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King EM, Carter A, Loutfy M, Webster K, Muchenje M, Murray MCM, de Pokomandy A, Ding E, Li J, Kaida A. Sexual Satisfaction of Midlife Women Living With HIV in Canada: A Prospective Cohort Analysis. J Acquir Immune Defic Syndr 2023; 93:272-281. [PMID: 37019076 DOI: 10.1097/qai.0000000000003204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 03/16/2023] [Indexed: 04/07/2023]
Abstract
BACKGROUND Although sexual activity and function decline in older women living with HIV, positive dimensions of sexual health, such as satisfaction, are relatively unexplored. We evaluated the prevalence of sexual satisfaction for midlife women with HIV and assessed its relation to women's physical, mental, and sociostructural experiences. SETTING We studied women in the Canadian HIV Women's Sexual and Reproductive Health Cohort Study (CHIWOS) over 3 survey waves (2013-2018). METHODS We included women living with HIV aged ≥45 years who reported ever having consensual sex. Sexual satisfaction was assessed using an item from the Sexual Satisfaction Scale for Women and was dichotomized into satisfactory ("completely/very/reasonably satisfactory") and not satisfactory ("not very/not at all satisfactory"). Probable depression was based on CES-D ≥10. Multivariable logistic regression and fixed effects models determined correlates of sexual satisfaction. Reasons for sexual inactivity and alternate forms of sexual expression were also explored. RESULTS Among 508 midlife women, 61% were satisfied with their sexual lives at baseline. Women with probable depression had lower odds of sexual satisfaction than those without (aOR: 0.44; 95% CI: 0.27 to 0.71) and worsening depressive symptoms over time were associated with poorer sexual satisfaction ( P = 0.001). Increased sexual activity was associated with higher sexual satisfaction (aOR: 2.75; 95% CI: 1.54 to 4.91); however, 51% of women reporting sexual satisfaction were sexually inactive. Sexually inactive women engaged in alternate forms of sexual expression such as self-pleasure (37%) and intimate relationships without sex (13%). CONCLUSION Midlife women with HIV have high rates of sexual satisfaction, even in the absence of sexual activity. Depressive symptoms were closely associated with sexual dissatisfaction, alerting providers to the importance of screening for depression and sexual health together.
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Affiliation(s)
- Elizabeth M King
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
- Women's Health Research Institute, British Columbia (BC) Women's Hospital, Vancouver, Canada
| | - Allison Carter
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
- Kirby Institute, Faculty of Medicine and Health, UNSW Sydney, Sydney, Australia
| | - Mona Loutfy
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Kathleen Webster
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
- Women's Health Research Institute, British Columbia (BC) Women's Hospital, Vancouver, Canada
- Division of Infectious Diseases, Department of Medicine, University of British Columbia (UBC), Vancouver, Canada
- Kirby Institute, Faculty of Medicine and Health, UNSW Sydney, Sydney, Australia
- Australian Human Rights Institute, Faculty of Law, UNSW Sydney, Sydney, Australia
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Oak Tree Clinic, BC Women's Hospital, Vancouver, Canada
- McGill University Health Center, Montreal, Quebec, Canada; and
- BC Center for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Marvelous Muchenje
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
- Women's Health Research Institute, British Columbia (BC) Women's Hospital, Vancouver, Canada
- Division of Infectious Diseases, Department of Medicine, University of British Columbia (UBC), Vancouver, Canada
- Kirby Institute, Faculty of Medicine and Health, UNSW Sydney, Sydney, Australia
- Australian Human Rights Institute, Faculty of Law, UNSW Sydney, Sydney, Australia
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Oak Tree Clinic, BC Women's Hospital, Vancouver, Canada
- McGill University Health Center, Montreal, Quebec, Canada; and
- BC Center for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Melanie C M Murray
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
- Women's Health Research Institute, British Columbia (BC) Women's Hospital, Vancouver, Canada
- Division of Infectious Diseases, Department of Medicine, University of British Columbia (UBC), Vancouver, Canada
- Oak Tree Clinic, BC Women's Hospital, Vancouver, Canada
| | | | - Erin Ding
- BC Center for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Jenny Li
- BC Center for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Angela Kaida
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
- Women's Health Research Institute, British Columbia (BC) Women's Hospital, Vancouver, Canada
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2
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Stanton AM, Bwana M, Owembabazi M, Atukunda E, Musinguzi E, Ezegbe H, Smith P, Psaros C, Matthews LT, Kaida A. Sexual and Relationship Benefits of a Safer Conception Intervention Among Men with HIV Who Seek to Have Children with Serodifferent Partners in Uganda. AIDS Behav 2022; 26:1841-1852. [PMID: 34796420 PMCID: PMC9050835 DOI: 10.1007/s10461-021-03533-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2021] [Indexed: 10/19/2022]
Abstract
Many men with HIV (MWH) in Uganda desire children, yet seldom receive reproductive counseling related to HIV care. Because men are under engaged in safer conception programming, they miss opportunities to reap the benefits of these programs. The objective of this sub-analysis was to explore the relationship and intimacy benefits of integrating safer conception counseling and strategies into HIV care, an emergent theme from exit interviews with men who participated in a pilot safer conception program and their partners. Twenty interviews were conducted with MWH who desired a child in the next year with an HIV-uninfected/status unknown female partner, and separate interviews were conducted with female partners (n = 20); of the 40 interviews, 28 were completed by both members of a couple. Interviews explored experiences participating in The Healthy Families program, which offered MWH safer conception counseling and access to specific strategies. Data were analyzed using thematic analysis. Three major subthemes or "pathways" to the relationship and intimacy benefits associated with participation in the program emerged: (1) improved dyadic communication; (2) joint decision-making and power equity in the context of reproduction; and (3) increased sexual and relational intimacy, driven by reduced fear of HIV transmission and relationship dissolution. These data suggest that the intervention not only helped couples realize their reproductive goals; it also improved relationship dynamics and facilitated intimacy, strengthening partnerships and reducing fears of separation. Directly addressing these benefits with MWH and their partners may increase engagement with HIV prevention strategies for conception.
