Sexual Anxiety Among Women Living with HIV in the Era of Antiretroviral Treatment Suppressing HIV Transmission

Carter, Allison; Patterson, Sophie; Kestler, Mary; de Pokomandy, Alexandra; Hankins, Catherine; Gormley, Becky; Nicholson, Valerie; Lee, Melanie; Wang, Lu; Greene, Saara; Loutfy, Mona; Kaida, Angela

doi:10.1007/s13178-020-00432-2

Published: 06 February 2020

Sexual Anxiety Among Women Living with HIV in the Era of Antiretroviral Treatment Suppressing HIV Transmission

Allison Carter ORCID: orcid.org/0000-0003-2151-2622^1,2,3,
Sophie Patterson⁴,
Mary Kestler^5,6,
Alexandra de Pokomandy⁷,
Catherine Hankins^8,9,
Becky Gormley^2,3,
Valerie Nicholson²,
Melanie Lee²,
Lu Wang³,
Saara Greene¹⁰,
Mona Loutfy^11,12 &
Angela Kaida¹
on behalf of the CHIWOS Research Team

Sexuality Research and Social Policy volume 17, pages 765–779 (2020)Cite this article

299 Accesses
4 Citations
29 Altmetric
Metrics details

Abstract

Introduction

Sustained undetectable viral loads (UDVLs) on antiretroviral therapy (ART) eliminate sexual HIV transmission. We measured prevalence and correlates of sexual anxiety among women living with HIV.

Methods

We used questionnaire data collected between August 2013 and May 2015 from 1422 women ≥ 16 years in the Canadian HIV Women’s Sexual and Reproductive Health Cohort Study. Among women reporting consensual sex in the past month (n = 474), we determined the proportion who reported high anxiety (“always/usually became anxious or inhibited during sexual activity with a partner”), low anxiety (“sometimes/seldom”), and no anxiety. Logistic regression identified medical, psychological, relational, and social correlates, including awareness of ART prevention benefits (i.e., “makes the risk of transmitting HIV a lot lower”).

Results

Cohort diversity is reflected in age (range 17–66; median 39), gender (5.7% trans), ethnicity (41.6% White, 24.5% Indigenous, 27.0% African/Caribbean/Black), sexual orientation (14.2% lesbian/queer), and time living with HIV (range 18 days–30 years.). Overall, 58.6% reported feeling no sexual anxiety, while the remainder said that they always/usually (14.6%) or sometimes/seldom (26.8%) became anxious or inhibited during sex. Current sex work, previous illicit drug use, and depression were associated with higher adjusted odds of sexual anxiety, while greater emotional closeness and more equitable relationship power were associated with lower odds. There was no correlation between awareness of ART prevention benefits and sexual anxiety.

Conclusions

Relatively few women reported high anxiety during sex with a partner. This was more socially and relationally influenced than linked to understanding ART prevention benefits.

Policy Implications

Women living with HIV should be supported to have great sex, free from worry, by tackling unequal power in women’s intimate relationships, lack of access to resources, and mental health difficulties.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

