Informing our psychosexual practice for treating erectile dysfunction in gay and bisexual men living with HIV: a response to the 2006 NHS Greater Glasgow HIV needs assessment report

Abstract

There is strong evidence to suggest that Highly Active Anti-Retroviral Therapy (HAART) used to treat HIV may directly affect sexual performance in men living with HIV. Opponents suggest that age, advanced HIV and general chronic ill health often associated with HIV might account for the high prevalence of reported erectile dysfunction in this group. Regarding gay and bisexual men, a constellation of psychogenic factors bundled with an HIV diagnosis also contributes to the prevalence of erectile dysfunction. HIV health care in Greater Glasgow has traditionally focused on addressing disease control. A recent Greater Glasgow HIV needs assessment consultation informed by the Scottish Executive's 2003 strategic framework for holistic health and sexual well-being identifies high levels of untreated sexual problems including erectile dysfunction in gay and bisexual men living with HIV. Understanding the complex nature of HIV, how HAART works, possible adverse affects of HAART as well as the implication of PDE5 inhibitors for HAART users are key areas of learning for informing safe practice if psychosexual therapists are to help meet those needs.

Keywords:

• erectile dysfunction
• epidemiology
• gender issues

Notes

1. For the purpose of this paper, gay and bisexual men will be referred to as MSM to include not only men who identify as gay or bisexual but also men who do not identify as such but who engage in sex with men. Equally, gay and bisexual men living with HIV will be referred to as MSM-LWHIV. These terms are in line with Terrence Higgins Trust Scotland (Scotland's leading HIV-charity) guidelines for respectful practice in referring to individuals as living with the virus and not identified primarily by their serostatus. The acronyms, also in line with THT Scotland guidelines, are used for brevity.

2. The US government is considering classifying non-prescribed Viagra in the drive to regulate the recreational use of PDE5 inhibitors because of the risk to public health (Kaiser Daily, 27/09/05).

3. Since the writing of this paper, the NHS Greater Glasgow has amalgamated with Clyde to form the NHS Greater Glasgow and Clyde.