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Affiliation(s)
- Amelia M Stanton
- Department of Psychiatry, Massachusetts General Hospital, Behavioral Medicine, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Mwebesa Bwana
- Faculty of Medicine, Mbarara University of Science and Technology (MUST), Mbarara, Uganda
- Department of Medicine, Mbarara Regional Referral Hospital, Mbarara, Uganda
| | - Moran Owembabazi
- Faculty of Medicine, Mbarara University of Science and Technology (MUST), Mbarara, Uganda
| | - Esther Atukunda
- Faculty of Medicine, Mbarara University of Science and Technology (MUST), Mbarara, Uganda
| | - Elijah Musinguzi
- Faculty of Medicine, Mbarara University of Science and Technology (MUST), Mbarara, Uganda
| | - Henrietta Ezegbe
- Simon Fraser University (SFU), Faculty of Health Sciences, BLU 10522, 8888 University Drive, Burnaby, B.C., V5A 1S6, Canada
| | - Patricia Smith
- Simon Fraser University (SFU), Faculty of Health Sciences, BLU 10522, 8888 University Drive, Burnaby, B.C., V5A 1S6, Canada
| | - Christina Psaros
- Department of Psychiatry, Massachusetts General Hospital, Behavioral Medicine, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | | | - Angela Kaida
- Simon Fraser University (SFU), Faculty of Health Sciences, BLU 10522, 8888 University Drive, Burnaby, B.C., V5A 1S6, Canada.
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3
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Carter A, Gormley B, Muchenje M, Zhu D, Patterson S, Kestler M, Hankins C, Logie CH, Brotto LA, Tharao W, Lee M, Li J, Ding E, de Pokomandy A, Loutfy M, Kaida A. Prevalence and correlates of sexual concerns and associated distress among women living with HIV in Canada. WOMEN'S HEALTH 2022; 18:17455065221074877. [PMID: 35088623 PMCID: PMC8801632 DOI: 10.1177/17455065221074877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives: We assessed the prevalence and correlates of sexual concerns and associated distress among women living with HIV in Canada. Methods: We analyzed cross-sectional survey data from the Canadian HIV Women’s Sexual and Reproductive Health Cohort Study (2017–2018). Self-identified women living with HIV were asked about sexual concerns post-HIV diagnosis and associated distress (none, mild, moderate, severe). Five areas of concern were assessed, including difficulties related to sexual self-esteem, sexual function, relationships, and emotional and behavioral aspects of sex. Logistic regression analyses identified correlates of reporting any sexual concerns and severe distress about these concerns. Results: Of 906 participants (median age 48, Q1–Q3 = 41–55), 596 (65.8%) reported sexual concerns post-HIV diagnosis. We found a high prevalence of concerns related to relationships (43.3%), sexual self-esteem (49.4%), and emotional aspects of sex (45.4%), relative to sexual functioning (38.4%) and behavioral aspects (33.7%). Of those with sexual concerns, 36.7% reported severe distress. Reports of severe distress were the highest for relationship difficulties (32.5%), relative to other areas of concern (21.4%–22.8%). In adjusted analyses, women reporting sexual dissatisfaction and high HIV-related stigma had significantly higher odds of reporting sexual concerns. Conversely, those reporting higher resilience, better mental health, African, Caribbean, and Black identity, and sex as somewhat unimportant, not at all important, or neutral to their lives had lower adjusted odds. Factors associated with severe distress about sexual concerns included older age, body dissatisfaction, sexual dissatisfaction, and high HIV-related stigma, while better mental health and getting support from someone living with HIV were protective. While 84.4% of women had discussed with a provider how viral load impacts transmission risk, only 40.6% had conversations about sexual wellbeing. Conclusion: More attention to women’s sexual wellbeing within social and relational contexts is critical to ensure the sexual rights of women living with HIV are upheld.