USD 39.95

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

References

Abelsohn, K., Benoit, A. C., Conway, T., Cioppa, L., Smith, S., Kwaramba, G., Lewis, J., et al. (2014). “Hear(ing) new voices”: Peer reflections from community-based survey development with women living with HIV. Progress in Community Health Partnerships, 9(4), 561–569. https://doi.org/10.1353/cpr.2015.0079.
Article Google Scholar
Albarracín, D., Gillette, J. C., Earl, A. N., Glasman, L. R., Durantini, M. R., & Ho, M.-H. (2005). A test of major assumptions about behavior change: A comprehensive look at the effects of passive and active HIV-prevention interventions since the beginning of the epidemic. Psychological Bulletin, 131(6), 856–897. https://doi.org/10.1037/0033-2909.131.6.856.
Article PubMed PubMed Central Google Scholar
Bancroft, J., Graham, C. A., Janssen, E., & Sanders, S. A. (2009). The dual control model: Current status and future directions. Journal of Sex Research, 46(2–3), 121–142. https://doi.org/10.1080/00224490902747222.
Article PubMed Google Scholar
Beckerman, N. L., & Auerbach, C. (2002). Couples of mixed HIV status: Psychosocial issues affecting intimacy. Journal of Couple & Relationship Therapy, 1(4), 73–85 13p. https://doi.org/10.1300/J398v01n04_04.
Article Google Scholar
Benoit, C., Roth, E., Hallgrimsdottir, H., Jansson, M., Ngugi, E., & Sharpe, K. (2013). Benefits and constraints of intimate partnerships for HIV positive sex workers in Kibera, Kenya. International Journal for Equity in Health, 12. doi:https://doi.org/10.1186/1475-9276-12-76.
Berger, B. E., Ferrans, C. E., & Lashley, F. R. (2001). Measuring stigma in people with HIV: Psychometric assessment of the HIV stigma scale. Research in Nursing & Health, 24(6), 518–529. https://doi.org/10.1002/nur.10011.
Article Google Scholar
Bova, C., & Durante, A. (2003). Sexual functioning among HIV-infected women. AIDS Patient Care and STDs, 17(2), 75–83. https://doi.org/10.1089/108729103321150809.
Article PubMed Google Scholar
Carter, A. (2018). Lovin’ with HIV. Retrieved from https://www.catie.ca/en/positiveside/summer-2018/lovin-hiv
Carter, A., de Pokomandy, A., Loutfy, M., Ding, E., Sereda, P., Webster, K., et al. (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.
Article PubMed PubMed Central Google Scholar
Carter, A., Greene, S., Money, D., Sanchez, M., Webster, K., Nicholson, V., Whitbread, J., Salters, K., Patterson, S., Loutfy, M., Pick, N., Brotto, L. A., Hankins, C., & 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.
Article Google Scholar
Carter, A., Greene, S., Money, D., Sanchez, M., Webster, K., Nicholson, V., et al. (2018a). The importance of sex in the lives of women living with HIV: A critical quantitative analysis. International Journal of Sexual Health, 30(1), 92–110. https://doi.org/10.1080/19317611.2018.1447527.
Article Google Scholar
Carter, A., Greene, S., Money, D., Sanchez, M., Webster, K., Nicholson, V., et al. (2018b). Supporting the sexual rights of women living with HIV: A critical analysis of sexual satisfaction and pleasure across five relationship types. The Journal of Sex Research, 1–21. https://doi.org/10.1080/00224499.2018.1440370.
Carter, A., Greene, S., Money, D., Sanchez, M., Webster, K., Nicholson, V., et al. (2019). Love with HIV: A latent class analysis of sexual and intimate relationship experiences among women living with HIV in Canada. Archives of Sexual Behavior, 48(4), 1015–1040. https://doi.org/10.1007/s10508-019-1418-5.
Article PubMed Google Scholar
Chen, Y. (2013a). Treatment-related optimistic beliefs and risk of HIV transmission: A review of recent findings (2009-2012) in an era of treatment as prevention. Current HIV/AIDS Reports, 10(1), 79–88.
Article Google Scholar
Chen, Y. (2013b). Treatment-related optimistic beliefs and risk of HIV transmission: A review of recent findings (2009–2012) in an era of treatment as prevention. Current HIV/AIDS Reports, 10(1), 79–88.
Article Google Scholar
Closson, E. F., Mimiaga, M. J., Sherman, S. G., Tangmunkongvorakul, A., Friedman, R. K., Limbada, M., et al. (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.
Article Google Scholar
Conrad, P. (1989). The social meaning of AIDS. In R. C. Rist (Ed.), Policy issues for the 1990s. Policy studies review annual. Volume 9. (pp. 75–88). London, UK: Transaction Publishers.
