMedPubMedCentralGoogle Scholar
- Bunnell, R. E., Nassozi, J., Marum, E., Mubangizi, J., Malamba, S., Dillon, B., … Mermin, J. H. (2005). Living with discordance: Knowledge, challenges, and prevention strategies of HIV-discordant couples in Uganda. AIDS Care, 17(8), 999–1012. https://doi.org/10.1080/09540120500100718.CrossRefPubMedGoogle Scholar
- Caballero, M. (2016). Pleasure is a human right. HIV Equal. Retrieved February 20, 2019 from http://www.hivequal.org/hiv-equal-online/feature-pleasure-is-a-human-right.
- Canadian HIV/AIDS Legal Network. (2014). The criminalization of HIV non-disclosure in Canada and internationally. Retrieved February 20, 2019 from http://www.aidslaw.ca/site/wp-content/uploads/2014/09/CriminalInfo2014_ENG.pdf.
- Cardinal, C., Lee, M., Nicholson, V., Webster, K., Carter, A., & Kaida, A. (2014). Women! It’s our time to talk about sexuality. In Positive Gathering Conference 2014, Vancouver, BC.Google Scholar
- Carter, A., de Pokomandy, A., Loutfy, M., Ding, E., Sereda, P., Webster, K., … Kaida, A. (2017a). Validating a self-report measure of HIV viral suppression: An analysis of linked questionnaire and clinical data from the Canadian HIV Women’s Sexual and Reproductive Health Cohort Study. BMC Research Notes, 10(1), 138–145. https://doi.org/10.1186/s13104-017-2453-8.CrossRefPubMedPubMedCentralGoogle Scholar
- Carter, A., Greene, S., Money, D., Sanchez, M., Webster, K., Nicholson, V., … Kaida, A. (2017b). The problematization of sexuality among women living with HIV and a new feminist approach for understanding and enhancing women’s sexual lives. Sex Roles, 77(11–12), 779–800. https://doi.org/10.1007/s11199-017-0826-z.CrossRefGoogle Scholar
- Carter, A., Greene, S., Money, D., Sanchez, M., Webster, K., Nicholson, V., … Kaida, A. (2018a). Supporting the sexual rights of women living with HIV: A critical analysis of sexual satisfaction and pleasure across five relationship types. Journal of Sex Research, 55(9), 1134–1154. https://doi.org/10.1080/00224499.2018.1440370.CrossRefPubMedGoogle Scholar
- Carter, A., Greene, S., Nicholson, V., O’Brien, N., Dahlby, J., de Pokomandy, A., … CHIWOS Research Team. (2015). ‘It’s a very isolating world’: The journey to HIV care for women living with HIV in British Columbia, Canada. Gender, Place & Culture, 23(7), 941–954. https://doi.org/10.1080/0966369x.2015.1073701.CrossRefGoogle Scholar
- Carter, A., Loutfy, M., de Pokomandy, A., Colley, G., Zhang, W., Sereda, P., … On behalf of the CHIWOS Research Team. (2018b). Health-related quality-of-life and receipt of women-centred HIV care among women living with HIV in Canada. Women and Health, 58, 498–518. https://doi.org/10.1080/03630242.2017.1316346.CrossRefPubMedGoogle Scholar
- Carter, A., Roth, E. A., Ding, E., Milloy, M.-J., Kestler, M., Jabbari, S., … Kaida, A. (2017c). Substance use, violence, and antiretroviral adherence: A latent class analysis of women living with HIV in Canada. AIDS and Behavior, 22(3), 971–985. https://doi.org/10.1007/s10461-017-1863-x.CrossRefGoogle Scholar
