Sexual Quality of Life of People Living with HIV in the Current Biomedical Prevention Era

Abstract

Past research on the sexual lives of people living with HIV (PLWH) has focused on reducing behaviours involving risk of transmission of HIV, and overlooked the sexual wellbeing of PLWH. This focus on risk behaviour was once understandable, given the past need to prevent transmission of HIV by changing behaviour. Yet in recent years, medications taken by HIV positive people and by HIV negative people at risk of acquiring the virus have been demonstrated to be highly effective in preventing transmission of HIV. These biomedical methods create an opportunity for research to shift focus away from risk of transmission behaviour and toward promoting sexual quality of life of PLWH. This thesis involved: i) systematic review with thematic synthesis of qualitative studies on sexual life with HIV, ii) two systematic reviews with narrative synthesis of quantitative studies on factors associated with sexual dysfunction and sexual satisfaction, and erectile dysfunction among PLWH, iii) a qualitative grounded theory study involving PLWH resulting in a model of sexual adjustment to HIV, and iv) a cross-sectional descriptive and analytic study of beliefs, covariates and impact of treatment as prevention as an HIV transmission prevention strategy among PLWH. The thematic synthesis and systematic reviews identified a lack of research on psychosocial and relational aspects of sexual life with HIV, and a lack of HIV specific theory to guide research. The model of sexual adjustment to HIV proposed facilitators to adjustment, including accurate understanding of risk of transmission of HIV. The final study explored the socio-demographic factors associated with lacking full confidence in treatment as prevention as an HIV transmission prevention strategy among PLWH. The thesis comprehensively synthesised past research, and developed a new model of sexual adjustment to HIV which offers theoretically-driven direction for future research and intervention to promote the sexual wellbeing of PLWH.