Ageing and healthy sexuality among women living with HIV

Abstract

Populations around the world are rapidly ageing and effective treatment for HIV means women living with HIV (WLHIV) can live longer, healthier lives. HIV testing and screening programmes and safer sex initiatives often exclude older sexually active WLHIV. Systematically reviewing the literature to inform World Health Organization guidelines on the sexual and reproductive health and rights (SRHR) of WLHIV, identified four studies examining healthy sexuality among older WLHIV. In Uganda, WLHIV reported lower rates of sexual activity and rated sex as less important than men. In the United States, HIV stigma, disclosure, and body image concerns, among other issues, were described as inhibiting relationship formation and safer sexual practices. Sexual activity declined similarly over time for all women, including for WLHIV who reported more protected sex, while a significant minority of WLHIV reported unprotected sex. A single intervention, the "ROADMAP" intervention, demonstrated significant increases in HIV knowledge and decreases in HIV stigma and high risk sexual behaviour. WLHIV face ageist discrimination and other barriers to remaining sexually active and maintaining healthy sexual relationships, including challenges procuring condoms and seeking advice on safe sex practices, reduced ability to negotiate safer sex, physical and social changes associated with menopause, and sexual health challenges due to disability and comorbidities. Normative guidance does not adequately address the SRHR of older WLHIV, and while this systematic review highlights the paucity of data, it also calls for additional research and attention to this important area.

Social representations of HIV/AIDS by older people and the interface with prevention

“…A difficulty faced by Canadian black women in adhering to HIV prevention was the lack of empathy among health professionals (31) . It is highlighted that older women living with HIV suffer from greater discrimination and face difficulties in adhering to safe sex practices, including access to condoms (32) .…”

The Problematization of Sexuality among Women Living with HIV and a New Feminist Approach for Understanding and Enhancing Women’s Sexual Lives

“…This drop across ages was higher among women than men in one study (25). Varied results, however, were found for function (12,23,31) and satisfaction (6,22), and the relative contribution of social and physical aging-related challenges on sexuality remains unstudied (Narasimhan, Payne, Caldas, Beard, & Kennedy, 2016). Research has also explored the role of substance use (1,5,12,14,32).…”

PRDM9 losses in vertebrates are coupled to those of paralogs ZCWPW1 and ZCWPW2

“…A possible explanation is that in the absence of the histone marks laid down by PRDM9, the recombination machinery defaults to those residual H3K4me3 marks found in the genome, often associated with sites of transcription initiation, or perhaps simply to wherever DNA is accessible (Brick et al 2012;Singhal et al 2015). The same concentration of DSBs around promoter-like features is seen in Prdm9 -/mice (Brick et al 2012) and in a woman who carries two loss of function copies of PRDM9 identical by descent (Narasimhan et al 2016). These findings suggest that mammals that carry an intact PRDM9 retain the mechanism to direct recombination employed by species lacking PRDM9, but it is normally outcompeted by PRDM9 binding.…”

“…A possible explanation is that in the absence of the histone marks laid down by PRDM9, the recombination machinery defaults to those residual H3K4me3 marks found in the genome, often associated with sites of transcription initiation, or perhaps simply to wherever DNA is accessible [15,18]. The same concentration of DSBs around promoter-like features is seen in Prdm9 -/mice [18] and in a woman who carries two loss of function copies of PRDM9 identical by descent [19].…”