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Affiliation(s)
- Allison Carter
- Kirby Institute, Faculty of Medicine and Health, UNSW Sydney, Sydney, NSW, Australia
- Australian Human Rights Institute, UNSW Sydney, Sydney, NSW, Australia
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Becky Gormley
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, Vancouver, BC, Canada
| | - Marvelous Muchenje
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
| | - Denise Zhu
- Faculty of Science, The University of British Columbia, Vancouver, BC, Canada
| | - Sophie Patterson
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
- Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Mary Kestler
- Division of Infectious Diseases, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
- Oak Tree Clinic, British Columbia Women’s Hospital and Healthcare Centre, Vancouver, BC, Canada
| | - Catherine Hankins
- Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine, McGill University, Montreal, QC, Canada
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Carmen H Logie
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
- Women’s College Research Institute, Women’s College Hospital, Toronto, ON, Canada
| | - Lori A Brotto
- Department of Obstetrics and Gynecology, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
- Women’s Health Research Institute, Vancouver, BC, Canada
| | | | - Melanie Lee
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Jenny Li
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, Vancouver, BC, Canada
| | - Erin Ding
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, Vancouver, BC, Canada
| | | | - Mona Loutfy
- Women’s College Research Institute, Women’s College Hospital, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Angela Kaida
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
- Women’s Health Research Institute, Vancouver, BC, Canada
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4
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Mitchell KR, Lewis R, O'Sullivan LF, Fortenberry JD. What is sexual wellbeing and why does it matter for public health? Lancet Public Health 2021; 6:e608-e613. [PMID: 34166629 DOI: 10.1016/s2468-2667(21)00099-2] [Citation(s) in RCA: 79] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 03/31/2021] [Accepted: 04/16/2021] [Indexed: 11/25/2022]
Abstract
Sexual health has provided a guiding framework for addressing sexuality in public health for several decades. Although the WHO definition of sexual health is revolutionary in acknowledging positive sexuality, public health approaches remain focused on risk and adverse outcomes. The long-standing conflation of sexual health and sexual wellbeing has affected our ability to address everyday sexual issues. This Viewpoint provides a way forward to resolve this impasse. We propose sexual wellbeing as a distinct and revolutionary concept that can be operationalised as a seven-domain model. We situate sexual wellbeing alongside sexual health, sexual justice, and sexual pleasure as one of four pillars of public health enquiry. We argue that sexual wellbeing is imperative to public health as a marker of health equity, a meaningful population indicator of wellbeing, a means to capture population trends distinct from sexual health, and an opportunity to refocus the ethics, form, and practices of public health.
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Affiliation(s)
- Kirstin R Mitchell
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK.
| | - Ruth Lewis
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
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5
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Carlsson-Lalloo E, Mellgren Å, Berg M, Rusner M. Supportive conditions for sexual and perinatal wellbeing in women living with HIV in Sweden: A phenomenological study. SEXUAL & REPRODUCTIVE HEALTHCARE 2021; 29:100640. [PMID: 34087654 DOI: 10.1016/j.srhc.2021.100640] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 03/26/2021] [Accepted: 05/15/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Women living with HIV have specific needs regarding sexuality, pregnancy, and childbirth. However, there is lack of knowledge about how these needs can be met. The aim of this study was to identify supportive conditions for sexual and perinatal wellbeing in women living with HIV in Sweden. METHODS A phenomenological reflective lifeworld research approach was used. Transcribed interviews with 18 women living with HIV in Sweden were analyzed focusing on the meanings of the study phenomenon. RESULTS When living with HIV, "feeling safe with oneself and in relationships with others" is essential for sexual and perinatal wellbeing. This is constituted by having good overall health, being in a caring context, having access to high quality information about HIV, and being ensured the same rights as other women. CONCLUSIONS The study shows that women living with HIV have specific needs for the support of their sexual and perinatal wellbeing. This knowledge can be used by all those engaged in HIV care and HIV prevention in order to improve and implement supportive conditions for women living with HIV. It is important that all those involved in the care of women living with HIV constantly update their knowledge about HIV and women's experiences of living with HIV in order to provide safe arenas and caring contexts that support the wellbeing of these women.
