Ageing and healthy sexuality among women living with HIV

Back view of a couple, husband hand on wife shoulder, Ghana.

Ageing and healthy sexuality among women living with HIV

Key Findings

Findings suggest that women living with HIV face significant barriers to maintaining healthy sexuality as they age. One of the main barriers is HIV stigma, which impacts older women living with HIV and can influence the perceived ability to initiate and maintain intimate relationships, sexual functioning, sexual practices, and self-image. In Uganda, WLHIV reported lower rates of sexual activity and rated sex as less important than men. In the United States, HIV stigma, disclosure, and body image concerns, among other issues, were described as inhibiting relationship formation and safer sexual practices. Sexual activity declined similarly over time for all women, including for WLHIV who reported more protected sex, while a significant minority of WLHIV reported unprotected sex. A single intervention, the “ROADMAP” intervention, demonstrated significant increases in HIV knowledge and decreases in HIV stigma and high risk sexual behaviour.

 

Evidence included in this review and Quality Assessment

Four articles met the criteria for inclusion in the review. These included: one individual, randomized controlled trial with 6 months of follow-up; one cross-sectional study and one qualitative study with no follow-up; and one longitudinal cohort study with 13 years of follow-up.

 

Clinical Implications

Greater attention from the public health community is required to meet the sexual health needs and rights of older women living with HIV. Access to health education during menopause is crucial. This will require a better understanding of sexuality in older age among health professionals, and enhanced support for women living with HIV to openly discuss sexuality. The sexual well-being of women beyond childbearing age is ignored. The absence of training for healthcare workers on the specific health issues and support strategies for older women living with HIV further contributes to their marginalization. It leaves healthcare providers ill equipped to address sexual health needs and rights and perpetuates discriminatory practices, even to the point of refusing services. Efforts and resources must be leveraged so that healthcare providers working with older women living with HIV remain nonjudgmental, supportive, responsive, and respectful. Older women living with HIV, their clinicians, and public health practitioners should consider the reduced risk of HIV transmission associated with viral suppression in discussions around the riskiness of sexual behaviour. Comorbidities and disability also impact sexual functioning among older women and should be addressed in strategies to help them achieve healthy sexual lives.

 

Further research

While sexual activity declines with age for all women, including women living with HIV, further research is needed on how much of this decline is by choice. Women living with HIV face ageist discrimination and significant barriers to maintaining healthy sexual relationships as they age. At this time, key normative guidance does not adequately address the needs of older women living with HIV. Our systematic review yielded few articles, which highlights the need for additional research and attention in this area, particularly as global population demographics and the epidemiology of HIV change.

 

References

Narasimhan M, Payne C, Caldas S, Beard JR, Kennedy CE. Ageing and healthy sexuality among women living with HIV. Reprod Health Matters. 2016 Nov;24(48):43-51. doi:10.1016/j.rhm.2016.11.001.

Abstract

Populations around the world are rapidly ageing and effective treatment for HIV means women living with HIV (WLHIV) can live longer, healthier lives. HIV testing and screening programmes and safer sex initiatives often exclude older sexually active WLHIV. Systematically reviewing the literature to inform World Health Organization guidelines on the sexual and reproductive health and rights (SRHR) of WLHIV, identified four studies examining healthy sexuality among older WLHIV. In Uganda, WLHIV reported lower rates of sexual activity and rated sex as less important than men. In the United States, HIV stigma, disclosure, and body image concerns, among other issues, were described as inhibiting relationship formation and safer sexual practices. Sexual activity declined similarly over time for all women, including for WLHIV who reported more protected sex, while a significant minority of WLHIV reported unprotected sex. A single intervention, the “ROADMAP” intervention, demonstrated significant increases in HIV knowledge and decreases in HIV stigma and high risk sexual behaviour. WLHIV face ageist discrimination and other barriers to remaining sexually active and maintaining healthy sexual relationships, including challenges procuring condoms and seeking advice on safe sex practices, reduced ability to negotiate safer sex, physical and social changes associated with menopause, and sexual health challenges due to disability and comorbidities. Normative guidance does not adequately address the SRHR of older WLHIV, and while this systematic review highlights the paucity of data, it also calls for additional research and attention to this important area.