Assessing sexual satisfaction amongst midlife women living with HIV in Canada


BACKGROUND: Although sexual activity and function both decline in older women living with HIV, positive dimensions of their sexual health, such as sexual satisfaction, are relatively unexplored. To address this gap, we evaluated the prevalence of sexual satisfaction and its correlates in midlife women living with HIV (aged'¥45).
METHODS: We used cross-sectional questionnaire data from cis and trans-gendered women living with HIV participating in the Canadian HIV Women's Sexual and Reproductive Health Cohort Study (CHIWOS; 2013-2015). We excluded women who were <45 years (n=783), only reported non-consensual sex (n=11) or had missing sexual health/satisfaction data (n=92). Sexual satisfaction was evaluated using one item from the Sexual Satisfaction Scale for Women (SSS-W): 'Overall, how satisfactory or unsatisfactory is your present sex life?' Responses were dichotomized into 'satisfied' ('completely/very/reasonably satisfactory') or 'not satisfied' ('not very/not at all satisfactory'). Multivariable logistic regression determined correlates of sexual satisfaction.
RESULTS: Among 524 women of median age 51.8 (IQR 48.2-56.9), 40.1% were sexually active. A total of 50.0% met criteria for probable depression (CES-D score'¥10) and 89.6% reported an undetectable viral load. Overall, 60.9% reported being satisfied with their sexual lives with higher prevalence among sexually active vs inactive women (74.1% vs 51.6%; p<0.001). Women with probable depression had 56.3% lower odds of sexual satisfaction than women without (aOR:0.44;95% CI:0.28-0.69). Women who were sexually active (aOR 2.42;1.46-4.01) or were in a relationship (aOR 2.50;1.07-5.83) had higher odds of sexual satisfaction than those not. Those with a detectable viral load also had higher odds of sexual satisfaction (aOR 2.50;1.07-5.83), however, this effect was no longer seen when differences in substance use and education were accounted for. Sexual orientation, menopause status, physical health, HIV stigma and sexual violence were not significantly associated with sexual satisfaction.
CONCLUSIONS: Most midlife women living with HIV were satisfied with their sexual lives, even those who were not sexually active. Associations with sexual activity, relationship status, and depression suggest that these aspects should be evaluated during sexual health screening. The close connection between mental and sexual health highlights the need to address both of these aspects of health in conjunction.

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