- Closson, E. F., Mimiaga, M. J., Sherman, S. G., Tangmunkongvorakul, A., Friedman, R. K., Limbada, M., … HPTN063 Study Team. (2015). Intimacy versus isolation: A qualitative study of sexual practices among sexually active HIV-infected patients in HIV care in Brazil, Thailand, and Zambia. PLoS ONE, 10(3), 16. https://doi.org/10.1371/journal.pone.0120957.CrossRefGoogle Scholar
- Clum, G., Chung, S.-E., Ellen, J. M., & The Adolescent Medicine Trials Network for HIV/AIDS Interventions. (2009). Mediators of HIV-related stigma and risk behavior in HIV infected young women. AIDS Care, 21(11), 1455–1462. https://doi.org/10.1080/09540120902883069.CrossRefPubMedPubMedCentralGoogle Scholar
- Dempster, A., Laird, N., & Rubin, D. (1977). Maximum likelihood estimation from incomplete data. Journal of the Royal Statistical Society: Series B (Methodological), 39(1), 1–38.Google Scholar
- Espinosa-Hernández, G., & Vasilenko, S. A. (2015). Patterns of relationship and sexual behaviors in Mexican adolescents and associations with well-being: A latent class approach. Journal of Adolescence, 44, 280–290. https://doi.org/10.1016/j.adolescence.2015.08.011.CrossRefPubMedPubMedCentralGoogle Scholar
- Fernet, M., Otis, J., Massie, L., St-Pierre-Gagné, S., Nengeh Mensah, M., de Pokomandy, A., … Hot, A. (2017). PLURIELLES: Evaluation of a Quebec-based program aimed at improving HIV-positive women’s sexual health beyond HIV. Paper presented at the Canadian Association of HIV Research Conference, Montreal, Canada.Google Scholar
- Fratti, K. (2017). I am HIV positive. This is what it’s like to date. Redbook Magazine. Retrieved February 20, 2019 from http://www.redbookmag.com/love-sex/relationships/a48131/dating-with-hiv/.
- Greenhalgh, C., Evangeli, M., Frize, G., Foster, C., & Fidler, S. (2016). Intimate relationships in young adults with perinatally acquired HIV: A qualitative study of strategies used to manage HIV disclosure. AIDS Care, 28(3), 283–288. https://doi.org/10.1080/09540121.2015.1093594.CrossRefPubMedGoogle Scholar
- Grodensky, C. A., Golin, C. E., Jones, C., Mamo, M., Dennis, A. C., Abernethy, M. G., & Patterson, K. B. (2015). “I should know better”: The roles of relationships, spirituality, disclosure, stigma, and shame for older women living with HIV seeking support in the South. Journal of the Association of Nurses in AIDS Care, 26(1), 12–23. https://doi.org/10.1016/j.jana.2014.01.005.CrossRefPubMedGoogle Scholar
- Holland, J., Ramazonoglu, C., Sharpe, S., & Thomson, R. (1992b). Pleasure, pressure and power: Some contradictions of gendered sexuality. Sociological Review, 40(4), 645–674. https://doi.org/10.1111/j.1467-954X.1992.tb00406.x.CrossRefGoogle Scholar
- International Community of Women Living with HIV/AIDS. (2015). Criminalization of women living with HIV: Non-disclosure, exposure and transmission. Retrieved February 20, 2019 from http://www.iamicw.org/resources/document-library/criminalization-of-women-living-with-hiv-non-disclosure-exposure-and-transmission.
- International Community of Women Living with HIV/AIDS. (2017). Love positive women. Retrieved February 20, 2019 from http://www.icwglobal.org/women-in-action/all-campaigns/love-positive-women.
