Sexual Quality of Life of People Living with HIV in the Current Biomedical Prevention Era

Past research on the sexual lives of people living with HIV (PLWH) has focused on reducing behaviours involving risk of transmission of HIV, and overlooked the sexual wellbeing of PLWH. This focus on risk behaviour was once understandable, given the past need to prevent transmission of HIV by changing behaviour. Yet in recent years, medications taken by HIV positive people and by HIV negative people at risk of acquiring the virus have been demonstrated to be highly effective in preventing transmission of HIV. These biomedical methods create an opportunity for research to shift focus away from risk of transmission behaviour and toward promoting sexual quality of life of PLWH. This thesis involved: i) systematic review with thematic synthesis of qualitative studies on sexual life with HIV, ii) two systematic reviews with narrative synthesis of quantitative studies on factors associated with sexual dysfunction and sexual satisfaction, and erectile dysfunction among PLWH, iii) a qualitative grounded theory study involving PLWH resulting in a model of sexual adjustment to HIV, and iv) a cross-sectional descriptive and analytic study of beliefs, covariates and impact of treatment as prevention as an HIV transmission prevention strategy among PLWH. The thematic synthesis and systematic reviews identified a lack of research on psychosocial and relational aspects of sexual life with HIV, and a lack of HIV specific theory to guide research. The model of sexual adjustment to HIV proposed facilitators to adjustment, including accurate understanding of risk of transmission of HIV. The final study explored the socio-demographic factors associated with lacking full confidence in treatment as prevention as an HIV transmission prevention strategy among PLWH. The thesis comprehensively synthesised past research, and developed a new model of sexual adjustment to HIV which offers theoretically-driven direction for future research and intervention to promote the sexual wellbeing of PLWH

The current state of qualitative research on sexual functioning with HIV in developed nations: a thematic synthesis

The life expectancy of HIV-positive and HIV-negative people is approaching parity. Therefore, quality of life concerns, such as sexual functioning, are increasingly important in HIV care and support. This thematic synthesis is the first of its kind to describe the current state of qualitative research on sexual functioning with HIV conducted in developed countries. A systematic search of key databases identified 15 peer-reviewed qualitative studies that met inclusion criteria. The synthesis revealed that qualitative research on the impact of HIV on sexual functioning, including the impact on desire, arousal, orgasm, and satisfaction, is limited. Findings revolved around the following themes: (i) disclosure of HIV status, (ii) changes in the experience of sex, (iii) celibacy: short-term or sustained, and (iv) condom use of HIV-positive people. Future research into sexual functioning with HIV is required, taking account of contemporary understandings of the risk of transmission in the context of undetectable viral load

Factors associated with erectile dysfunction among men living with HIV : a systematic review

Erectile dysfunction (ED) is more prevalent among men with HIV than HIV negative men. This study systematically reviewed quantitative studies published since 1997 which sampled men with HIV to examine factors associated with ED. Searches on PsycINFO, Medline, Scopus, Embase and Cinahl databases produced 5552 records, and 14 studies met inclusion criteria. Two researchers independently extracted data and assessed the quality studies using standardized criteria. Age and depression were found to be significantly associated with ED. Importantly, factors unique to HIV emerged as consistently significant across studies, including time on antiretroviral medication and protease inhibitor medication use. However, these relate to organic cause factors associated with ED only. Only four studies examined social factors with inconsistent findings. There was a paucity of research related to psychosocial factors associated with ED. This systematic review used a broad search strategy employed across multiple data-bases, however, it is limited by the over-representation of treatment centre based studies conducted in high-income nations. Future research should examine psychosocial factors, such as undue fear of transmission of HIV or fear of rejection by a sexual partner and develop a psychosocial model of sexual difficulties with HIV, from which casual hypotheses can be derived and tested

Factors associated with erectile dysfunction among men living with HIV : a systematic review

Erectile dysfunction (ED) is more prevalent among men with HIV than HIV negative men. This study systematically reviewed quantitative studies published since 1997 which sampled men with HIV to examine factors associated with ED. Searches on PsycINFO, Medline, Scopus, Embase and Cinahl databases produced 5552 records, and 14 studies met inclusion criteria. Two researchers independently extracted data and assessed the quality studies using standardized criteria. Age and depression were found to be significantly associated with ED. Importantly, factors unique to HIV emerged as consistently significant across studies, including time on antiretroviral medication and protease inhibitor medication use. However, these relate to organic cause factors associated with ED only. Only four studies examined social factors with inconsistent findings. There was a paucity of research related to psychosocial factors associated with ED. This systematic review used a broad search strategy employed across multiple data-bases, however, it is limited by the over-representation of treatment centre based studies conducted in high-income nations. Future research should examine psychosocial factors, such as undue fear of transmission of HIV or fear of rejection by a sexual partner and develop a psychosocial model of sexual difficulties with HIV, from which casual hypotheses can be derived and tested

Factors Associated with General Sexual Functioning and Sexual Satisfaction among People Living with HIV: A Systematic Review

Sexual difficulties, experienced by half of the people living with HIV (PLWH), not only affect quality of life but have been associated with lower adherence to antiretroviral medication. This systematic review synthesizes studies published since 1997 which used statistical methods to investigate factors associated with general sexual functioning or sexual satisfaction of PLWH. We searched Medline, PsycINFO, Embase, Cinahl and Scopus with terms: HIV AND sexual dysfunction AND factors. Of 5552 records, 26 studies met selection criteria. Twenty-one studies on general sexual function, and five studies on sexual satisfaction. Two researchers separately extracted data and applied standardized quality assessment criteria. (Registration: CRD42018094146.) Regarding general sexual dysfunction, older age, general physical health, depression, body image and psychological distress were the most relevant factors. There was inconsistent evidence for: CD4, viral load, HIV symptom severity, HIV disease progression and time since diagnosis. From limited available evidence on sexual satisfaction, age, unemployment, and psychosocial factors were significant. Overall, anxiety and relational factors were under-researched, treatment center studies were over-represented and non-validated measurement of outcomes was common. Future research is required to build theoretical models of sexual well-being specific to PLWH to guide effective research and intervention to promote sexual quality of life of PLWH