Cooper, D., Moore, E., & Mantell, J. E. (2013). Renegotiating intimate relationships with men: How HIV shapes attitudes and experiences of marriage for South African women living with HIV: ‘Now in my life, everything I do, looking at my health’. Acta Juridica, 2013, 218–238. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4260330/.
Courtenay-Quirk, C., Zhang, J., & Wolitski, R. J. (2009). Intentional abstinence among homeless and unstably housed persons living with HIV/AIDS. AIDS and Behavior., 13(6), 1119–1128. https://doi.org/10.1007/s10461-008-9461-6.
Article PubMed Google Scholar
Cranson, D. A., & Caron, S. L. (1998). An investigation of the effects of HIV on the sex lives of infected individuals. AIDS Education and Prevention, 10(6), 506–522.
PubMed Google Scholar
Crepaz, N., Hart, T., & Marks, G. (2004a). Highly active antiretroviral therapy and sexual risk behavior: A meta-analytic review. Jama, 292(2), 224–236.
Article Google Scholar
Crepaz, N., Hart, T. A., & Marks, G. (2004b). Highly active antiretroviral therapy and sexual risk behavior: A meta-analytic review. Journal of the American Medical Association, 292(2), 224–236.
Article Google Scholar
Eisinger, R. W., Dieffenbach, C. W., & Fauci, A. S. (2019). HIV viral load and transmissibility of HIV infection: Undetectable equals untransmittable. Journal of the American Medical Association, 321(5), 451–452. https://doi.org/10.1001/jama.2018.21167.
Article PubMed Google Scholar
El Fane, M., Bensghir, R., Sbai, S., Chakib, A., Kadiri, N., Ayouch, A., & Himmich, H. (2011). Quality of sexual life for people living with HIV (PLWHA). Sexologies, 20(3), 158–162. https://doi.org/10.1016/j.sexol.2010.12.006.
Article Google Scholar
Fair, C., & Albright, J. (2012). “Don’t tell him you have HIV unless he’s ‘the one’”: Romantic relationships among adolescents and young adults with perinatal HIV infection. AIDS Patient Care and STDs, 26(12), 746–754. https://doi.org/10.1089/apc.2012.0290.
Article PubMed Google Scholar
Florence, E., Schrooten, W., Dreezen, C., Gordillo, V., Schönnesson, L. N., Asboe, D., et al. (2004). Prevalence and factors associated with sexual dysfunction among HIV-positive women in Europe. AIDS Care, 16(5), 550–557. https://doi.org/10.1080/09540120410001716333.
Article PubMed Google Scholar
Goggin, K., Engelson, E. S., Rabkin, J. G., & Kotler, D. P. (1998). The relationship of mood, endocrine, and sexual disorders in human immunodeficiency virus positive (HIV+) women: An exploratory study. Psychosomatic Medicine, 60(1), 11–16 http://journals.lww.com/psychosomaticmedicine/Abstract/1998/01000/The_Relationship_of_Mood,_Endocrine,_and_Sexual.01003.aspx.
Article Google Scholar
Gurevich, M., Mathieson, C. M., Bower, J., & Dhayanandhan, B. (2007). Disciplining bodies, desires and subjectivities: Sexuality and HIV-positive women. Feminism & Psychology, 17(1), 9–38. https://doi.org/10.1177/0959353507072910.
Article Google Scholar
Hanif, H., Bastos, F., Malta, M., Bertoni, N., Winch, P., & Kerrigan, D. (2014). Where does treatment optimism fit in? Examining factors associated with consistent condom use among people receiving antiretroviral treatment in Rio de Janeiro, Brazil. AIDS Behavior, 18(10), 1945–1954.
Article Google Scholar
Hankins, C., Gendron, S., Tran, T., Lamping, D., & Lapointe, N. (1997). Sexuality in Montreal women living with HIV. AIDS Care, 9(3), 261–272. https://doi.org/10.1080/713613156.
Article PubMed Google Scholar
Hasse, B., Ledergerber, B., Hirschel, B., Vernazza, P., Glass, T. R., Jeannin, A., et al. (2010). Frequency and determinants of unprotected sex among HIV-infected persons: The Swiss HIV cohort study. Clinical Infectious Diseases, 51(11), 1314–1322. https://doi.org/10.1086/656809.
Article PubMed Google Scholar
Jarman, M., Walsh, S., & De Lacey, G. (2005). Keeping safe, keeping connected: A qualitative study of HIV-positive women's experiences of partner relationships. Psychology & Health, 20(4), 533–551. https://doi.org/10.1080/14768320500083667.
Article Google Scholar
Jones, J. (2018). ‘Great sex is free from worry’: The importance of undetectable viral loads. Retrieved from http://www.starobserver.com.au/news/national-news/new-video-campaign-fighting-hiv-stigma/166574
Kaida, A., Carter, A., de Pokomandy, A., Patterson, S., Proulx-Boucher, K., Nohpal, A., et al. (2015). Sexual inactivity and sexual satisfaction among women living with HIV in Canada in the context of growing social, legal and public health surveillance. JIAS, 18(5), 20284–20294. https://doi.org/10.7448/IAS.18.6.20284.
Article Google Scholar
