Affirming the Rights of Women Living with HIV to Sexual Satisfaction and Sexual Pleasure: A Quantitative Analysis Across Five Relationship Types

Abstract

Introduction and objectives: The right to sexual satisfaction and pleasure for women living with HIV (WLWH) remains unrecognized. We described these experiences across relationship types among 1,335 Canadian WLWH. Population Sample: A community-based cohort diverse in gender (4.3% trans), sexual orientation (12.5% lesbian/queer), race (22.3% Indigenous; 28.9% African/ Caribbean/Black), and age (median:42; range:16-74). Methods: We delineated relationship types using latent class analysis with seven indicators (relationship status, duration, exclusivity, partner HIV-serostatus, power, physical intimacy, emotional intimacy); measured women's satisfaction with their sex life (“completely” to “not at all”) and pleasure during solo/partnered sex last month (“always” to “none”); and assessed associations using multinomial logistic regression, adjusting for confounders (age, violence, depression, physical health-related quality-oflife, HIV stigma, sex work, and drug use). Results: Latent classes included: no relationship (46.5%), relationship without sex (8.6%), and three sexual relationshipseshort-term/casual (15.4%), long-term/unhappy (6.4%), and long-term/happy (characterized by high intimacy and shared power) (23.2%). Womenin long-term/happy relationshipsweremost likely to be “completely” sexually satisfied (48.7%), followed by women in relationships without sex (20.4%) and no relationship (12.4%)), versus short-term/casual (7.6%) and long-term/unhappy (8.2%) relationships. Fifty-two percent had recent sex, including 22% of women reporting no partnered sex (of which one-quarter “always” felt pleasure).Amongwomen having partnered sex, 63%of those in long-term/happy relationships “always” felt pleasure, versus 30.7% in short-term/casual and 16.2% in long-term/unhappy relationships. Some reported “no” pleasure during sex: 24.2% short-term/casual, 21.6% long-term/unhappy, 2.8% long-term/happy. Relative to no relationship, women in long-term/happy relationships [AOR:75.92(95% CI:31.58e182.55)] and relationships without sex [AOR:2.04(95%CI:1.46e4.54)] had increased odds of being “completely” satisfied (vs. “not very/not at all”). The former group also had increased odds of “always” feeling pleasure (vs. “seldom/none”) [AOR:10(95%CI:4.14e24.15)], relative to short-term/casual. Conclusion and recommendations: Findings underscore the relational and social bases of HIV-positive women's sexuality, and affirm their rights to sexual satisfaction and pleasure.