- Israel, B. A., Schulz, A. J., Parker, E. A., & Becker, A. B. (1998). Review of community-based research: Assessing partnership approaches to improve public health. Annual Review of Public Health, 19(1), 173–202. https://doi.org/10.1146/annurev.publhealth.19.1.173.CrossRefPubMedGoogle Scholar
- Jakubiak, B. K., & Feeney, B. C. (2016). Affectionate touch to promote relational, psychological, and physical well-being in adulthood: A theoretical model and review of the research. Personality and Social Psychology Review, 21(3), 228–252. https://doi.org/10.1177/1088868316650307.CrossRefPubMedGoogle Scholar
- Kaida, A., Carter, A., Lemay, J., O’Brien, N., Greene, S., Nicholson, V., … CHIWOS Research Team. (2014). Hiring, training, and supporting peer researchers: Operationalizing community-based research principles within epidemiological studies by, with, and for women living with HIV (Abstract O106). Paper presented at the Canadian Conference on HIV/AIDS Research, St. John’s, Newfoundland. Retrieved February 20, 2019 from http://www.chiwos.ca/wp-content/uploads/2014/05/May-3_15.15_Social-Sciences_Kaida_O106_2-web.pdf.
- Kaida, A., Nicholson, V., Patterson, S., Carter, A., Ding, E., Sereda, P., … CHIWOS Research Team. (2017). The influence of the criminalization of HIV non-disclosure on intentional sexual inactivity among women living with HIV in Canada. Paper presented at the Canadian Conference on HIV/AIDS Research, Montreal, QC.Google Scholar
- Kaida, A., Carter, A., de Pokomandy, A., Patterson, S., Proulx-Boucher, K., Nohpal, A., … on behalf of the CHIWOS Research Team. (2015). Sexual inactivity and sexual satisfaction among women living with HIV in Canada in the context of growing social, legal and public health surveillance. Journal of the International AIDS Society, 18(5), 20284–20294. https://doi.org/10.7448/IAS.18.6.20284.CrossRefPubMedPubMedCentralGoogle Scholar
- Lang, A. J., Wilkins, K., Roy-Byrne, P. P., Golinelli, D., Chavira, D., Sherbourne, C., … Stein, M. B. (2012). Abbreviated PTSD Checklist (PCL) as a guide to clinical response. General Hospital Psychiatry, 34(4), 332–338. https://doi.org/10.1016/j.genhosppsych.2012.02.003.CrossRefPubMedPubMedCentralGoogle Scholar
- Lanza, S., Bray, B., & Collins, L. (2013). An introduction to latent class and latent transition analysis. In I. B. Weiner, J. A. Schinka, & W. F. Velicer (Eds.), Handbook of psychology (Vol. 2, pp. 691–716). Hoboken, NJ: Wiley.Google Scholar
- Lanza, S. T., Dziak, J. J., Huang, L., Xu, S., & Collins, L. M. (2015). PROC LCA and PROC LTA user’s guide (Version 1.3.2). University Park: The Methodology Center, Pennsylvania State University.Google Scholar
- Lawless, S., Crawford, J., Kippax, S., & Spongberg, M. (1996a). ‘If it’s not on…’: Heterosexuality for HIV-positive women. Venereology, 9(1), 15–23.Google Scholar
- Life and Love with HIV. (2017). Retrieved from www.lifeandlovewithhiv.ca.