Kaida, A., Carter, A., Nicholson, V., Lemay, J., O’Brien, N., Greene, S., et al. (2019). Hiring, training, and supporting Peer Research Associates: Operationalizing community-based research principles within epidemiological studies by, with, and for women living with HIV. Harm Reduction Journal, 16(1), 47. https://doi.org/10.1186/s12954-019-0309-3.
Article PubMed PubMed Central Google Scholar
Keegan, A., Lambert, S., & Petrak, J. (2005). Sex and relationships for HIV-positive women since HAART: A qualitative study. AIDS Patient Care & STDs, 19(10), 645–654. https://doi.org/10.1089/apc.2005.19.645.
Article Google Scholar
Kouyos, R. D., Hasse, B., Calmy, A., Cavassini, M., Furrer, H., Stockle, M., et al. (2015). Increases in condomless sex in the Swiss HIV Cohort Study. Open Forum Infect Dis, 2(2), ofv077. https://doi.org/10.1093/ofid/ofv077.
Article PubMed PubMed Central Google Scholar
Lambert, S., Keegan, A., & Petrak, J. (2005). Sex and relationships for HIV positive women since HAART: A quantitative study. Sexually Transmitted Infections, 81(4), 333–337. https://doi.org/10.1136/sti.2004.013516.
Article PubMed PubMed Central Google Scholar
Lawless, S., Kippax, S., & Crawford, J. (1996a). Dirty, diseased and undeserving: The positioning of HIV positive women. Social Science & Medicine, 43(9), 1371–1377. https://doi.org/10.1016/0277-9536(96)00017-2.
Article Google Scholar
Lawless, S., Crawford, J., Kippax, S., & Spongberg, M. (1996b). ‘If it’s not on...’: Heterosexuality for HIV-positive women. Venereology, 9(1), 15–23 http://search.informit.com.au/documentSummary;dn=561250395072397;res=IELAPA.
Google Scholar
Life and Love with HIV. (2017). Retrieved from www.lifeandlovewithhiv.ca
Logie, C. H., Kaida, A., Marcus, N., de Pokomandy, A., Ding, E., Wang, L., et al. (2017). Prevalence and correlates of forced sex as a mode of HIV acquisition among a cohort of women living with HIV in Canada. J Interpers Violence, 00(0), 1–36. https://doi.org/10.1177/0886260517718832.
Article Google Scholar
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. doi:https://doi.org/10.1186/s12874-016-0190-7.
Loutfy, M., de Pokomandy, A., Carter, A., O’Brien, N., Lewis, J., Nicholson, V., et al. (2017). Cohort profile: The Canadian HIV Women’s Sexual and Reproductive Health Cohort Study (CHIWOS). PLoS One, 12(9), e0184708. https://doi.org/10.1371/journal.pone.0184708.
Article PubMed PubMed Central Google 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
Mazanderani, F. (2012). An ethics of intimacy: Online dating, viral-sociality and living with HIV. BioSocieties, 7(4), 393–409. https://doi.org/10.1057/biosoc.2012.24.
Article Google Scholar
Mazer, N., Leiblum, S., & Rosen, R. (2000). The Brief Index for Sexual Functioning for Women: A new scoring algorithm and comparison of normative and surgically menopausal populations. The Journal of the North American Menopause Society, 7(5), 350–363. https://doi.org/10.1363/3913407.
Article Google Scholar
Montaner, J. S. (2011). Treatment as prevention—A double hat-trick. Lancet, 378. https://doi.org/10.1016/s0140-6736(11)60821-0.
Moody, R. L., Starks, T. J., Grov, C., & Parsons, J. T. (2018). Internalized homophobia and drug use in a national cohort of gay and bisexual men: Examining depression, sexual anxiety, and gay community attachment as mediating factors. Archives of Sexual Behavior, 47(4), 1133–1144. https://doi.org/10.1007/s10508-017-1009-2.
Article PubMed Google Scholar
Mykhalovskiy, E., Hastings, C., Sanders, C., Hayman, M., & Bisaillon, L. (2016). “Callous, cold, and deliberately duplicitous:” Racialization, immigration, and representation of HIV criminalization in Canadian mainstream newspapers (1911–0227). Retrieved from http://www.publicimpactpr.com/images/clients/can/callous_cold_report_final.pdf
Nevedal, A., & Sankar, A. (2015). The significance of sexuality and intimacy in the lives of older African Americans with HIV/AIDS. The Gerontologist, 56(4), 762–771. https://doi.org/10.1093/geront/gnu160.
Article PubMed PubMed Central Google Scholar
Patterson, S., Carter, A., Nicholson, V., Webster, K., Ding, E., Kestler, M., Ogilvie, G., de Pokomandy, A., Loutfy, M., & Kaida, A. (2017). Condomless sex among virally suppressed women with HIV with regular HIV-serodiscordant sexual partners in the era of treatment-as-prevention. Journal of Acquired Immune Deficiency Syndromes, 76(4), 372–381. https://doi.org/10.1097/QAI.0000000000001528.
Article PubMed Google Scholar