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Affiliation(s)
- Ewa Carlsson-Lalloo
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Box 457, 405 30 Gothenburg, Sweden; Regional Cancer Center West, Region Västra Götaland, Medicinaregatan 18 G, 413 45 Gothenburg, Sweden.
| | - Åsa Mellgren
- Department of Infectious Diseases, Sahlgrenska University Hospital, Region Västra Götaland, Journalvägen 10, 416 50 Gothenburg, Sweden
| | - Marie Berg
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Box 457, 405 30 Gothenburg, Sweden; Department of Obstetrics, Sahlgrenska University Hospital, Region Västra Götaland, Diagnosvägen 15, 416 50 Gothenburg, Sweden; Department of Gynaecology and Obstetrics, Faculty of Medicine and Community Health, Evangelical University of Africa, Bukavu, The Democratic Republic of the Congo
| | - Marie Rusner
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Box 457, 405 30 Gothenburg, Sweden; Department of Research, Education and Innovation, Södra Älvsborg Hospital, Region Västra Götaland, Brämhultsvägen 53, 501 82 Borås, Sweden
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6
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An Initial Look into the Sexuality and Well-Being of Women Living with HIV: Making the Invisible Visible. SEXUALITY AND DISABILITY 2021. [DOI: 10.1007/s11195-021-09689-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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7
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Carter A, Anam F, Sanchez M, Roche J, Wynne ST, Stash J, Webster K, Nicholson V, Patterson S, Kaida A. Radical Pleasure: Feminist Digital Storytelling by, with, and for Women Living with HIV. ARCHIVES OF SEXUAL BEHAVIOR 2021; 50:83-103. [PMID: 33231828 DOI: 10.1007/s10508-020-01822-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 08/11/2020] [Accepted: 08/13/2020] [Indexed: 06/11/2023]
Abstract
Despite the fact that HIV can be controlled with medication to undetectable levels where it cannot be passed on, stigmatization of women living with HIV persists. Such stigmatization pivots on stereotypes around sex and sexism and has force in women's lives. Our aim was to create an inspirational resource for women living with HIV regarding sex, relationships, and sexuality: www.lifeandlovewithhiv.ca (launched in July 2018). This paper describes the development and mixed-method evaluation of our first year and a half activities. We situated our work within a participatory arts-based knowledge translation planning framework and used multiple data sources (Google Analytics, stories and comments on the website, team reflections over multiple meetings) to report on interim outcomes and impacts. In our first 1.5 years, we recruited and mentored 12 women living with HIV from around the world (Canada, Australia, New Zealand, Kenya, South Africa, Spain, Nigeria, and the U.S.) to write their own stories, with the support of a mentor/editor, as a way of regaining control of HIV narratives and asserting their right to have pleasurable, fulfilling, and safer sexual lives. Writers published 43 stories about pleasure, orgasm, bodies, identities, trauma, resilience, dating, disclosure, self-love, and motherhood. Our social media community grew to 1600, and our website received approximately 300 visits per month, most by women (70%) and people aged 25-44 years (65%), from more than 50 cities globally, with shifts in use and demographics over time. Qualitative data indicated the power of feminist digital storytelling for opportunity, access, validation, and healing, though not without risks. We offer recommendations to others interested in using arts-based digital methods to advance social equity in sexual health.
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Affiliation(s)
- Allison Carter
- Kirby Institute, University of New South Wales, Level 6, Wallace, Wurth Building, Sydney, NSW, 2052, Australia.
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada.
| | - Florence Anam
- Medécins Sans Frontières, Johannesburg, South Africa
| | - Margarite Sanchez
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
- ViVA Women, Positive Living Society of British Columbia, Vancouver, BC, Canada
| | | | - S T Wynne
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Just Stash
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Kath Webster
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Valerie Nicholson
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | | | - Angela Kaida
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
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Huntingdon B, Muscat DM, de Wit J, Duracinsky M, Juraskova I. Factors Associated with General Sexual Functioning and Sexual Satisfaction among People Living with HIV: A Systematic Review. JOURNAL OF SEX RESEARCH 2020; 57:824-835. [PMID: 31755793 DOI: 10.1080/00224499.2019.1689379] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Sexual difficulties, experienced by half of the people living with HIV (PLWH), not only affect quality of life but have been associated with lower adherence to antiretroviral medication. This systematic review synthesizes studies published since 1997 which used statistical methods to investigate factors associated with general sexual functioning or sexual satisfaction of PLWH. We searched Medline, PsycINFO, Embase, Cinahl and Scopus with terms: HIV AND sexual dysfunction AND factors. Of 5552 records, 26 studies met selection criteria. Twenty-one studies on general sexual function, and five studies on sexual satisfaction. Two researchers separately extracted data and applied standardized quality assessment criteria. (Registration: CRD42018094146.) Regarding general sexual dysfunction, older age, general physical health, depression, body image and psychological distress were the most relevant factors. There was inconsistent evidence for: CD4, viral load, HIV symptom severity, HIV disease progression and time since diagnosis. From limited available evidence on sexual satisfaction, age, unemployment, and psychosocial factors were significant. Overall, anxiety and relational factors were under-researched, treatment center studies were over-represented and non-validated measurement of outcomes was common. Future research is required to build theoretical models of sexual well-being specific to PLWH to guide effective research and intervention to promote sexual quality of life of PLWH.
