Association of HIV status with sexual function in women aged 45–60 in England: results from two national surveys

ABSTRACT

Increasing numbers of women living with HIV are reaching their midlife. We explore the association of HIV status with sexual function (SF) in women aged 45–60 using two national cross-sectional surveys: the third British National Survey of Sexual Attitudes and Lifestyles (“Natsal-3”) and “PRIME”, a survey of women living with HIV attending HIV clinics across England. Both studies asked the same questions about SF that take account not only sexual difficulties but also the relationship context and overall level of satisfaction, which collectively allowed an overall SF score to be derived. We undertook analyses of sexually-active women aged 45–60 from Natsal-3 (N = 1228, presumed HIV-negative given the low estimated prevalence of HIV in Britain) and PRIME (N = 386 women living with HIV). Women living with HIV were compared to Natsal-3 participants using multivariable logistic regression (adjusting for key confounders identified a priori: ethnicity, ongoing relationship status, depression and number of chronic conditions) and propensity scoring. Relative to Natsal-3 participants, women living with HIV were more likely to: have low overall SF (adjusted odds ratio (AOR) 3.75 [2.15–6.56]), report ≥1 sexual problem(s) lasting ≥3 months (AOR 2.44 [1.49–4.00]), and report almost all 8 sexual problems asked about (AORs all ≥2.30). The association between HIV status and low SF remained statistically significant when using propensity scoring (AOR 2.43 [1.68–3.51]). Among women living with HIV (only), low SF was more common in those who were postmenopausal vs. Premenopausal (55.6% vs. 40.4%). This study suggests a negative association between HIV status and sexual function in women aged 45–60. We recommend routine assessment of SF in women living with HIV.

KEYWORDS:

• HIV
• women
• sexual function
• menopause

Acknowledgments

CM and CS are members of the NIHR Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections at University College London in partnership with Public Health England (PHE) and in collaboration with the London School of Hygiene and Tropical Medicine. The views expressed are those of the authors and not necessarily those of the NIHR, the Department of Health and Social Care, the Wellcome Trust, or PHE. NT, CM, KM and ST conceived and designed this analysis. NT conducted all analyses and drafted the first version of this article, under the supervision of CM and ST. All authors critically reviewed the first version of the article and approved the final draft for publication. The PRIME Study Expert Advisory Group: Comfort Adams, Jane Anderson, Mwenza Blell, Jonathan Elford (Chair), Janine MacGregor-Read, Fiona Pettitt, Janice Rymer, Jane Shepherd, Lorraine Sherr, Emily Wandolo. The PRIME Study Research Team: Saliha Abbassi, Tuhina Bhattacharyya and Alexandra Rolland. The PRIME Study recruiting sites: Barking Community Hospital (Rageshri Dhairyawan, Emma Macfarlane, Sharmin Obeyesekera, Cecelia Theodore); Barts Health NHS Trust (James Hand, Helena Miras, Liat Sarner); Brighton and Sussex University Hospital (Yvonne Gilleece, Alyson Knott, Celia Richardson); Chelsea and Westminster Hospital (Mimi Chirwa, Ann Sullivan, Mini Thankachen, Sathya Visvendra); City of Coventry Health Centre (Sris Allen, Kerry Flahive); Guy’s and St Thomas’ Hospital (Julie Fox, Julianne Iwanga, Annemiek DeRuiter, Mark Taylor); 10 Hammersmith Broadway (Sophie Hobday, Rachael Jones, Clare Turvey); Homerton University Hospital (Monica James, Sambasivarao Pelluri, Iain Reeves); Kings College Hospital (Sarah Barber, Priya Bhagwandin, Lucy Campbell, Leigh McQueen, Frank Post, Selin Yurdakul, Beverley White); Lewisham and Greenwich NHS Trust (Tarik Moussaoui, Melanie Rosenvinge, Judith Russell); Mortimer Market Centre (Tuhina Bhattacharya, Alexandra Rolland, Shema Tariq); New Cross Hospital Wolverhampton (Sarah Milgate, Anjum Tariq); North Manchester General Hospital (Claire Fox, Gabriella Lindergard, Andrew Ustianowski); Royal Free Hospital NHS Trust (Fiona Burns, Nargis Hemat, Nnenna Ngwu, Rimi Shah); Southend Hospital (Sabri Abubakar, John Day, Laura Hilton, Henna Jaleel, Tina Penn); St Mary’s Hospital (Angela Bailey, Nicola Mackie); University Hospital Birmingham (Reka Drotosne-Szatmari, Jan Harding, Satwant Kaur, Tessa Lawrence, Monika Oriak, Jonathan Ross); West Middlesex Hospital (Kimberley Forbes, Ursula Kirwan, Shamela De Silva, Marie-Louise Svensson, Rebecca Wilkins). Natsal-3 is a collaboration between University College London (London, UK), the London School of Hygiene & Tropical Medicine (London, UK), NatCen Social Research, Public Health England (formerly the Health Protection Agency), and the University of Manchester (Manchester, UK). We thank the team of interviewers from NatCen Social Research. We acknowledge the support of the steering committee members of the NIHR HPRU in Blood Borne and Sexually Transmitted Infections: Caroline Sabin (Director), John Saunders (PHE Lead), Catherine Mercer, Gwenda Hughes, Jackie Cassell, Greta Rait, Samreen Ijaz, Tim Rhodes, Kholoud Porter, Sema Mandal and William Rosenberg. Finally, and most importantly, we thank all our participants for sharing their time and experiences so generously with us.

