Sexual dysfunction in people living with HIV in France

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Sexual dysfunction in people living with HIV in
France

• Results from a large representative sample of
  outpatients attending French hospitals
  (ANRS-EN12-VESPA)

Anne-Déborah BOUHNIK1, Marie PREAU1,2, Marie-Ange
SCHILTZ3, Yolande OBADIA1, Bruno SPIRE1 and the
VESPA group 1-INSERM U379 / ORS PACA Marseille,
France 2-Social Health Psychology department,
University of Provence, Aix-en-Provence 3-CAMS-CER
MES-CNRS-EHESS Paris
Supported by the National agency for AIDS research
2
Background

• The advent of highly active antiretroviral
  therapy (HAART) has changed life perspectives of
  HIV-infected individuals especially regarding
  their sexual life.
• HAART can bring back desire, good physical shape
  and the will to reengage in sexual life.
• The causative role of HAART on sexual dysfunction
  is still a matter for debate.

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Objective

• This study analyzed factors associated with
  sexual dysfunction among HIV-treated patients in
  a representative sample of French People Living
  With HIV/AIDS (PLWHA).

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Methods

• Sample
• National cross-sectional survey in 2003
• Conducted in hospital departments delivering HIV
  care
• Stratified on HIV regional prevalence and on the
  number of HIV patients in each hospital
  department
• Eligible patients
• French speaking outpatients
• Aged 18 or older
• HIV-infected for at least 6 months
• Living in France for at least 6 months

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(No Transcript)
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Selected participants

• Sexually active in the prior 4 weeks
• Receiving an antiretroviral treatment at time of
  the survey

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Description of the sample (n1,343) (1)
Homo/bisexual 44 UDI 11 Native heterosexual
16 Migrant heterosexual 6
Men
UDI 4 Native heterosexual 12 Migrant
heterosexual 7
Women
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Description of the sample (n1,343) (2)

• Mean year of HIV-diagnosis 1993
• 95 were HAART-treated
• 76 had an undetectable viral load
• 88 had more than 200 CD4 cell count
• 25 were in stage C of the illness

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Number of times individuals had sexual
intercourse in the prior 4 weeks
44
p0.002
20
19
17
37
30
30
24
1 to 4
5 to 8
9 to 12
gt 12
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Factors not associated with the report of sexual
dysfunction

• Medical outcomes (CD4 cell count, viral load
  level, clinical stage)
• Age, level of education

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Factors associated with the report of sexual
dysfunction in univariate analysis
p
Total
of Sexual dysfunction
0.014
30.839.629.5
55.819.125.1
Steady partner onlySteady and casual
partners Casual partners only
lt0.001
Homo/bisexual men IDU men Native heterosexual
men Migrant heterosexual men IDU women Native
heterosexual women Migrant heterosexual women
34.329.025.5 30.2 44.1 25.3 43.4
43.611.1 15.5 6.2 4.3 12.27.1
0.004
Longer time since HIV diagnosis (mean10 years
SD5)
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Factors associated with the report of sexual
dysfunction in univariate analysis
Total
Thought treatment was very efficient No Yes
28.871.2
Perceived side-effects as very disturbing No Yes
74.425.6
Report of lipodystrophy-related symptoms No Yes
46.853.2
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Factors associated with the report of sexual
dysfunction in univariate analysis
Total
Knew more than 5 people who had died of AIDS
No Yes
70.829.2
Experienced the death of a sexual partner No Yes
88.511.5
66.833.2
Knew more than 5 PLWHA No Yes
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Factors associated with the report of sexual
dysfunction in univariate analysis
Total
Experience of HIV-discrimination by relatives
No Yes
88.012.0
Experience of HIV-discrimination by
friends No Yes
88.012.0
Experience of HIV-discrimination by a sexual
partner No Yes
81.518.5
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Factors associated with the report of sexual
dysfunction (multivariate logistic model)
 
95 CI
AOR
p-value
0.5-1.00.5-0.90.4-0.7
10.70.70.5
Number of times patient had sexual intercourse in
the previous 4 weeks 1 to 4 5 to 8 9 to
12 More than 12
0.001
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Conclusions

• Sexual dysfunction is frequent among HIV-treated
  individuals
• No factor related to the severity of illness
  intervenes in sexual dysfunction
• Negative HIV experience and negative treatment
  experience play an major role in sexual
  dysfunction
• Psychological support aimed at improving
  HIV-infection experience could have a positive
  impact on sexual dysfunction.

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The ANRS-EN12-VESPA group

• Inserm U687 / IFR69
• Inserm U379 / ORSPACA
• HEGP
• Inserm U512-Cermes
• CNRS-Matisse
• Ined
• Insee

• F Lert, R Dray-Spira, R Sitta
• Y Obadia, B Spire, P Peretti-Wattel, AD Bouhnik
• I Heard
• J Pierret, MA Schiltz
• J Fagnani
• B Riandey
• C Afsa