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Affiliation(s)
- Ben Huntingdon
- Clinical Psychology Unit, School of Psychology, The University of Sydney
| | - Danielle Marie Muscat
- Faculty of Medicine and Health, School of Public Health, Sydney Health Literacy Lab, The University of Sydney
| | - John de Wit
- Centre for Social Research in Health, UNSW Sydney
- Department of Interdisciplinary Social Science, Utrecht University
| | - Martin Duracinsky
- Patient-Centered Outcomes Research, Université Paris-Diderot, Sorbonne Paris Cité
- Service de Médecine Interne et d'Immunologie Clinique, Hospital Bicetre , France
- Unité de Recherche Clinique (URC-ECO), Hospital Hotel-Dieu
| | - Ilona Juraskova
- Clinical Psychology Unit, School of Psychology, The University of Sydney
- Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), The University of Sydney
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9
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Toorabally N, Mercer CH, Mitchell KR, Blell M, Burns F, Gilson R, McGregor-Read J, Allan S, De Ruiter A, Dhairyawan R, Fox J, Gilleece Y, Jones R, Mackie N, Obeyesekera S, Post F, Reeves I, Rosenvinge M, Ross J, Sarner L, Sullivan A, Tariq A, Ustianowski A, Sabin CA, Tariq S. Association of HIV status with sexual function in women aged 45-60 in England: results from two national surveys. AIDS Care 2020; 32:286-295. [PMID: 31411046 PMCID: PMC7034538 DOI: 10.1080/09540121.2019.1653436] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 08/02/2019] [Indexed: 01/23/2023]
Abstract
Increasing numbers of women living with HIV are reaching their midlife. We explore the association of HIV status with sexual function (SF) in women aged 45-60 using two national cross-sectional surveys: the third British National Survey of Sexual Attitudes and Lifestyles ("Natsal-3") and "PRIME", a survey of women living with HIV attending HIV clinics across England. Both studies asked the same questions about SF that take account not only sexual difficulties but also the relationship context and overall level of satisfaction, which collectively allowed an overall SF score to be derived. We undertook analyses of sexually-active women aged 45-60 from Natsal-3 (N = 1228, presumed HIV-negative given the low estimated prevalence of HIV in Britain) and PRIME (N = 386 women living with HIV). Women living with HIV were compared to Natsal-3 participants using multivariable logistic regression (adjusting for key confounders identified a priori: ethnicity, ongoing relationship status, depression and number of chronic conditions) and propensity scoring. Relative to Natsal-3 participants, women living with HIV were more likely to: have low overall SF (adjusted odds ratio (AOR) 3.75 [2.15-6.56]), report ≥1 sexual problem(s) lasting ≥3 months (AOR 2.44 [1.49-4.00]), and report almost all 8 sexual problems asked about (AORs all ≥2.30). The association between HIV status and low SF remained statistically significant when using propensity scoring (AOR 2.43 [1.68-3.51]). Among women living with HIV (only), low SF was more common in those who were postmenopausal vs. Premenopausal (55.6% vs. 40.4%). This study suggests a negative association between HIV status and sexual function in women aged 45-60. We recommend routine assessment of SF in women living with HIV.
