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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

Abstract

In the context of HIV, women’s sexual rights and sexual autonomy are important but frequently overlooked and violated. Guided by community voices, feminist theories, and qualitative empirical research, we reviewed two decades of global quantitative research on sexuality among women living with HIV. In the 32 studies we found, conducted in 25 countries and composed mostly of cis-gender heterosexual women, sexuality was narrowly constructed as sexual behaviours involving risk (namely, penetration) and physiological dysfunctions relating to HIV illness, with far less attention given to the fullness of sexual lives in context, including more positive and rewarding experiences such as satisfaction and pleasure. Findings suggest that women experience declines in sexual activity, function, satisfaction, and pleasure following HIV diagnosis, at least for some period. The extent of such declines, however, is varied, with numerous contextual forces shaping women’s sexual well-being. Clinical markers of HIV (e.g., viral load, CD4 cell count) poorly predicted sexual outcomes, interrupting widely held assumptions about sexuality for women with HIV. Instead, the effects of HIV-related stigma intersecting with inequities related to trauma, violence, intimate relations, substance use, poverty, aging, and other social and cultural conditions primarily influenced the ways in which women experienced and enacted their sexuality. However, studies framed through a medical lens tended to pathologize outcomes as individual “problems,” whereas others driven by a public health agenda remained primarily preoccupied with protecting the public from HIV. In light of these findings, we present a new feminist approach for research, policy, and practice toward understanding and enhancing women’s sexual lives—one that affirms sexual diversity; engages deeply with society, politics, and history; and is grounded in women’s sexual rights.

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Acknowledgements

We would like to thank all of the women living with HIV, researchers, providers, and policymakers who supported this grant and review. We also thank Dr. Robert S. Hogg for his involvement as a Doctoral Supervisory Committee Member, and Alexandra de Pokomandy, Mary Kestler, Gina McGowan, Joanne Otis, and Wangari Tharao for their contributions to the grant. Lastly, we thank the editor and reviewers for their critical comments and suggestions, which strengthened the final manuscript. We dedicate this work to the many women living with HIV around the world.

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Correspondence to Allison Carter.

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The present review was supported by a Knowledge Synthesis Grant from the Canadian Institutes of Health Research (CIHR, 147983). AC and KS received support through a Doctoral Research Award from the CIHR HIV/AIDS Research Initiative and the Canadian Association for HIV Research (CAHR). AK received salary support through a Tier 2 Canada Research Chair in Global Perspectives on HIV and Sexual and Reproductive Health.

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Carter, A., Greene, S., Money, D. et al. 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, 779–800 (2017). https://doi.org/10.1007/s11199-017-0826-z

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Keywords

  • Women
  • Sexuality
  • HIV
  • Feminism
  • Quantitative research
  • Review