April 3, 2003
The authors conducted a cross-sectional descriptive survey with data from a study of adjustment to chronic illness among HIV-positive women. Sexual functioning and activity were measured as part of the study. One hundred thirteen women responded to recruitment efforts and 101 (89 percent) completed the study.
Sexual activity and functioning were assessed using questions developed through a review of existing literature on sexual functioning and upon a pilot testing with HIV-positive women regarding the most significant aspects of their sexual health. Questions about sexual orientation, frequency of condom use, and other safe sex practices were included in the interview.
Study participants represented all phases of HIV illness (32 percent asymptomatic, 34 percent symptomatic, and 34 percent with AIDS). Participants had a mean CD4 cell count of 392 (median=352; range=4-1,024), and 38 percent of the sample had undetectable HIV-1 viral loads. Participants' average age was 37 years (median=35; range=21-59). The sample was 51 percent Caucasian, 29 percent Latina (of which, 94 percent were of Puerto Rican origin), 17 percent African-American, and 3 percent other. Sixty-four percent had a history of injection drug use, and 55.4 percent had exchanged sex for money, food or shelter.
Ninety percent of the women remained sexually active after testing HIV-positive. Of these women, more than half reported sexual activity within the past month (58 percent). For those women not sexually active, reasons given included no current partner (31 percent), no interest in sex (27 percent), because of HIV (19 percent), physical symptoms (6 percent), partner not interested (4 percent) and other (13 percent). Sexually active HIV-positive women were more likely to be younger in age and have more positive meaning associated with HIV infection.
Over half of the women reported that the quality of their sexual activity had either stayed the same (31 percent) or improved (21 percent) after testing positive for HIV. Only 11 percent reported that their sex life became significantly worse after testing HIV positive.
Fifty-one percent of participants used condoms all of the time when having sex. However, 25.4 percent reported never using condoms during sexual activity and 37 percent reported using no safe sex practices when engaged in sexual activity.
By exploring sexual activity, sexual functioning and safer sex behavior, the study's findings illustrated several points. First, although 90 percent of this sample continued to be sexually active after testing positive for HIV, safer sex practices remained low, with more than one-third engaging in unprotected sexual activity on a regular basis. These findings highlight the need for ongoing assessment by health care providers regarding changes in sexual activity over time. Second, among women, sexual functioning does not change as a function of HIV illness stage and it cannot be assumed that women with advanced HIV are not sexually active. Research and clinical interventions to prevent sexual transmission need to be designed that target women with advanced HIV. Finally, few women report that HIV itself caused a decrease in sexual functioning. Women with better mental health, more positive meaning attached to life with HIV, better quality of life and no history of injection drug use had higher levels of sexual functioning.