Toward structured peer support interventions in oncology: a qualitative insight into the experiences of gynaecological cancer survivors providing peer support

Purpose: research into dyadic (one-to-one) peer support has predominantly focused on the recipients of peer support whilst neglecting the impact on the peer support providers (PSPs). Increasingly, structured/protocolised peer support interventions are employed. The aim of this qualitative study was to explore the experience of providing peer support within a protocolised intervention and how common key characteristics of such interventions (guidelines and checklists, rigorous training and partnerships with health professionals) may influence PSPs' experiences. This research was conducted within the context of an ongoing randomised controlled trial investigating a protocolised peer support intervention (the Peer and Nurse support Trial to Assist women in Gynaecological Oncology (PeNTAGOn) study). Methods: Eleven women (gynaecological cancer survivors) providing peer support within the PeNTAGOn study participated in semi-structured telephone interviews. Transcribed interviews were analysed using interpretative phenomenological analysis. Results: Five key themes were identified which described the overall experience of providing protocolised peer support: (i) fitting oneself to the protocolised PSP role, (ii) the impact of personal beliefs about the value of research, (iii) protocolisation as both blessing and curse, (iv) discussing taboo or sensitive topics and (v) the impact of interactions with study personnel. Conclusions: These insights into the advantages and disadvantages of protocolised peer support can be used to inform future research and social support programs and maximise the effectiveness of such programs for patients, PSPs and the health-care system

The current state of qualitative research on sexual functioning with HIV in developed nations: a thematic synthesis

The life expectancy of HIV-positive and HIV-negative people is approaching parity. Therefore, quality of life concerns, such as sexual functioning, are increasingly important in HIV care and support. This thematic synthesis is the first of its kind to describe the current state of qualitative research on sexual functioning with HIV conducted in developed countries. A systematic search of key databases identified 15 peer-reviewed qualitative studies that met inclusion criteria. The synthesis revealed that qualitative research on the impact of HIV on sexual functioning, including the impact on desire, arousal, orgasm, and satisfaction, is limited. Findings revolved around the following themes: (i) disclosure of HIV status, (ii) changes in the experience of sex, (iii) celibacy: short-term or sustained, and (iv) condom use of HIV-positive people. Future research into sexual functioning with HIV is required, taking account of contemporary understandings of the risk of transmission in the context of undetectable viral load

Factors Associated with General Sexual Functioning and Sexual Satisfaction among People Living with HIV: A Systematic Review

Sexual difficulties, experienced by half of the people living with HIV (PLWH), not only affect quality of life but have been associated with lower adherence to antiretroviral medication. This systematic review synthesizes studies published since 1997 which used statistical methods to investigate factors associated with general sexual functioning or sexual satisfaction of PLWH. We searched Medline, PsycINFO, Embase, Cinahl and Scopus with terms: HIV AND sexual dysfunction AND factors. Of 5552 records, 26 studies met selection criteria. Twenty-one studies on general sexual function, and five studies on sexual satisfaction. Two researchers separately extracted data and applied standardized quality assessment criteria. (Registration: CRD42018094146.) Regarding general sexual dysfunction, older age, general physical health, depression, body image and psychological distress were the most relevant factors. There was inconsistent evidence for: CD4, viral load, HIV symptom severity, HIV disease progression and time since diagnosis. From limited available evidence on sexual satisfaction, age, unemployment, and psychosocial factors were significant. Overall, anxiety and relational factors were under-researched, treatment center studies were over-represented and non-validated measurement of outcomes was common. Future research is required to build theoretical models of sexual well-being specific to PLWH to guide effective research and intervention to promote sexual quality of life of PLWH

Positive relations between sexual quality of life and satisfaction with healthcare in women living with HIV and/or HCV: Results from a multicountry study

International audienceIntroduction: The sexual quality of life is a neglected concern in women living with HIV (WHIV) or with HCV (WHCV), which can further be affected by their experience with stigma, social instability, fear of transmission and reduced access to treatment. The objective of this study was to identify sociodemographic, psychosocial, and behavioural factors associated with sexual quality of life (SQoL) in this study group.Methods: Between December 2017 and December 2018, PROQoL-Sex Life questionnaire was administered to 404 WHIV and WHCV in five countries. PROQoL-SQoL consists of four dimensions: positive sexual perception (Psp), stigma and social distress (Sti), soft sexual practices (Sof), sexual practices with a partner (Sp), all of which were scored from 0 to 100 and considered as main outcomes, lower scores mean better sexual quality of life. Linear mixed effects models were used to evaluate the association with sociodemographic and psychosocial factors.Results: Of the participants analyzed, 191 were living with HCV, 180 with HIV and 33 with HIV and HCV, median age was 48. Among WHIV, a higher satisfaction with health care, and talking about sexuality with healthcare workers were associated with lower scores in all the dimensions of the SQoL, while psychoactive substance use was associated with lower scores of Sti and Sof. Moreover, higher satisfaction with health care, talking about sexuality with healthcare workers, and psychoactive substance use (except cocaine use) in WHCV were associated with lower scores in Psp, Sti, and Sof. Besides, cocaine use was associated with higher scores of Sof.Conclusion: This study highlighted strong relationship between the quality of health care, and psychoactive substance use (except cocaine) and the sexual quality of life in WHIV and WHCV in these five countries. These findings draw attention to the different interventions that can be proposed for improving the sexual quality of life