NATAP/HIV-DART: Sex Activity in HIV+

[Guest guest]

Begin forwarded message:From:julev <julev@...>Subject:NATAP/HIV-DART: Sex Activity in HIV+Date:December 13, 2008 9:26:32 AM ESTTo:hiv@..., nataphcvhiv@..., natapindustry@..., natapdoctors@...Vancouver HIV Team Tackles Tough Question: What To Say About SexHIV DART 2008, December 9-12, 2008, Rio Grande, Puerto RicoMark MascoliniSex is good.That seeming tautology (redundancy, obviously true) headlined a cross-sectional survey of 457 HIV-infected people in a cohort studied at the British Columbia Centre for Excellence in HIV/AIDS [1]. But if healthy sex reflects a healthy psyche in people with HIV, Andy Mtambo and colleagues asked, should HIV clinicians be telling their patients to abstain? Preaching abstinence, they suggested, may run counter to a well-accepted HIV management goal--"to maximize function and well-being in individuals living with HIV"--though they are quick to add that a simultaneous focus on HIV prevention cannot be abandoned.To disentangle the ties between demographics, depression, body image, quality of life, and sex, the BC team interviewed 457 antiretroviral-treated adults, 299 of them (65%) heterosexual, 125 (27%) gay or lesbian, and 33 (8%) bisexual. The survey included 201 heterosexual men, 147 gay or bisexual men, and 98 heterosexual women.Of the 457 respondents, 251 (55%) reported being sexually active, with a median of 2 partners and a range of 1 to 500 over the past 6 months. High proportions of people with a detectable viral load (42%) and a CD4 count below 350 (41%) had sex in the past half year. Among men, 55% of gays, 22% of heterosexuals, and 13% of bisexuals had more than one sex partner in the past 6 months. Median condom use per sex act among all sexually active people was under 30%.In the cohort as a whole, median age did not differ much between the active group (44.7 years) and the inactive group (46.8 years). But certain demographics correlated with a significantly greater or lesser likelihood of sexual activity:·      Gays and lesbians: 70% active, 30% not active (P < 0.001)·      Less than high-school education: 47% active, 53% not active (P < 0.05)·      Annual income of at least $15,000: 66% active, 34% not active (P < 0.001)·      Employed: 68% active, 32% not active (P < 0.001)·      In relationship: 78% active, 22% not active (P < 0.001)A higher proportion of depressed people were sexually active (55% versus 45%), but this difference did not reach statistical significance.People who were sexually active had significantly higher median scores on five of six quality-of-life measures: overall function (55 versus 43 for sexually inactive people, P < 0.001), life satisfaction (72 versus 68, P < 0.001), mastery of HIV diagnosis (66.7 versus 58, P < 0.05), sexual function (66.7 versus 50, P < 0.001), and body image (31.3 versus 40, with a lower score indicating a better image, P < 0.001). Sexually active people also scored better on HIV disclosure worries, but the difference from the sexually inactive people lacked statistical significance.These better quality-of-life scores were generally consistent when the investigators analyzed gay or bisexual men and heterosexual men separately. But among heterosexual women, sexually active respondents scored significantly better than inactive women on only two measures--sexual function and disclosure worries. Sexually inactive women did not score significantly better than active women on any measure.Multivariate analysis confirmed the intuitive assumptions that being in a sexual relationship, having a better body images, and having a better sexual function score independently predicted sexual activity. This analysis also found that gays were 2.15 times more likely than heterosexuals to be sexually active, and bisexuals were 2.34 times more likely than heterosexuals to be sexually active. Being attacked, assaulted, or suffering any kind of violence in the past 6 months independently raised the likelihood of sexual activity 91%, probably because sexually active people run a higher risk of violence rather than because violence victims have a higher libido.Although survey results show that sexually active people generally feel better about themselves and their HIV status than their inactive counterparts, the study also underlines the complexity of these issues. "There are sexually active individuals," Mtambo and coworkers observed, "who have many sexual partners, do not consistently use condoms and report better quality of life scores."The Vancouver team urged clinicians and community groups to ensure that "sex is on the agenda in ways that make sense to these individual groups" and that it is "creatively incorporated into long-term HIV management programs and strategies."Reference1. Mtambo A, Brandson EK, Kaida A, et al. Sex is good: an investigation into the quality of life and sexual practices of individuals on HAART in British Columbia. HIV DART, December 9-12, 2008, Rio Grande, Puerto Rico. Abstract 26.