Declaration of interests

ADR is a full time employee of ViiV Healthcare. AU has received speaker and advisory board fees from: Abbvie, Gilead, Janssen, MSD, ViiV Healthcare; research grants from: Abbvie, Gilead; and has participated in research programmes for Abbvie, Gilead, Janssen-Cilag, MSD, and ViiV Healthcare. CS has received funding for membership of Data Safety and Monitoring Boards, Advisory Boards, speaker panels and for preparation of educational materials from Gilead Sciences, ViiV Healthcare and Janssen-Cilag. FB has received consultancy fees and conference support from Gilead Sciences. FP reports grants to King’s College Hospital NHS Foundation Trust from ViiV Healthcare and Gilead Sciences, and personal fees from Gilead Sciences, Janssen-Cilag, GlaxoSmithKline/ViiV Healthcare, and Merck. JR reports personal fees from GSK Pharma, Hologic Diagnostics and Janssen Pharma, as well as ownership of shares in GSK Pharma and AstraZeneca Pharma. RD has received educational grants from Gilead Sciences and MSD, and consultation fees from Gilead Sciences. RJ has received educational grants and personal fees from Gilead Sciences, MSD, Janssen-Cilag, Abbvie and ViiV Healthcare. ST has previously received a travel bursary funded by Janssen-Cilag through the British HIV Association, and speaker honoraria and funding for preparation of educational materials from Gilead Sciences. YG has received payment for medical education meetings and advisory boards from ViiV Healthcare, Gilead Sciences and MSD. ST, FB and CS are members of the steering group of SWIFT, a networking group for people involved in research in HIV and women, funded by Bristol Myers Squibb. All authors reporting funding from pharmaceutical companies confirm that this is outside the submitted work. For the remaining authors no COI were declared.

ORCID

Catherine H. Mercer http://orcid.org/0000-0002-4220-5034

Kirstin R. Mitchell http://orcid.org/0000-0002-4409-6601

Mwenza Blell http://orcid.org/0000-0002-6794-3826

Shema Tariq http://orcid.org/0000-0001-9802-7727

Additional information

Funding

The PRIME Study was funded by the National Institute for Health Research (NIHR) in the form of a postdoctoral fellowship to ST [grant number PDF-2014-07-071]. Natsal-3 was supported by grants from the Medical Research Council [grant number G0701757] and the Wellcome Trust [grant number 084840], with contributions from the Economic and Social Research Council and Department of Health. Since September 2015, KM has been supported by the United Kingdom Medical Research Council [grant number MC_UU_12017/11], and Scottish Government Chief Scientist Office [grant number SPHSU11]. Since March 2018, ST has received salary support through a UCL/Wellcome Institutional Strategic Support Fund Flexible Support Awards (grant number 204841/Z/16/Z).