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

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.

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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.

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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.

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Correspondence to Allison Carter.

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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

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Keywords

  • HIV
  • Women
  • Sexual anxiety
  • Antiretroviral therapy
  • Canada
  • CHIWOS