• Aucun résultat trouvé

Quality of sexual life for people living with HIV (PLWHA)

N/A
N/A
Protected

Academic year: 2021

Partager "Quality of sexual life for people living with HIV (PLWHA)"

Copied!
5
0
0

Texte intégral

(1)

ORIGINAL ARTICLE

Quality of sexual life for people living with HIV (PLWHA)

M. El Fane (MD)

a,∗

, R. Bensghir (MD)

a

, S. Sbai (MD)

b

, A. Chakib (MD)

a

, N. Kadiri (MD)

b

, A. Ayouch (PhD)

a

, H. Himmich (MD)

a

aInfectious diseases unit, CHU Ibn Rochd, quartier des hôpitaux, 20100 Casablanca, Morocco

bUniversity Psychiatric centre, CHU Ibn Rochd, Casablanca, Morocco

Accepted 16 September 2010 Available online 20 January 2011

KEYWORDS Sexuality;

HIV infection;

PLWHA;

Sexual disorders;

Prevention

Summary HIV infection is a very intimate issue since it is transmitted through sexual inter- course; the virus suddenly invades the conscious and the subconscious mind of the HIV-positive person, becoming a critical element of their life. Since the use of antiretroviral therapy and increased life expectancy, the sexual and emotional aspects of quality of life have become a concern for people living with HIV (PLWHA), as well as for the health care staff. The purpose of our study is to identify sexual disorders affecting PLWHA and to determine factors influencing their sexuality. We studied a sample of 134 PLWHA attending the infectious diseases department of the Ibn Rochd Casablanca university hospital. A pre-drafted questionnaire provided informa- tion concerning sociodemographic characteristics, as well as information relating to the course of HIV infection, sexuality and the prevention of the transmission of HIV. The diagnosis of sexual disorders was made according to DSM-IV criteria. Sixty four percent of the men surveyed claim they have insufficient sexual activity and 80% report sexual disorders, in particular erectile dys- function. Seventy percent of the women claim they have insufficient sexual activity, and 69%

report sexual disorders, particularly decreased libido, anorgasmia and dyspareunia. In addi- tion, only 63% of the persons surveyed report the systematic use of condoms during sexual intercourse.

© 2011 Elsevier Masson SAS. All rights reserved.

DOI of original article:10.1016/j.sexol.2010.12.006.

Également en version franc¸aise dans ce numéro : El Fane M, Bens- ghir R, Sbai S, Chakib A, Kadiri N, Ayouch A, Himmich H. Qualité de vie sexuelle chez les personnes vivant avec le VIH.

Corresponding author.

E-mail address:elfanemouna@gmail.com(M. El Fane).

Introduction

For a long period of the epidemic, no attention was devoted at all to the quality of sexual life for people living with HIV/Aids (PLWHA), at least partly due to the short life expectancy of these patients. It was not until the arrival of highly effective antiretroviral therapies that the issue of sexuality for PLWHA arose in research topics and in social and behavioral science (Troussier and Tourette-Turgis, 2006).

1158-1360/$ – see front matter © 2011 Elsevier Masson SAS. All rights reserved.

doi:10.1016/j.sexol.2010.12.007

(2)

Conceptions of sexuality for PLWHA have changed since the beginning of the 80’s. In the first publications on this subject, all sexual relationships were strongly discouraged, even when protected by a condom (Kaplan et al., 1985). Cur- rently, quality of life is significantly better, life expectancy is much longer, sometimes equal to that of a seronegative per- son; researchers are increasingly interested in quality of life for PLWHA and focus on the necessity to offer more global care services (Kaplan et al., 1985).

The objective of our work is to assess the prevalence of sexual disorders and the impact of HIV infection on the sexual quality of life of PLWHA as monitored in the infectious diseases unit of the University Hospital Centre Ibn Rochd of Casablanca.

Patients and methods Population

One hundred and thirty-four HIV-infected patients treated at the infectious diseases unit of the university hospital Centre Ibn Rochd of Casablanca agreed to participate in our study.

Inclusion criteria

Patients between 18 and 60 years old, infected with HIV, having consulted at the day hospital and who agreed to pro- vide verbal answers to a questionnaire. Patients treated for a severe psychiatric illness (psychosis) or mental deficiency, were excluded from our study.