- Loutfy, M., Greene, S., Kennedy, V. L., Lewis, J., Thomas-Pavanel, J., Conway, T., … on Behalf of the CHIWOS Research Team. (2016). Establishing the Canadian HIV Women’s Sexual and Reproductive Health Cohort Study (CHIWOS): Operationalizing community-based research in a large national quantitative study. BMC Medical Research Methodology, 16(1), 101–110. https://doi.org/10.1186/s12874-016-0190-7.CrossRefPubMedPubMedCentralGoogle Scholar
- Maticka-Tyndale, E., Adam, B. D., & Cohen, J. (2002). Sexual desire and practice among people living with HIV and using combination anti-retroviral therapies. Canadian Journal of Human Sexuality, 11(1), 33–40.Google Scholar
- McClelland, A., & Whitbread, J. (2016). PosterVirus: Claiming sexual autonomy for people with HIV through collective action. In C. Kelly & M. Orsini (Eds.), Mobilizing metaphor: Art, culture, and disability activism in Canada (pp. 76–97). Vancouver, BC: UBC Press.Google Scholar
- Miller, J. M. (2014). When love becomes dangerous: An in-depth look into heterosexual relationships in Saint Vincent and the Grenadines and their link to HIV transmission amongst Vincentian women. Birmingham, UK: University of Birmingham.Google Scholar
- Nicholson, V., Sanchez, M., Webster, K., & Carter, A. (2016) Life and love after HIV: A woman’s sharing circle. In Positive Gathering Conference 2016, Vancouver, BC.Google Scholar
- Patel, S. N., Hennink, M., Yount, K. M., Wingood, G., Kosambiya, J., McCarty, F., & Windle, M. (2016). Relationship dynamics and challenges of safer sex in an HIV serodiscordant couple in India: A case review from the Positive Jeevan Saathi Study. Journal of HIV/AIDS & Social Services, 15(3), 319–329. https://doi.org/10.1080/15381501.2016.1165158.CrossRefGoogle Scholar
- Persson, A. (2005). Women, HIV, and the heterosexual encounter. Paper presented at The Pozhet Women’s Forum, Sydney, Australia.Google Scholar
- Petretti, S. (2017). Love positive women. Retrieved February 20, 2019 from https://hivpolicyspeakup.wordpress.com/2017/02/16/love-positive-women/.
- Prevention Access Campaign. (2017). Undetectable = untransmittable. Retrieved February 20, 2019 from https://www.preventionaccess.org/undetectable.
- Public Health Agency of Canada. (2014). HIV/AIDS epi updates: National HIV prevalence and incidence estimates for 2011. Retrieved February 20, 2019 from https://www.canada.ca/en/public-health/services/hiv-aids/publications/epi-updates/chapter-1-national-hiv-prevalence-incidence-estimates-2011.html.
- Rispel, L. C., Metcalf, C. A., Moody, K., Cloete, A., & Caswell, G. (2011). Sexual relations and childbearing decisions of HIV-discordant couples: An exploratory study in South Africa and Tanzania. Reproductive Health Matters, 19(37), 184–193. https://doi.org/10.1016/S0968-8080(11)37552-0.CrossRefPubMedGoogle Scholar
- Robertson, A. M., Syvertsen, J. L., Amaro, H., Martinez, G., Rangel, M. G., Patterson, T. L., & Strathdee, S. A. (2013). Can’t buy my love: A typology of female sex workers’ commercial relationships in the Mexico–U.S. border region. Journal of Sex Research, 51(6), 711–720. https://doi.org/10.1080/00224499.2012.757283.CrossRefPubMedPubMedCentralGoogle Scholar
- Rodger, A., Cambiano, V., Bruun, T., Vernazza, P., Collins, S., van Lunzen, J., & Beloukas, A. (2016). Sexual activity without condoms and risk of HIV transmission in serodifferent couples when the HIV-positive partner is using suppressive antiretroviral therapy. Journal of the American Medical Association, 316(2), 171–181. https://doi.org/10.1001/jama.2016.5148.CrossRefPubMedPubMedCentralGoogle Scholar
- Sanchez, M., Webster, K., Salters, K., Kaida, A., & Carter, A. (2017) Life, love and lunch: A pleasureful pre-positive gathering for women. In Positive Gathering Conference, Vancouver, BC.Google Scholar