Patterson, S., Nicholson, V., Milloy, M. J., Ogilvie, G., Hogg, R. S., Carter, A., et al. (2019). Awareness and understanding of HIV non-disclosure case law and the role of healthcare providers in discussions about the criminalization of HIV non-disclosure among women living with HIV in Canada. AIDS and Behavior, 1–19. https://doi.org/10.1007/s10461-019-02463-2.
Persson, A. (2005). Women, HIV, and the heterosexual encounter. Paper presented at the the Pozhet Women’s Forum, Sydney, Australia.
Persson, A. (2016). ‘The world has changed’: Pharmaceutical citizenship and the reimagining of serodiscordant sexuality among couples with mixed HIV status in Australia. Sociology of Health & Illness, 38(3), 380–395. https://doi.org/10.1111/1467-9566.12347.
Article Google Scholar
Persson, A., & Newman, C. (2008). Making monsters: Heterosexuality, crime and race in recent Western media coverage of HIV. Sociology of Health & Illness, 30(4), 632–646. https://doi.org/10.1111/j.1467-9566.2008.01082.x.
Article Google Scholar
Persson, A., Ellard, J., Newman, C. E. J. S., & Culture. (2016a). Bridging the HIV divide: Stigma, stories and serodiscordant sexuality in the biomedical age. 20(2), 197–213.
Persson, A., Ellard, J., & Newman, C. E. (2016b). Bridging the HIV divide: Stigma, stories and serodiscordant sexuality in the biomedical age. Sexuality & Culture, 20(2), 197–213. https://doi.org/10.1007/s12119-015-9316-z.
Article Google Scholar
Prevention Access Campaign. (2017). Undetectable=untransmittable. Retrieved from https://www.preventionaccess.org/undetectable
Public Health Agency of Canada. (2012). Population-specific HIV/AIDS status report: Women. Retrieved from Ottawa: http://www.phac-aspc.gc.ca/aids-sida/publication/epi/2010/index-eng.php
Pulerwitz, J., Gortmaker, S. L., & DeJong, W. (2000). Measuring sexual relationship power in HIV/STD research. Sex Roles, 42(7–8), 637–660. https://doi.org/10.1023/A:1007051506972.
Article Google Scholar
Radloff, L. S. (1977). The CES-D scale: A self-report depression scale for research in the general population. Applied Psychological Measurement, 1(3), 385–401. https://doi.org/10.1177/014662167700100306.
Article Google Scholar
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.
Article PubMed Google Scholar
Roche, J. (2018). A radical space? Retrieved from https://www.lifeandlovewithhiv.ca/a-radical-space/
Rodger, A., Cambiano, V., Bruun, T., Vernazza, P., Collins, S., van Lunzen, J., et al. (2016a). 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.
Article PubMed Google Scholar
Rodger, A. J., Cambiano, V., Bruun, T., Vernazza, P., Collins, S., van Lunzen, J., . . . Group, P. S. (2016b). Sexual activity without condoms and risk of HIV transmission in serodifferent couples when the HIV-positive partner is using suppressive antiretroviral therapy. JAMA, 316(2), 171–181. doi:https://doi.org/10.1001/jama.2016.5148.
Rodger, A. J., Cambiano, V., Bruun, T., Vernazza, P., Collins, S., Degen, O., et al. (2019). Risk of HIV transmission through condomless sex in serodifferent gay couples with the HIV-positive partner taking suppressive antiretroviral therapy (PARTNER): Final results of a multicentre, prospective, observational study. Lancet, 393(10189), 2428–2438. https://doi.org/10.1016/s0140-6736(19)30418-0.
Article PubMed PubMed Central Google Scholar
Shannon, K. (2010). The hypocrisy of Canada’s prostitution legislation. Canadian Medical Association Journal, 182(12), 1388–1388.
Article Google Scholar
Shannon, K., Bright, V., Gibson, K., & Tyndall, M. W. (2007). Sexual and drug-related vulnerabilities for HIV infection among women engaged in survival sex work in Vancouver, Canada. Canadian Journal of Public Health, 98(6), 465–469.
Article Google Scholar
Shannon, K., Rusch, M., Shoveller, J., Alexson, D., Gibson, K., & Tyndall, M. (2008a). Mapping violence and policing as an environmental–structural barrier to health service and syringe availability among substance-using women in street-level sex work. International Journal of Drug Policy, 19(2), 140–147.
Article Google Scholar
Shannon, K., Kerr, T., Allinott, S., Chettiar, J., Shoveller, J., & Tyndall, M. W. (2008b). Social and structural violence and power relations in mitigating HIV risk of drug-using women in survival sex work. Social Science & Medicine, 66(4), 911–921.
Article Google Scholar
Shannon, K., Strathdee, S. A., Shoveller, J., Rusch, M., Kerr, T., & Tyndall, M. W. (2009). Structural and environmental barriers to condom use negotiation with clients among female sex workers: Implications for HIV-prevention strategies and policy. American Journal of Public Health, 99(4), 659.
