Ditte Scofield [1], Nina Weis [1,2], Mikael Andersson [3], Merete Storgaard [4], Gitte Pedersen [5], Isik S. Johansen [6], Terese L. Katzenstein [7], Christian Graugaard [8], Morten Frisch [3], Ellen Moseholm [1,9].

Affiliates

Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre, Denmark [1], Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen University, Denmark [2], Department of Epidemiology Research, Statens Serum Institut, Denmark [3], Department of Infectious Diseases, Aarhus University Hospital, Denmark [4], Department of Infectious Diseases, Aalborg University Hospital, Denmark [5], Department of Infectious Diseases, Odense University Hospital, Denmark [6], Department of Infectious Diseases, Copenhagen University Hospital, Denmark [7], Department of Clinical Medicine, Center for Sexology Research, Aalborg University, Denmark [8], Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen University, Denmark [9].

Abstract

Introduction: The significant improvements in treatment have transformed HIV into a manageable, chronic illness for women with HIV (WWH) in the Nordic countries. Consequently, clinical considerations need to include all aspects of health-related quality of life including psychosocial and sexual health. Data suggests that WWH are at increased risk of mental and sexual health problems when compared to women without HIV (WWOH). Specifically, sexual dysfunctions and lower sexual activity levels have been identified. In general, not much is known about other aspects of sexual health, such as sexual quality of life or sexual desire, in WWH, and no previous studies on sexual health in WWH have been conducted in Denmark.

Aim: To investigate the psychosocial and sexual health of WWH compared to WWOH in Denmark. Secondly, to examine the severity of menopausal symptoms in WWH.

Methods: Data was retrieved from Perception of psychosocial, sexual, and reproductive health among people living with and without HIV in Denmark – the SHARE study; a nationwide cross-sectional study examining the psychosocial, sexual and reproductive health of people with HIV in Denmark. WWH were recruited during routine clinical care from five centers in Denmark. A control group of WWOH, matched 1:10 in one-year age groups, was included from the large Danish population-based cohort study Project SEXUS. Data was collected from March 2021 to February 2022 by a survey consisting of several standardised and validated Patient Reported Outcome Measures (PROMs), including the Patient Health Questionnaire – 2-item scale (PHQ-2), the Generalized Anxiety Disorder – 7-item scale (GAD-7) and the 6-item Female Sexual Function Index scale (FSFI-6), as well as individual items covering multiple areas of health. The main analyses applied logistic regression models to compare psychosocial and sexual health data from WWH and WWOH including univariate and multivariable models adjusted for sociodemographic, physical, mental and lifestyle-related factors. A secondary analysis explored the severity of menopausal symptoms in WWH compared to published reference norms based on a European population of WWOH.

Results: In total, 144 WWH and 1440 WWOH, with a median age of 49.5 years, were included. WWH were more likely to be single (36% vs. 18%), hold shorter lengths of education (19% vs. 7%), be of non-Danish origin (49% vs. 3%) and not have children (26% vs. 17%). No significant differences were seen in the physical health characteristics. Feeling lonely was associated with HIV status (aOR 1.79 [95% CI: 1.08-2.96]). No other psychosocial outcomes were significant. After adjusting for partner status and other potential confounding variables, several significant associations between HIV status and sexual health outcomes were evident: lower sexual desire levels (aOR 3.42 [95% CI:1.73-6.76]), less sexual activity (aOR 1.91 [95% CI: 1.02-3.58]), low FSFI-6 score indicative of sexual dysfunction (aOR 3.25 [95% CI: 1.45-7.30]), lubrication dysfunction (aOR 4.87 [95% CI: 2.06-11.54]) and genital pain dysfunction (aOR 5.13 [95% CI: 1.77-14.87]). The sub-analysis revealed no significant differences in severity of menopausal symptoms in WWH compared to WWOH.

Conclusion: The findings demonstrated that WWH in Denmark reported more loneliness and suffered significantly more sexual problems and dysfunctions than WWOH. There were no differences evident in the physical health outcomes or in the severity of menopausal symptoms.