Women: sexual function and relationships

Two posters from Keegan, Lambert and colleagues at St Bartholomew’s Hospital, London, explored sexual functioning and relationships of HIV-positive women living in the UK. [1, 2] The findings from this study reveal a wide range of sexual difficulties including abstinence and avoidance of relationships.

For these studies, 82 HIV-positive women completed semi-structured interviews and questionnaires. Of the group participating, 75% were African and their mean age was 37.9 years and the mean length of time since their diagnoses was 68.5 months (range 4-191 months). Only 37% had an undetectable viral load and 19% had a CD4 count below 200 cells/mm3.

Twenty-eight per cent of women reported no sexual partners since diagnosis and 36% reported having had one partner since diagnosis. Time since diagnosis was not associated with having a sexual partner. A shocking 41% of women reported a history of sexual abuse, 34% reported past physical abuse and 6% reported that they were currently being abused.

In addition the women reported high levels of impaired sexual satisfaction – as defined by the Golombok and Rust Inventory of Sexual Satisfaction (GRISS) – predominately infrequency of sex (84%), avoidance (84%), non-communication (68%) and dysfunction (60%). The women also reported high levels of depression and anxiety.

The investigators reported high prevalence of sexual and relationship difficulties in this sample, which point to the need for more psychosexual and psychosocial interventions to address their needs. Clearly, given the high proportion of HIV-positive women from Africa in the UK, such interventions would need to be culturally appropriate to this population.

Association of torture and abuse with HIV transmission

More alarming still was a poster from Miah and colleagues from Newham Hospital, east London, documenting emerging patterns among their HIV-positive African women patients reporting rape and torture prior to seeking asylum and treatment in the UK. [3]

Approximately 80% of refugees worldwide are women and children and 50% of these women have experienced rape by soldiers or police. Many asylum seekers arrive in the UK having experienced such traumas and this pattern is reflected at the Sun Clinic at Newham.

The investigators illustrated this emerging pattern of HIV transmission associated with histories of torture (involving rape) and trauma of African women with case studies showing the problems of clinical management of such patients.

They reported that women with undisclosed histories of torture and trauma associated with HIV diagnosis have reported feeling retraumatised at the point of diagnosis due to the association; that language barriers and the nature of the experiences can result in non-disclosure to their healthcare team necessitating referral to a psychologist and in turn such difficulties with engagement with the medical system can impact on adherence, disclosure, sexual and mental health.

Clearly models of care for patients with high levels of distress, such as the one developed at Newham are essential in facing these challenges.

All references are to abstracts presented at 9th BHIVA Conference, 24-26 April 2003, Manchester.