title: Sexual inactivity and sexual satisfaction among women living with HIV in Canada in the context of growing social, legal and public health surveillance.
abstract: BACKGROUND
  Women represent nearly one-quarter of the 71,300 people living with HIV in Canada. Within a context of widespread HIV-related stigma and discrimination and on-going risks to HIV disclosure, little is known about the influence of growing social, legal and public health surveillance of HIV on sexual activity and satisfaction of women living with HIV (WLWH).
  
  
  METHODS
  We analyzed baseline cross-sectional survey data for WLWH (≥16 years, self-identifying as women) enrolled in the Canadian HIV Women's Sexual and Reproductive Health Cohort Study (CHIWOS), a multisite, longitudinal, community-based research study in British Columbia (BC), Ontario (ON) and Quebec (QC). Sexual inactivity was defined as no consensual sex (oral or penetrative) in the prior six months, excluding recently postpartum women (≤6 months). Satisfaction was assessed using an item from the Sexual Satisfaction Scale for Women. Multivariable logistic regression analysis examined independent correlates of sexual inactivity.
  
  
  RESULTS
  Of 1213 participants (26% BC, 50% ON, 24% QC), median age was 43 years (IQR: 35, 50). 23% identified as Aboriginal, 28% as African, Caribbean and Black, 41% as White and 8% as other ethnicities. Heterosexual orientation was reported by 87% of participants and LGBTQ by 13%. In total, 82% were currently taking antiretroviral therapy (ART), and 77% reported an undetectable viral load (VL<40 copies/mL). Overall, 49% were sexually inactive and 64% reported being satisfied with their current sex lives, including 49% of sexually inactive and 79% of sexually active women (p<0.001). Sexually inactive women had significantly higher odds of being older (AOR=1.06 per year increase; 95% CI=1.05-1.08), not being in a marital or committed relationship (AOR=4.34; 95% CI=3.13-5.88), having an annual household income below $20,000 CAD (AOR: 1.44; 95% CI=1.08-1.92), and reporting high (vs. low) HIV-related stigma (AOR=1.81; 95% CI=1.09-3.03). No independent association was found with ART use or undetectable VL.
  
  
  CONCLUSIONS
  Approximately half of WLWH in this study reported being sexually inactive. Associations with sexual dissatisfaction and high HIV-related stigma suggest that WLWH face challenges navigating healthy and satisfying sexual lives, despite good HIV treatment outcomes. As half of sexually inactive women reported being satisfied with their sex lives, additional research is required to determine whether WLWH are deliberately choosing abstinence as a means of resisting surveillance and disclosure expectations associated with sexual activity. Findings underscore a need for interventions to de-stigmatize HIV, support safe disclosure and re-appropriate the sexual rights of WLWH.
authors.affiliation: Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada; kangela@sfu.ca.
authors.forename: Angela
authors.initials: A
authors.lastname: Kaida
authors.affiliation: Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada.|British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada.
authors.forename: Allison
authors.initials: A
authors.lastname: Carter
authors.affiliation: Chronic Viral Illness Service, McGill University Health Centre, Montreal, Quebec, Canada.|Department of Family Medicine, McGill University, Montreal, Quebec, Canada.
authors.forename: Alexandra
authors.initials: A
authors.lastname: de Pokomandy
authors.affiliation: Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada.|British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada.
authors.forename: Sophie
authors.initials: S
authors.lastname: Patterson
authors.affiliation: Chronic Viral Illness Service, McGill University Health Centre, Montreal, Quebec, Canada.
authors.forename: Karène
authors.initials: K
authors.lastname: Proulx-Boucher
authors.affiliation: British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada.
authors.forename: Adriana
authors.initials: A
authors.lastname: Nohpal
authors.affiliation: British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada.
authors.forename: Paul
authors.initials: P
authors.lastname: Sereda
authors.affiliation: British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Colley
authors.affiliation: Chronic Viral Illness Service, McGill University Health Centre, Montreal, Quebec, Canada.|Department of Family Medicine, McGill University, Montreal, Quebec, Canada.
authors.forename: Nadia
authors.initials: N
authors.lastname: O'Brien
authors.affiliation: Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.
authors.forename: Jamie
authors.initials: J
authors.lastname: Thomas-Pavanel
authors.affiliation: Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.
authors.forename: Kerrigan
authors.initials: K
authors.lastname: Beaver
authors.affiliation: Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada.
authors.forename: Valerie J
authors.initials: VJ
authors.lastname: Nicholson
authors.affiliation: Women's Health in Women's Hands Community Health Centre, Toronto, Ontario, Canada.
authors.forename: Wangari
authors.initials: W
authors.lastname: Tharao
authors.affiliation: Département de Sexologie, Université du Québec à Montréal, Montréal, Quebec, Canada.
authors.forename: Mylène
authors.initials: M
authors.lastname: Fernet
authors.affiliation: Département de Sexologie, Université du Québec à Montréal, Montréal, Quebec, Canada.
authors.forename: Joanne
authors.initials: J
authors.lastname: Otis
authors.affiliation: Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada.|British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada.
authors.forename: Robert S
authors.initials: RS
authors.lastname: Hogg
authors.affiliation: Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.|Department of Medicine and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Mona
authors.initials: M
authors.lastname: Loutfy
mesh_terms: D000328:Adult; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000523:psychology*; D006801:Humans; D016015:Logistic Models; D009948:Orgasm; D062486:Public Health Surveillance; D060728:Reproductive Health; D012725:Sexual Behavior; D057545:Social Stigma
keywords: CHIWOS; Canada; HIV; antiretroviral therapy; community-based research; sexual abstinence; sexual and reproductive health; sexual satisfaction; women