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Affiliation(s)
| | - Catherine H. Mercer
- Institute for Global Health, University College London, London, UK
- NIHR Health Protection Research Unit in Blood Borne and Sexually Transmitted Infections, University College London, London, UK
| | - Kirstin R. Mitchell
- MRC/CSO Social and Public Health Sciences Unit, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Mwenza Blell
- The Policy Ethics and Life Sciences (PEALS) Research Centre, School of Geography, Politics, and Sociology, Newcastle University, Newcastle, UK
| | - Fiona Burns
- Institute for Global Health, University College London, London, UK
- Ian Charleson Day Centre, Royal Free London NHS Foundation Trust, London, UK
| | - Richard Gilson
- Institute for Global Health, University College London, London, UK
| | | | - Sris Allan
- City of Coventry Health Centre (Integrated Sexual Health Services), Coventry and Warwickshire Partnership NHS Trust, Coventry, UK
| | - Annemiek De Ruiter
- Harrison Wing, Guy’s & St Thomas’ NHS Foundation Trust, London, UK
- ViiV Healthcare, London, UK
| | | | - Julie Fox
- Harrison Wing, Guy’s & St Thomas’ NHS Foundation Trust, London, UK
| | - Yvonne Gilleece
- Lawson Unit, Brighton & Sussex University Hospitals NHS Trust, Brighton, UK
| | - Rachael Jones
- Kobler Outpatient Clinic, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Nicola Mackie
- The Wharfside Clinic, Imperial College Healthcare NHS Trust, London, UK
| | | | - Frank Post
- Caldecot Centre, King's College Hospital NHS Foundation Trust, London, UK
| | - Iain Reeves
- Jonathan Mann Clinic, Homerton University Hospital Foundation Trust, London, UK
| | | | - Jonathan Ross
- Queen Elizabeth Hospital Birmingham HIV Clinic, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
| | - Liat Sarner
- Grahame Hayton Unit, Barts NHS Trust, London, UK
| | - Ann Sullivan
- Kobler Outpatient Clinic, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Anjum Tariq
- Wolverhampton Sexual Health Service, The Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - Andrew Ustianowski
- Department of Infectious Diseases, North Manchester General Hospital, Penine Acute Hospitals NHS Trust, Manchester, UK
| | - Caroline A. Sabin
- Institute for Global Health, University College London, London, UK
- NIHR Health Protection Research Unit in Blood Borne and Sexually Transmitted Infections, University College London, London, UK
| | - Shema Tariq
- Institute for Global Health, University College London, London, UK
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10
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Huntingdon B, Sharpe L, de Wit J, Duracinsky M, Juraskova I. A new grounded theory model of sexual adjustment to HIV: facilitators of sexual adjustment and recommendations for clinical practice. BMC Infect Dis 2020; 20:31. [PMID: 31931733 PMCID: PMC6958581 DOI: 10.1186/s12879-019-4727-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 12/23/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Life expectancy of people living with HIV (PLWH) is increasing. Effective biomedical prevention methods (treatment as prevention and preexposure prophylaxis) are being widely implemented in high-income nations. Therefore, research into quality of life, including sexual adjustment, is of increasing importance to HIV care. Yet, sexual adjustment of PLWH has been neglected in past research. We propose a new model of sexual adjustment to HIV which explores the dynamic process, facilitators and barriers characterising sexual life of PLWH overtime. METHOD Thirty PLWH (19 male, 11 female) recruited from two HIV treatment centres as well as community groups, completed semi-structured interviews which were audio-recorded and transcribed verbatim for analysis using grounded theory. RESULTS The model of sexual adjustment to HIV is the first to establish how undue fears of transmission of HIV during sex and/or fear of rejection by sexual partners determine initial sexual behaviour after diagnosis and also sexual adjustment over time. Within the model, sexual adjustment to HIV is facilitated by factors which assist PLWH to overcome such fears, including: partner acceptance, peer, community and health professional support, and accurate knowledge of risk of transmission including of undetectable viral load and pre-exposure prophylaxis. Adjustment is inhibited when undue fears of transmission and of rejection persist long term, resulting in maladaptive behaviours to cope with such fears including avoidance of sex and problematic drug and alcohol use. CONCLUSION This model offers clear directions for promoting sexual adjustment to HIV. Health professionals should: (a) assess and intervene for sexual quality of life (not just risk) among PLWH; (b) be aware that serosorting facilitates adjustment in the short to medium term, but may interfere with adjustment long-term, (c) promote opportunities for positive connection between PLWH, and (d) intervene directly with PLWH and HIV negative sexual partners to promote accurate risk of transmission knowledge, including how this applies to their own sexual practices, and whether they are experiencing undue fear of transmission over time.
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Affiliation(s)
- Ben Huntingdon
- Clinical Psychology Unit, School of Psychology, The University of Sydney, Brennan MacCallum Building (A18), NSW, Sydney, Australia.