Article Google Scholar
Siegel, K., & Schrimshaw, E. W. (2003). Reasons for the adoption of celibacy among older men and women living with HIV/AIDS. Journal of Sex Research, 40(2), 189–200. https://doi.org/10.1080/00224490309552180.
Article PubMed Google 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.
Article PubMed PubMed Central Google Scholar
Squire, C. (2003). Can an HIV-positive woman find true love?: Romance in the stories of women living with HIV. Feminism & Psychology, 13(1), 73–100. https://doi.org/10.1177/0959353503013001009.
Article Google Scholar
van der Straten, A., Vernon, K. A., Knight, K. R., Gomez, C. A., & Padian, N. S. (1998). Managing HIV among serodiscordant heterosexual couples: Serostatus, stigma and sex. AIDS Care, 10(5), 533–548. https://doi.org/10.1080/09540129848406.
Article PubMed Google Scholar
Tiefer, L. (2002). Arriving at a “new view” of women’s sexual problems: Background, theory, and activism. Women & Therapy, 24(1–2), 63–98. https://doi.org/10.1300/J015v24n01_12.
Article Google Scholar
VanDevanter, N., Thacker, A. S., Bass, G., & Arnold, M. (1999). Heterosexual couples confronting the challenges of HIV infection. AIDS Care, 11(2), 181–193. https://doi.org/10.1080/09540129948072.
Article PubMed Google Scholar
Vernazza, P., & Bernard, E. (2016). HIV is not transmitted under fully suppressive therapy: The Swiss Statement – eight years later. Swiss Medical Weekly, 146(w14246), 1–6. https://doi.org/10.4414/smw.2016.14246.
Article Google Scholar
Vernazza, P., Hirschel, B., Bernasconi, E., & Flepp, M. (2008). Les personnes séropositives ne souffrant d’aucune autre MST et suivant un traitement antirétroviral efficace ne transmettent pas le VIH par voie sexuelle. Bulletin des Médecins Suisses, 89(5), 165–169.
Article Google 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.
Article Google Scholar
Webster, K., Carter, A., Proulx-Boucher, K., Dubuc, D., Nicholson, V., Beaver, K., Gasingirwa, C., Ménard, B., O'Brien, N., Mitchell, K., Bajard, M. P., Ding, E., de Pokomandy, A., Loutfy, M., & Kaida, A. (2018). Strategies for recruiting women living with human immunodeficiency virus in community-based research: Lessons from Canada. Progress in Community Health Partnerships: Research Education and Action, 12(1), 21–34. https://doi.org/10.1353/cpr.2018.0003.
Article Google Scholar
Whitfield, T. H. F., Jones, S. S., Wachman, M., Grov, C., Parsons, J. T., & Rendina, H. J. (2019). The impact of pre-exposure prophylaxis (PrEP) use on sexual anxiety, satisfaction, and esteem among gay and bisexual men. Journal of Sex Research, 56(9), 1128–1135. https://doi.org/10.1080/00224499.2019.1572064.
Article PubMed Google Scholar
Williams, D. R., Yan, Y., Jackson, J. S., & Anderson, N. B. (1997). Racial differences in physical and mental health: Socio-economic status, stress and discrimination. Journal of Health Psychology, 2(3), 335–351. https://doi.org/10.1177/135910539700200305.
Article PubMed Google Scholar
Wilson, T., & Minkoff, H. (2001). Brief report: Condom use consistency associated with beliefs regarding HIV disease transmission among women receiving HIV antiretroviral therapy. Journal of Acquired Immune Deficiency Syndromes, 27(3), 289–291.
Article Google Scholar
Wilson, T., Feldman, J., Vega, M., Gandhi, M., Richardson, J., Cohen, M., et al. (2007). Acquisition of new sexual partners among women with HIV infection: Patterns of disclosure and sexual behavior within new partnerships. AIDS Education and Prevention, 19(2), 151–159.
Article Google Scholar
Wright, K., Naar-King, S., Lam, P., Templin, T., & Frey, M. (2007). Stigma scale revised: Reliability and validity of a brief measure of stigma for HIV+ youth. Journal of Adolescent Health, 40(1), 96–98. https://doi.org/10.1016/j.jadohealth.2006.08.001.
Article PubMed Google Scholar
Zhang, W., O’Brien, N., Forrest, J. I., Salters, K. A., Patterson, T. L., Montaner, J. S., et al. (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.
Article PubMed PubMed Central Google Scholar
Zierler, S., Mayer, K., Moore, J., Stein, M., Schoenbaum, E., Schuman, P., & Rompalo, A. (1999). Sexual practices in a cohort of US women with and without human immunodeficiency virus. HERS Study. HIV Epidemiology Research Study. Journal of the American Medical Women’s Association, 54(2), 79–83 https://www.ncbi.nlm.nih.gov/pubmed/10319596.
PubMed Google Scholar