- Seeley, J., Russell, S., Khana, K., Ezati, E., King, R., & Bunnell, R. (2009). Sex after ART: Sexual partnerships established by HIV-infected persons taking anti-retroviral therapy in Eastern Uganda. Culture, Health & Sexuality, 11(7), 703–716. https://doi.org/10.1080/13691050903003897.CrossRefGoogle Scholar
- Siegel, K., Schrimshaw, E., & Lekas, H.-M. (2006). Diminished sexual activity, interest, and feelings of attractiveness among HIV-infected women in two eras of the AIDS epidemic. Archives of Sexual Behavior, 35(4), 437–449. https://doi.org/10.1007/s10508-006-9043-5.CrossRefPubMedPubMedCentralGoogle Scholar
- Sontag, S. (1988). Illness as metaphor and AIDS and its metaphors. New York: Picador.Google Scholar
- Sprague, J. (2016). How feminists count: Critical strategies for quantitative methods. In J. Sprague (Ed.), Feminist methodologies for critical researchers: Bridging differences (pp. 94–143). London: Rowman and Littlefield.Google Scholar
- Taylor, T. N., Munoz-Plaza, C. E., Goparaju, L., Martinez, O., Holman, S., Minkoff, H. L., & Golub, E. T. (2016). “The pleasure is better as I’ve gotten older”: Sexual health, sexuality, and sexual risk behaviors among older women living with HIV. Archives of Sexual Behavior, 46(4), 1137–1150. https://doi.org/10.1007/s10508-016-0751-1.CrossRefPubMedPubMedCentralGoogle Scholar
- Vasilenko, S. A., Kugler, K. C., Butera, N. M., & Lanza, S. T. (2014). Patterns of adolescent sexual behavior predicting young adult sexually transmitted infections: A latent class analysis approach. Archives of Sexual Behavior, 44(3), 705–715. https://doi.org/10.1007/s10508-014-0258-6.CrossRefPubMedPubMedCentralGoogle Scholar
- Vasilenko, S. A., Kugler, K. C., & Lanza, S. T. (2015). Latent classes of adolescent sexual and romantic relationship experiences: Implications for adult sexual health and relationship outcomes. Journal of Sex Research, 53(7), 742–753. https://doi.org/10.1080/00224499.2015.1065952.CrossRefPubMedPubMedCentralGoogle Scholar
- Wamoyi, J., Mbonye, M., Seeley, J., Birungi, J., & Jaffar, S. (2011). Changes in sexual desires and behaviours of people living with HIV after initiation of ART: Implications for HIV prevention and health promotion. BMC Public Health, 11, 1–11. https://doi.org/10.1186/1471-2458-11-633.CrossRefGoogle Scholar
- Webster, K., Carter, A., Proulx-Boucher, K., Dubuc, D., Nicholson, V., Beaver, K., & Kaida, A. (2018). Strategies for recruiting women living with human immunodeficiency virus in community-based research: Lessons from Canada. Progress in Community Health Partnerships, 12(1), 21–34. https://doi.org/10.1353/cpr.2018.0003.CrossRefPubMedGoogle Scholar
- Welbourn, A. (2013). Desires denied: Sexual pleasure in the context of HIV. In S. Jolly, A. Cornwall, & K. Hawkins (Eds.), Women, sexuality and the political power of pleasure (pp. 142–161). London: Zed Books.Google Scholar
- Wentland, J. J., & Reissing, E. D. (2011). Taking casual sex not too casually: Exploring definitions of casual sexual relationships. Canadian Journal of Human Sexuality, 20(3), 75–91.Google Scholar
- Wessman, M., Aho, I., Thorsteinsson, K., Storgaard, M., Johansen, I. S., Lunding, S., & Weis, N. (2015). Perception of sexuality and fertility in women living with HIV: A questionnaire study from two Nordic countries. Journal of the International AIDS Society, 18(19962), 1–10. https://doi.org/10.7448/ias.18.1.19962.CrossRefGoogle Scholar
- Whitbread, J. (2017). Love positive women. Jessica Whitbread. Retrieved February 20, 2019 from http://jessicawhitbread.com/project/love-positive-women/.
- World Association for Sexual Health. (2014). Declaration of sexual rights. Retrieved February 20, 2019 from http://www.worldsexology.org.
- Zhang, W., O’Brien, N., Forrest, J. I., Salters, K. A., Patterson, T. L., Montaner, J. S., & Lima, V. D. (2012). Validating a shortened depression scale (10 item CES-D) among HIV-positive people in British Columbia, Canada. PLoS ONE, 7(7), e40793. https://doi.org/10.1371/journal.pone.0040793.CrossRefPubMedPubMedCentralGoogle Scholar