| | - Louise Sharpe
- Clinical Psychology Unit, School of Psychology, The University of Sydney, Brennan MacCallum Building (A18), NSW, Sydney, Australia
| | - John de Wit
- Centre for Social Research in Health, UNSW Sydney, Kensington, NSW, Australia
- Department of Interdisciplinary Social Science, Utrecht University, Utrecht, The Netherlands
| | - Martin Duracinsky
- Sorbonne Paris Cité, EA 7334, Patient-Centered Outcomes Research, Université Paris-Diderot, Paris, France
- Service de Médecine Interne et d'Immunologie Clinique, Hopital Bicetre, Kremlin-Bicetre, France
- Unité de Recherche Clinique (URC-ECO), hopital Hotel-Dieu, Paris, France
| | - Ilona Juraskova
- Clinical Psychology Unit, School of Psychology, The University of Sydney, Brennan MacCallum Building (A18), NSW, Sydney, Australia
- Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), The University of Sydney, Sydney, Australia
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Carter A, Greene S, Money D, Sanchez M, Webster K, Nicholson V, Brotto LA, Hankins C, Kestler M, Pick N, Salters K, Proulx-Boucher K, O'Brien N, Patterson S, de Pokomandy A, Loutfy M, Kaida A. Love with HIV: A Latent Class Analysis of Sexual and Intimate Relationship Experiences Among Women Living with HIV in Canada. ARCHIVES OF SEXUAL BEHAVIOR 2019; 48:1015-1040. [PMID: 30891711 DOI: 10.1007/s10508-019-1418-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2017] [Revised: 02/04/2019] [Accepted: 02/06/2019] [Indexed: 06/09/2023]
Abstract
Love remains hidden in HIV research in favor of a focus on risk. Among 1424 women living with HIV in Canada, we explored (1) whether eight facets of sex and intimacy (marital status, sexual activity, physical intimacy, emotional closeness, power equity, sexual exclusivity, relationship duration, and couple HIV serostatus) may coalesce into distinct relationship types, and (2) how these relationship types may be linked to love as well as various social, psychological, and structural factors. Five latent classes were identified: no relationship (46.5%), relationships without sex (8.6%), and three types of sexual relationships-short term (15.4%), long term/unhappy (6.4%), and long term/happy (23.2%, characterized by equitable power, high levels of physical and emotional closeness, and mainly HIV-negative partners). While women in long-term/happy relationships were most likely to report feeling love for and wanted by someone "all of the time," love was not exclusive to sexual or romantic partners and a sizeable proportion of women reported affection across latent classes. Factors independently associated with latent class membership included age, children living at home, sexism/genderism, income, sex work, violence, trauma, depression, HIV treatment, awareness of treatment's prevention benefits, and HIV-related stigma. Findings reveal the diversity of women's experiences with respect to love, sex, and relationships and draw attention to the sociostructural factors shaping intimate partnering in the context of HIV. A nuanced focus on promoting healthy relationships and supportive social environments may offer a more comprehensive approach to supporting women's overall sexual health and well-being than programs focused solely on sexual risk reduction.
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Affiliation(s)
- Allison Carter
- Faculty of Health Sciences, Simon Fraser University, Blusson Hall Room 10522, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada
- Epidemiology and Population Health, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
- Kirby Institute, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Saara Greene
- School of Social Work, McMaster University, Hamilton, ON, Canada
| | - Deborah Money
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Margarite Sanchez
- ViVA, Positive Living Society of British Columbia, Vancouver, BC, Canada
| | - Kath Webster
- Faculty of Health Sciences, Simon Fraser University, Blusson Hall Room 10522, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada
| | - Valerie Nicholson
- Faculty of Health Sciences, Simon Fraser University, Blusson Hall Room 10522, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada
| | - Lori A Brotto
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Catherine Hankins
- Amsterdam Institute for Global Health and Development (AIGHD), Department of Global Health, University of Amsterdam, Amsterdam, The Netherlands
- Department of Epidemiology, Biostatistics, and Occupational Health, Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Mary Kestler
- Division of Infectious Diseases, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Neora Pick
- Division of Infectious Diseases, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- Oak Tree Clinic, British Columbia Women's Hospital and Health Centre, Vancouver, BC, Canada
| | - Kate Salters
- Faculty of Health Sciences, Simon Fraser University, Blusson Hall Room 10522, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada
- Epidemiology and Population Health, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - Karène Proulx-Boucher
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC, Canada
| | - Nadia O'Brien
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC, Canada
- Department of Family Medicine, McGill University, Montreal, QC, Canada
| | - Sophie Patterson
- Faculty of Health Sciences, Simon Fraser University, Blusson Hall Room 10522, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
| | - Alexandra de Pokomandy
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC, Canada
- Department of Family Medicine, McGill University, Montreal, QC, Canada
| | - Mona Loutfy
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Angela Kaida
- Faculty of Health Sciences, Simon Fraser University, Blusson Hall Room 10522, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada.
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Carlsson-Lalloo E, Berg M, Mellgren Å, Rusner M. Sexuality and childbearing as it is experienced by women living with HIV in Sweden: a lifeworld phenomenological study. Int J Qual Stud Health Well-being 2018; 13:1487760. [PMID: 29972346 PMCID: PMC6032009 DOI: 10.1080/17482631.2018.1487760] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/04/2018] [Indexed: 11/10/2022] Open
Abstract
The effectiveness of antiretroviral treatment has reduced sexual HIV transmission and mother-to-child-transmission. To optimally support women living with HIV, health care providers need deepened knowledge about HIV, sexuality and childbearing. The aim of this study was to describe the phenomenon sexuality and childbearing as experienced by women living with HIV in Sweden. Data were collected by phenomenon-oriented interviews with 18 HIV-positive women. A reflective lifeworld analysis based on phenomenological philosophy was conducted, describing the meaning structure of the phenomenon. The essence of the phenomenon is that perceptions about HIV and its contagiousness profoundly influence sexual habits and considerations in relation to pregnancy and childbearing. These perceptions are formed in combination with knowledge and interpretations about HIV by the women themselves and by their environments. The essence is further described by its constituents: Risk of transmission imposes demands on responsibility; The contagiousness of HIV limits sexuality and childbearing; Knowledge about HIV transmission provides confident choices and decisions; and To re-create sexuality and childbearing. Although HIV has a low risk of transmission if being well treated, our study shows that HIV-positive women feel more or less contagious, which influences sexuality and decision-making in relation to become pregnant and give birth.