Download references

Acknowledgments

The CHIWOS Research Team would like to thank women living with HIV for their contributions to this study. We also thank the national team of co-investigators, collaborators, and Peer Research Associates and acknowledge the national Steering Committee, our three provincial Community Advisory Boards, the national CHIWOS Aboriginal Advisory Board, the BC Centre for Excellence in HIV/AIDS for the data support and analysis, and all our partnering organizations for supporting the study.

Listed here are all research team members and affiliated institutions; all those not listed by name on the title page are to be hyperlinked as authors:

The CHIWOS Research Team: Rahma Abdul-Noor (Women’s College Research Institute), Aranka Anema (University of British Columbia), Jonathan Angel (Ottawa Hospital Research Institute), QC-Jean-Guy Baril (Université de Montréal), Fatimatou Barry (Women’s College Research Institute), Greta Bauer (University of Western Ontario), Kerrigan Beaver (Women’s College Research Institute), Denise Becker (Positive Living Society of British Columbia), Anita Benoit (Women’s College Research Institute), Jason Brophy (Children’s Hospital of Eastern Ontario), Lori Brotto (University of British Columbia), Ann Burchell (Ontario HIV Treatment Network), Claudette Cardinal (Simon Fraser University), Allison Carter (British Columbia Centre for Excellence in HIV/AIDS and Simon Fraser University), Angela Cescon (British Columbia Centre for Excellence in HIV/AIDS), Lynne Cioppa (Women’s College Research Institute), Jeffrey Cohen (Windsor Regional Hospital), Guillaume Colley (British Columbia Centre for Excellence in HIV/AIDS), Tracey Conway (Women’s College Research Institute), Curtis Cooper (Ottawa Hospital Research Institute), Jasmine Cotnam (Women’s College Research Institute), Janette Cousineau (Women’s College Research Institute), Janice Dayle, (McGill University Health Centre), Marisol Desbiens (Women’s College Research Institute), Hania Dubinsky, (McGill University Health Centre), Danièle Dubuc, (McGill University Health Centre), Janice Duddy (Pacific AIDS Network), Brenda Gagnier (Women’s College Research Institute), Jacqueline Gahagan (Dalhousie University), Claudine Gasingirwa (Women’s College Research Institute), Nada Gataric (British Columbia Centre for Excellence in HIV/AIDS), Saara Greene (McMaster University), Trevor Hart (Ryerson University), Catherine Hankins (UNAIDS), Bob Hogg (British Columbia Centre for Excellence in HIV/AIDS and Simon Fraser University), Terry Howard (Positive Living Society of British Columbia), Shazia Islam (Women’s College Research Institute), Evin Jones (Pacific AIDS Network), Charu Kaushic (McMaster University), Alexandria Keating (ViVA and Southern Gulf Islands AIDS Society), Logan Kennedy (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), Gladys Kwaramba (Women’s College Research Institute), Andrea Langlois (Pacific AIDS Network), Rebecca Lee (CIHR Canadian HIV Trials Network), Lynne Leonard (University of Ottawa), Johanna Lewis (Women’s College Research Institute),Viviane Lima (British Columbia Centre for Excellence in HIV/AIDS), Elisa Lloyd-Smith (Providence Health Care), Carmen Logie (University of Toronto), Shari Margolese (Women’s College Research Institute), Carrie Martin (Native Women’s Shelter of Montreal), Renee Masching (Canadian Aboriginal AIDS Network), Lyne Massie, (Université de Québec à Montréal), Melissa Medjuck (Positive Women’s Network), Brigitte Ménard, (McGill University Health Centre), Cari Miller (Simon Fraser University), Deborah Money (Women’s Health Research Institute), Marvelous Muchenje (Women’s Health in Women’s Hands), Mary Mwalwanda (Women’s College Research Institute), Mary (Muthoni) Ndung’u (Women’s College Research Institute), Valerie Nicholson (Simon Fraser University), Illuminée Nzikwikiza (McGill University Health Centre), Kelly O’Brien (University of Toronto), Nadia O’Brien (McGill University Health Centre and Université de Montréal), Gina Ogilvie (British Columbia Centre for Disease Control), Susanna Ogunnaike-Cooke (Public Health Agency of Canada), Joanne Otis (Université du Québec à Montréal), Ali Palmer (Simon Fraser University), Sophie Patterson (Simon Fraser University), Doris Peltier (Canadian Aboriginal AIDS Network), Yasmeen (Ashria) Persad (Women’s College Research Institute), Neora Pick (Oak Tree Clinic, BC Women’s Hospital and Health Centre), Alie Pierre, (McGill University Health Centre), Jeff Powis (Toronto East General Hospital), Karène Proulx-Boucher (McGill University Health Centre), Corinna Quan (Windsor Regional Hospital), Janet Raboud (Ontario HIV Treatment Network), Anita Rachlis (Sunnybrook Health Science Centre), Edward Ralph (St. Joseph’s Health Care), Stephanie Rawson, (Simon Fraser University, BC), Eric Roth (University of Victoria), Danielle Rouleau (Centre Hospitalier de l’Université de Montréal), Sean Rourke (Ontario HIV Treatment Network), Sergio Rueda (Ontario HIV Treatment Network), Mercy Saavedra (Women’s College Research Institute), Kate Salters (Simon Fraser University), Margarite Sanchez (ViVA and Southern Gulf Islands AIDS Society), Roger Sandre (Haven Clinic), Jacquie Sas (CIHR Canadian HIV Trials Network), Paul Sereda (British Columbia Centre for Excellence in HIV/AIDS), Fiona Smaill (McMaster University), Stephanie Smith (Women’s College Research Institute), Marcie Summers (Positive Women’s Network), Tsitsi Tigere (Women’s College Research Institute), Wangari Tharao (Women’s Health in Women’s Hands), Jamie Thomas-Pavanel (Women’s College Research Institute), Christina Tom (Simon Fraser University, BC), Cécile Tremblay (Centre Hospitalier de l’Université de Montréal), Benoit Trottier (Clinique l’Actuel), Sylvie Trottier (Centre Hospitalier Universitaire de Québec), Christos Tsoukas (McGill University Health Centre), Sharon Walmsley (Toronto General Research Institute), Kath Webster (Simon Fraser University), Wendy Wobeser (Kingston University), Jessica Yee (Native Youth Sexual Health Network), Mark Yudin (St. Michael’s Hospital), and Wendy Zhang (British Columbia Centre for Excellence in HIV/AIDS). All other CHIWOS Research Team Members wish to remain anonymous.

Funding

CHIWOS is funded by the Canadian Institutes of Health Research (CIHR), the CIHR Canadian HIV Trials Network (CTN 262), the Ontario HIV Treatment Network (OHTN), and the Academic Health Science Centres (AHSC) Alternative Funding Plans (AFP) Innovation Fund. Title page listing all authors and affiliations Innovation Fund. AC received support from a CIHR Doctoral Award, SP received support in the form of a Study Abroad Studentship from the Leverhulme Trust, AdP received support from Fonds de Recherche du Quebéc – Santé (FRQS) (Chercheur-boursier clinicien – Junior 1 & 2), and AK received salary support through a Tier 2 Canada Research Chair in Global HIV and Sexual and Reproductive Health.

Author information

Authors and Affiliations

Kirby Institute, University of New South Wales, Level 6, Wallace Wurth Building, Sydney, NSW, 2052, Australia
Allison Carter & Angela Kaida
Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
Allison Carter, Becky Gormley, Valerie Nicholson & Melanie Lee
British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, Vancouver, Canada
Allison Carter, Becky Gormley & Lu Wang
Health Education North West, Regatta Place, Liverpool, UK
Sophie Patterson
Department of Medicine, Division of Infectious Diseases, University of British Columbia, Vancouver, British Columbia, Canada
Mary Kestler
Oak Tree Clinic, British Columbia Women’s Hospital and Healthcare Centre, Vancouver, Canada
Mary Kestler
Chronic Viral Illness Service, McGill University Health Centre, Montreal, Canada
Alexandra de Pokomandy
Department of Epidemiology, Biostatistics, and Occupational Health, Faculty of Medicine, McGill University, Montreal, Québec, Canada
Catherine Hankins
Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, England
Catherine Hankins
School of Social Work, McMaster University, Hamilton, Ontario, Canada
Saara Greene
Women’s College Research Institute, Women’s College Hospital, Toronto, Canada
Mona Loutfy
Department of Medicine, University of Toronto, Toronto, Ontario, Canada
Mona Loutfy

