Sexual Functioning, Sexual Distress, and Well-being of Sexually Active Adult Women Living with HIV: an HIV Program-Based Cross-sectional Study



Chronic diseases, including HIV, are associated with psychosocial factors known to influence sexual functioning. This study aimed to assess the sexual functioning and well-being of sexually active HIV-positive women.


In this HIV program-based cross-sectional study (October 2018 to March 2019), 458 sexually active women in Ogun State, Nigeria, completed the Female Sexual Function Index, the Revised Female Sexual Distress Scale, and the World Health Organization-5 Well-Being Scale to assess different domains of sexual functioning and well-being.


The mean age was 41.82 (± 10.27) years. Forty-four (9.6%) of the women had symptoms of depression while 77.29% had scores suggestive of a high risk of female sexual dysfunction. The prevalence of female sexual dysfunction subtypes was as follows: (1) 92.36% for difficulties in the interest domain, (2) 74.67% for symptoms suggestive of Candace syndrome, (3) 60.04% for difficulties in the orgasmic domain, and (4) 76.69% for dyspareunia. The prevalence of female sexual distress and poor well-being was 6.55% and 6.99% respectively. The correlation between dyadic adjustment scores and the participants’ sexuality (− 0.122, 95% CI − 0.211 to − 0.030) and well-being (− 0.420, 95% CI − 0.492 to − 0.341) was statistically significant (p < 0.05). There was significant correlation between depression and female sexual dysfunction (0.108, 95% CI 0.017 to 0.198, p = 0.022), and between depression and poor well-being (0.282, 95% CI 0.185 to 0.364, p < 0.001). There was a borderline correlation between poor well-being and sexual distress (− 0.087, 95% CI − 0.176 to 0.004, p = 0.062).


Although the prevalence of female sexual distress is low among HIV-positive women accessing care in Nigeria, female sexual dysfunction is a significant problem. Sexual health interventions in HIV setting should be holistic and must address HIV stigmatization, criminalization of sex, and partner relationship, among other things. Couple-based interventions, as well as those that boost mood and reduce depression, are also recommended.

Social Policy Implications

The study highlights the need for policies that address HIV stigmatization, decriminalize sex, and promote healthy partner relationships as a means to mitigate sexual dysfunction and boost the well-being of women living with HIV.

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Data Availability

The datasets from which we conducted analyses for this manuscript is available on the ResearchGate repository at Interested entities can gain access to the data upon reasonable request to the lead author.



antiretroviral treatment


area under the receiver operating characteristic curve


Beck Depression Inventory 11


Female Sexual Distress Scale


revised Female Sexual Distress Scale


Female Sexual Function Index


human immunodeficiency virus


International Conference on Population and Development


people living with HIV


revised Dyadic Adjustment Scale


sexual and reproductive health


sub-Saharan Africa


World Health Organization-5 Well-Being Scale


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The authors wish to acknowledge the immense contributions made by the staff of the HIV care units of the three tertiary hospitals involved in the study. We also appreciate the participants for their patience and kind participation.


The authors did not get any external funding for the conduct of this research.

Author information




OA conceptualized and designed the study; he performed the statistical analyses and wrote the first draft of the manuscript. KS supervised the data collection. All the authors conducted the study and revised and approved the final submission.

Corresponding author

Correspondence to Olumide Abiodun.

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The authors declare that they have no conflict of interest.

Ethics Approval and Consent to Participate

The study was approved by the local human research ethics committee (OOUTH/HREC/206/2018AP) and complied with all the guidelines recommended by the Nigeria National Health Research Ethics Committee. All participants signed an informed consent form. Each participant received a unique identification code. The study did not require the personal identification details of the participants, and the investigators ensured the maintenance of privacy and confidentiality throughout the study.

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Abiodun, O., Sodeinde, K., Adepoju, A. et al. Sexual Functioning, Sexual Distress, and Well-being of Sexually Active Adult Women Living with HIV: an HIV Program-Based Cross-sectional Study. Sex Res Soc Policy 17, 558–567 (2020).

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  • Depression
  • Dyadic adjustment
  • Female sexual distress
  • Female sexual dysfunction
  • HIV
  • Nigeria
  • Well-being