Means of assessment

A questionnaire pre-drafted by the authors identified sociodemographic characteristics, as well as information on HIV, sexuality and HIV prevention. The diagnosis of sexual disorders was made according to DSM-IV criteria.

Statistical analysis

Analysis and data entry were made using SPSS.

Results

Sociodemographic characteristics

The mean age was 38 years (18—60 years) with a slight female prelevance (54%). Sixty-eight (51%) patients were unemployed and 39 % illiterate. Eighty-eight patients (66%) lived with their parents or with a partner.

Results related to HIV infection

The average duration of follow-up was sixty months (1—12 years). Sixty patients (48%) were in stage C of HIV infection. One hundred and seven patients (80%) were under antiretroviral therapy and 80% had an undetectable viral load.

Addiction-related results

Tobacco addiction was reported especially by men in 73% of cases and alcohol addiction in 16% of cases; 41% of women had a stable sexual partner against 47% of men.

Sexuality-related results

Eighty-four patients in our study (70%) have informed their partner(s) of their HIV status. All the women who maintained sexual activity had heterosexual intercourse and 14.51% of men had sex with other men. Serology of the partner was unknown in a majority of cases (65%), whereas it was known in 35% of cases: positive in 16% of cases and negative in 19%

of cases.

Sexual activity was maintained by 56% of women and 58% of men. Ninety-four patients (70%) affirm that they do not have satisfying sexual activity (Table 1). Forty-two per- cent of men reported sexual abstinence, mainly related to religious beliefs and guilt.

Sexual disorders were dominated by ejaculation prob- lems (18%) and erectile dysfunction (17%) attributed to the physical fatigue related to HIV infection and to the fear of infecting the partner (Table 2). Fifty women (68%) report sexual disorders especially sexual abstinence in 44% of cases which was associated with religious beliefs in 28% of cases and with feelings of guilt in 17% of cases.

Other disorders included desire disorder (23%), fol- lowed by dyspareunia (12%). These disorders were mainly attributed to the fact that sexuality reminds them of their disease and to the fear of infecting their partner (Table 3).

These disorders existed before the HIV diagnosis in only 8% of cases. Twenty women (30%) and six men (10%) affirm that their problems have improved after starting antiretro- viral treatment. Seventy-nine patients (59%) use condoms consistently during sexual intercourse.

The issue of sexuality has been discussed with the physi- cian in 45% of cases, with treatment counselors in 50% of cases and with the psychologist or psychiatrist in 30% of cases.

Discussion

HIV infection is a chronic disease affecting all aspects of individual and social life, either by the physical and psycho- logical impacts of the illness, emotional and sexual life, and difficulties of social and professional inclusion (Préaua and Morina, 2005).

The sexuality of PLWHA, faced with the constraints of a serious disease, its treatment and risks of transmission and exclusion, is highly disrupted as shown in the VESPA survey (Schiltz et al., 2006).

The first studies published on sexuality and HIV show that HIV affects the sexual life of PLWHA, associated with difficul- ties in announcing their HIV serology status to the partner.

Eighty-four patients in our study (70%) have announced their HIV status to their partners.

In our study, 64% of men report that they do not have satisfying sexual activity and 80% report sexual disorders especially erectile dysfunction.

(3)

Table 1 Sexuality-related results.

Female Male

Number % Number %

Partner

Single partner 29 40,27 29 47

No partner 29 40,27 22 36

Multiple partners 14 19 10 17

Sexual orientation

Heterosexual 72 100 53 85,48

Homosexual 0 0 4 6,45

Bisexuel 0 0 5 8,06

Partner’s HIV status

Negative 12 17 14 22

Positive 9 12 12 20

Maintenance of sexual activity 40 56 36 58

Sexual satisfaction 22 30 22 36

Current sexual disorders 50 69 50 80

Sexual disorders before diagnosis 5 7 6 10

Improvement of sexual disorders after ART 22 30 6 10

Secondary prevention

Systematic 41 66 38 61,29

Occasional 21 34 24 38,71

Table 2 Female sexual disorders.