Authors

Allison Carter
View author publications
You can also search for this author in PubMed Google Scholar
Sophie Patterson
View author publications
You can also search for this author in PubMed Google Scholar
Mary Kestler
View author publications
You can also search for this author in PubMed Google Scholar
Alexandra de Pokomandy
View author publications
You can also search for this author in PubMed Google Scholar
Catherine Hankins
View author publications
You can also search for this author in PubMed Google Scholar
Becky Gormley
View author publications
You can also search for this author in PubMed Google Scholar
Valerie Nicholson
View author publications
You can also search for this author in PubMed Google Scholar
Melanie Lee
View author publications
You can also search for this author in PubMed Google Scholar
Lu Wang
View author publications
You can also search for this author in PubMed Google Scholar
Saara Greene
View author publications
You can also search for this author in PubMed Google Scholar
Mona Loutfy
View author publications
You can also search for this author in PubMed Google Scholar
Angela Kaida
View author publications
You can also search for this author in PubMed Google Scholar

Consortia

on behalf of the CHIWOS Research Team

Rahma Abdul-Noor
, Aranka Anema
, Jonathan Angel
, QC-Jean-Guy Baril
, Fatimatou Barry
, Greta Bauer
, Kerrigan Beaver
, Denise Becker
, Anita Benoit
, Jason Brophy
, Lori Brotto
, Ann Burchell
, Claudette Cardinal
, Allison Carter
, Angela Cescon
, Lynne Cioppa
, Jeffrey Cohen
, Guillaume Colley
, Tracey Conway
, Curtis Cooper
, Jasmine Cotnam
, Janette Cousineau
, Janice Dayle
, Marisol Desbiens
, Hania Dubinsky
, Danièle Dubuc
, Janice Duddy
, Brenda Gagnier
, Jacqueline Gahagan
, Claudine Gasingirwa
, Nada Gataric
, Saara Greene
, Trevor Hart
, Catherine Hankins
, Bob Hogg
, Terry Howard
, Shazia Islam
, Evin Jones
, Charu Kaushic
, Alexandria Keating
, Logan Kennedy
, Mary Kestler
, Maxime Kiboyogo
, Marina Klein
, Gladys Kwaramba
, Andrea Langlois
, Rebecca Lee
, Lynne Leonard
, Johanna Lewis
, Viviane Lima
, Elisa Lloyd-Smith
, Carmen Logie
, Shari Margolese
, Carrie Martin
, Renee Masching
, Lyne Massie
, Melissa Medjuck
, Brigitte Ménard
, Cari Miller
, Deborah Money
, Marvelous Muchenje
, Mary Mwalwanda
, Mary Muthoni Ndung’u
, Valerie Nicholson
, Illuminée Nzikwikiza
, Kelly O’Brien
, Nadia O’Brien
, Gina Ogilvie
, Susanna Ogunnaike-Cooke
, Joanne Otis
, Ali Palmer
, Sophie Patterson
, Doris Peltier
, Yasmeen Ashria Persad
, Neora Pick
, Alie Pierre
, Jeff Powis
, Karène Proulx-Boucher
, Corinna Quan
, Janet Raboud
, Anita Rachlis
, Edward Ralph
, Stephanie Rawson
, Eric Roth
, Danielle Rouleau
, Sean Rourke
, Sergio Rueda
, Mercy Saavedra
, Kate Salters
, Margarite Sanchez
, Roger Sandre
, Jacquie Sas
, Paul Sereda
, Fiona Smaill
, Stephanie Smith
, Marcie Summers
, Tsitsi Tigere
, Wangari Tharao
, Jamie Thomas-Pavanel
, Christina Tom
, Cécile Tremblay
, Benoit Trottier
, Sylvie Trottier
, Christos Tsoukas
, Sharon Walmsley
, Kath Webster
, Wendy Wobeser
, Jessica Yee
, Mark Yudin
& Wendy Zhang

Contributions

AC and AK conceived the idea for this analysis. All the authors contributed to the design and acquisition of data. Data preparation and statistical analysis were conducted by LW. Data interpretation was performed by AC and AK. AC drafted the initial manuscript; all the authors provided critical feedback. All the authors have critically reviewed and approved the final manuscript, gave approval for publication, and acted as guarantors of the work.

Corresponding author

Correspondence to Allison Carter.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Carter, A., Patterson, S., Kestler, M. et al. Sexual Anxiety Among Women Living with HIV in the Era of Antiretroviral Treatment Suppressing HIV Transmission. Sex Res Soc Policy 17, 765–779 (2020). https://doi.org/10.1007/s13178-020-00432-2

Download citation

Published: 06 February 2020
Issue Date: December 2020
DOI: https://doi.org/10.1007/s13178-020-00432-2

Keywords

HIV
Women
Sexual anxiety
Antiretroviral therapy
Canada
CHIWOS