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Affiliation(s)
- Ewa Carlsson-Lalloo
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Clinic of Infectious Diseases, Södra Älvsborg Hospital, Borås, Sweden
| | - Marie Berg
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Åsa Mellgren
- Clinic of Infectious Diseases, Södra Älvsborg Hospital, Borås, Sweden
| | - Marie Rusner
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Research, Södra Älvsborg Hospital, Borås, Sweden
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Carter A, Greene S, Money D, Sanchez M, Webster K, Nicholson V, Brotto LA, Hankins C, Kestler M, Pick N, Salters K, Proulx-Boucher K, O'Brien N, Patterson S, de Pokomandy A, Loutfy M, Kaida A. Supporting the Sexual Rights of Women Living With HIV: A Critical Analysis of Sexual Satisfaction and Pleasure Across Five Relationship Types. JOURNAL OF SEX RESEARCH 2018; 55:1134-1154. [PMID: 29624080 DOI: 10.1080/00224499.2018.1440370] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
In the context of human immunodeficiency virus (HIV), a focus on protecting others has overridden concern about women's own sexual well-being. Drawing on feminist theories, we measured sexual satisfaction and pleasure across five relationship types among women living with HIV in Canada. Of the 1,230 women surveyed, 38.1% were completely or very satisfied with their sexual lives, while 31.0% and 30.9% were reasonably or not very/not at all satisfied, respectively. Among those reporting recent sexual experiences (n = 675), 41.3% always felt pleasure, with the rest reporting usually/sometimes (38.7%) or seldom/not at all (20.0%). Sex did not equate with satisfaction or pleasure, as some women were completely satisfied without sex, while others were having sex without reporting pleasure. After adjusting for confounding factors, such as education, violence, depression, sex work, antiretroviral therapy, and provider discussions about transmission risk, women in long-term/happy relationships (characterized by higher levels of love, greater physical and emotional intimacy, more equitable relationship power, and mainly HIV-negative partners) had increased odds of sexual satisfaction and pleasure relative to women in all other relational contexts. Those in relationships without sex also reported higher satisfaction ratings than women in some sexual relationships. Findings put focus on women's rights, which are critical to overall well-being.
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Affiliation(s)
- Allison Carter
- a Faculty of Health Sciences , Simon Fraser University
- b Epidemiology and Population Health , British Columbia Centre for Excellence in HIV/AIDS
| | | | - Deborah Money
- d Department of Obstetrics and Gynecology and Department of Medicine, Faculty of Medicine , University of British Columbia
| | | | - Kath Webster
- a Faculty of Health Sciences , Simon Fraser University
| | | | - Lori A Brotto
- f Department of Obstetrics and Gynecology, Faculty of Medicine , University of British Columbia
| | - Catherine Hankins
- g Amsterdam Institute for Global Health and Development, Department of Global Health , University of Amsterdam
- h Department of Epidemiology, Biostatistics, and Occupational Health, Faculty of Medicine , McGill University
| | - Mary Kestler
- i Division of Infectious Diseases, Faculty of Medicine , University of British Columbia
| | - Neora Pick
- i Division of Infectious Diseases, Faculty of Medicine , University of British Columbia
- j Oak Tree Clinic , British Columbia Women's Hospital and Health Centre
| | - Kate Salters
- a Faculty of Health Sciences , Simon Fraser University
- b Epidemiology and Population Health , British Columbia Centre for Excellence in HIV/AIDS
| | | | - Nadia O'Brien
- k Chronic Viral Illness Service , McGill University Health Centre
- l Department of Family Medicine , McGill University
| | - Sophie Patterson
- a Faculty of Health Sciences , Simon Fraser University
- m Department of Public Health and Policy , University of Liverpool
| | - Alexandra de Pokomandy
- k Chronic Viral Illness Service , McGill University Health Centre
- o Department of Medicine , University of Toronto
| | - Mona Loutfy
- n Women's College Research Institute , Women's College Hospital
- o Department of Medicine , University of Toronto
| | - Angela Kaida
- a Faculty of Health Sciences , Simon Fraser University
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