Disorder Number % Reasons %

Sexual abstinence

32 44 Religious taboos 28

feelings of guilt 17

Fear of infecting partner 10

Difficulty in finding partner 8

Other Sexuality reminds patients of disease 21

Desire disorder 16 22,22 Fear of infecting partner 18

Dyspareunia 8 11,11 Condom use 16

Lack of pleasure 6 8,33 Instability/ Insecurity 10

Lack of orgasm 6 8,33 Hostility towards partner 10

Table 3 Male sexual disorders.

Disorder Number % Reasons %

Sexual absti- nence

26 42 Religious taboos 25

Feelings of guilt 10

Fear of infecting partner 5

Others Physical asthenia related to HIV 20

Ejaculation dysfunction 11 18 Fear of infecting partner 18

Erectile dysfunction 11 17 Sexuality reminds patient of disease 10

Desire disorder 9 15 Condom use 5

A study conducted in France (Lallemand et al., 2002) on 156 male patients undergoing antiretroviral ther- apy, showed that 71% report sexual disorders (loss of libido, erectile dysfunction, difficulties with orgasm).

Note that 18% of them already had this problem before becoming aware of their HIV status and 32.4% before taking antiretroviral drugs. These figures are consistent with our results (Table 4).

(4)

Table 4 Prevalence of sexual disorders according to different studies (Lallemand et al., 2002;Lert et al., 2004;Troussier and Tourette-Turgis, 2006).

Lallemand (%) Lert (%) Our study (%)

Maintained sexual activity 60 57

Current sexual disorders 71 35—44 75

Sexual disorders before diagnosis 18 9

Sexual disorders before HAART 32

In the Vespa survey (Lert et al., 2004), also con- ducted in France, 35 to 44% of infected people undergoing treatment declared they suffered from sexual disorders.

Sixty percent report having sex with a stable partner, of whom 32 to 45% report having interrupted preventive measures.

In the literature, there is very little data on the sexuality of women living with HIV (Luzi et al., 2009). Women consult mainly for the desire to have children, few consult concern- ing sexuality and desire (Rochet, 2006).

A British study (Keegan et al., 2005) among 21 HIV- positive women demonstrated the negative impact of HIV on the quality of their sexual life (decreased libido, reduced sexual pleasure, difficulties in finding partners), as well as for prevention (difficulty to negotiate the use of condoms, fear of rejection if they inform their partners of their HIV status).

Other studies have found that 63.4% of women living with HIV report that their sexual practices have changed, 74.6%

affirm that their intimate life is generally less satisfying and half of the HIV-positive women reported low or absent active sexual life.

In our study, 70.5% of patients say they do not have a satisfying sexual activity and 69% report sexual disorders, especially decreased libido, anorgasmia and dyspareunia.

The results of our study are relatively high compared to studies conducted in Western countries. This slight increase is probably related to social and religious beliefs that pro- hibit sex outside marriage.

Sexual disorders can be caused by the psychological impact of HIV as a sexually transmitted disease (guilt, fear of contamination), by a decrease in the level of some hormones, by depression, or by treatment. Possible deficiencies in vitamins and minerals can aggravate the situation (Guaraldi, 2007). Sexual disorders are higher among people undergoing treatment regardless of the drug combination (Lallemand et al., 2002). Erectile dysfunc- tion is more common among men treated with protease inhibitors (Moreno-Perez, 2010). The impact of antiretro- viral therapy in these disorders is more likely to be due to the global side effects and to the stress caused by the drugs (Lallemand et al., 2002). Other studies have shown that physical changes are the major determinants of sexual dysfunction among PLWHA (Luzi et al., 2009).

In our study, 73% of male patients have a current addic- tion to tobacco, and 16.3% to alcohol which may explain the high rates of sexual disorders, because smokers are four times more likely to become ‘‘impotent’’ than non-smokers.

Moreover, alcohol causes a deficiency in vitamin B and a drop in the rate of testosterone which is necessary to sexuality (Kaplan et al., 1985).

Prevention messages focus on the risks of infection (or superinfection) associated with sexual activity and recom- mend the systematic use of condoms. Among HIV positive women, 42% report unprotected sexual intercourse with stable partners and 29% unprotected sex with occasional partners. Among gay men, 40% report unprotected sexual intercourse with a stable partner and 23% unprotected sex with occasional partners (Lert et al., 2004).

A study conducted in California among 145 heterosexual sero-discordant couples shows that 45% of these couples reported having had unprotected vaginal or anal sex in the last six months (Buchacz, 2001). In our study, only 59%

use condoms consistently during sexual intercourse: the systematic use of condoms is often experienced as a frus- trating limitation to the spontaneity and fantasy of sexual intercourse and this is a major problem for prevention.

Conclusion

This study demonstrates the prevalence of sexual disorders among PLWHA. In the global care services offered to these patients, clinicians should explore their patients’ emotional and sexual life. The existence of sexual disorders, whether related or not to HIV, must be considered by health workers to reduce their negative impact on both quality of life of patients and their behavior for prevention.

Conflict of interest

None.

References

Buchacz K, Van der Straten A, Saul J, Shiboski SC. Sociode- mographic, behavioral, and clinical correlates of inconsistent condom use in HIV- serodiscordant heterosexual couples. J Acquir Immune Defic Syndr 2001;28(3):289—97.

Guaraldi G. Sexual dysfunction in HIV-infected men: role of antiretroviral therapy, hypogonadism and lipodystrophy. Antivir ther 2007;12(7):1059—65.

Kaplan HS, Sager CJ, Schiavi RC. AIDS and the sex therapist. J Sex Marital Ther 1985;11(4):210—4.

Keegan A, Lambert S, Petrk J. Sex and relationships for HIV-Positive women since HAART: a qualitative study. AIDS Patient Care STDS 2005;19(10):645—54.

Lallemand F, Salhi Y, Linard F, Giami A, Rozenbaum W.

Sexual dysfunction in 156 ambulatory HIV-infected men receiv- ing highly active antiretroviral therapy combinations with and without protease inhibitors. J Acquir Immune Defic Syndr 2002;30(2):187—90.

(5)

Lert F, Obadia Y, et al. Comment vit-on en France avec le VIH/sida ? Popul Soc 2004:406.

Luzi K, Guaraldi G. Body image is a major determinant of sexual dysfunction in stable HIV-infected women. Antivir Ther 2009;14(1):85—92.

Moreno-Perez. Risk factor for sexual and erectile dysfunction in HIV-infected men/the role of protease inhibitors. AIDS 2010;24(2):255—64.

Préaua N, Morina M. L’évaluation psychosociale de la qualité de vie des personnes infectées par le VIH. Prat Psychol 2005;11(4):387—440.

Rochet S. Consultation sexologique chez des patients VIH + ou co-infectés VHB-VHC. Sexologies 2006;15(3):

210—9.

Schiltz MA, Bouhnik A, Préau M, Spire B. La sexualité des personnes atteintes par le VIH : l’impact d’une infec- tion sexuellement transmissible. Sexologies 2006;15(3):

157—64.

Troussier T, Tourette-Turgis C. La qualité de la vie sexuelle et affective favorise la prévention chez les personnes vivant avec le VIH. Sexologies 2006;15(2):

165—75.

Références

Documents relatifs

Parental environment also affected fitness measures – flies that evolved in the presence of sexual conflict showed reduced nonsexual fitness when their parents experienced a

The term cluster in this context is not considered in the epidemiological sense of the term, that is, a group that is connected in time and/or place but it was used to identify

Simbayi LC and Deribe et al in South Africa and Ethiopia respectively confirmed that, the revelation of serological status is strongly associated to reduction of

15 Another case report described using 1 mg of the synthetic estrogen diethylstilbestrol daily to reduce sexual aggression displayed by an elderly man with dementia (level

Case report: Sexual intercourse as potential treatment for intractable hiccups.. 1632 Canadian Family Physician • Le Médecin de famille canadien ❖ VOL 46: AUGUST •

In studies that looked at violence as an outcome of HIV status disclosure for women who chose to dis- close, violent outcomes were reported more often by women in sub-Saharan

This paper presents fi ndings from a biobe- havioural survey conducted among MSM in Agadir and Marrakesh, Morocco to provide information and establish baseline measurements of HIV

Hence, we inquired about low sexual desire (hypoactive sexual disorder, aversion), sexual arousal disorder, orgasmic disorder, and sexual pain disorder (dyspareunia, vaginismus)..