Women and HIV infection: investigation of its psychosocial consequences

Disciplining Bodies, Desires and Subjectivities: Sexuality and HIV-Positive Women

Very little is known about the sexuality of women who are living with HIV, outside the context of risk prevention and education. Available research in the first-world context shows that, although most women continue to be sexually active following diagnosis, decreased sexual functioning is very common and more prevalent than among HIV-positive men. The present multi-site Canadian study is concerned with the ways in which women’s sexuality is transformed by the experience of living with HIV. Semi-structured interviews with 20 women were analysed using thematic decomposition, an analytic technique that combines discursive approaches with thematic analysis. The women in this study construct HIV as inhibiting in relation to sexuality. A predominant discourse of disciplining bodies, desires and subjectivities emerges, which centers on the restrictions imposed by an HIV-positive diagnosis. The following discursive constructions, in particular, emerge from the women’s accounts: diminished spontaneity, foreclosed (provisional) sexual freedom, foreclosed power, foreclosed flirtation, inciting violence, (un)natural sex, responsibility imperatives, muted/mutated sexuality, and diminished intimacy. The women’s predominant positioning within AIDS discourses as conduits of transmission, the relative neglect of women’s psychological and sexual health concerns in both research and public health agendas, and women’s relatively anomalous standing in AIDS communities imposes limits on bodies, lives, and subjectivities. These are reflected in these women’s accounts, wherein a focus on protecting others frequently impedes access to fulfilling (and safe) sexual and emotional relationships.

The effect of serostatus on HIV risk behaviour change among women sex workers in Miami, Florida

HIV prevention and risk reduction are especially salient and timely issues for women, particularly among those who are drug-involved or who exchange sex for drugs or money. Studies suggest that HIV-prevention measures can be effective with highly vulnerable women, and have the potential to produce significant reductions in risk behaviours among both HIV-negative and HIV-positive women. Within this context, this paper examines risk behaviours and HIV serostatus among 407 drug-involved women sex workers in Miami, Florida, and investigates the effects of participation in HIV testing, counselling, and a risk-reduction intervention on subsequent behavioural change among this population. Overall, at follow-up, the HIV-positive women were 2.4 times more likely than the HIV-negative women to have entered residential treatment for drug abuse, 2.2 times more likely to have decreased the number of their sex partners, 1.9 times more likely to have decreased the frequency of unprotected sex, 1.9 times more likely to have reduced their levels of alcohol use, and 2.3 times more likely to have decreased their crack use. These data support the importance of HIV testing and risk-reduction programmes for drug-involved women sex workers.

Spirituality and sexual orientation: relationship to mental well-being and functional health status

BACKGROUND

Research has shown that spirituality has a positive effect on physical and mental health; however, few studies have explored the influence of spirituality and sexuality on mental well-being and functional health status in people with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS).

AIM

This descriptive cross-sectional study was designed to examine the relationships among spirituality, sexual orientation, mental well-being and aspects of functional health status (physical, role, social and cognitive functioning) in a sample of 117 African-American men and women living with HIV/AIDS.

METHODS

Spirituality was measured using the Spiritual Well-Being Scale. A demographic questionnaire gathered data on sexual orientation, age and gender. The Medical Outcomes Study Questionnaire-30 assessed aspects of functional health status and mental well-being. The HIV Symptom Checklist for Persons With HIV disease was used to collect data on HIV symptoms. The data were collected in 1996.

FINDINGS

The findings indicate that spirituality had a direct relationship with cognitive and social functioning and was inversely related to HIV symptoms. Sexual orientation had direct relationships with mental well-being, cognitive, physical, social and role functioning. t-Tests showed that heterosexual participants reported poorer mental well-being and functional health status compared with homosexual participants. Regression analysis showed that spirituality, sexual orientation, age and HIV symptoms contributed significantly to mental well-being and functional health status.

CONCLUSIONS

The regression analysis showed that spirituality, sexual orientation, age and HIV symptoms contributed significantly to mental well-being and functional health status. Further research is needed to explore the various ways that sexual orientation influences health status findings in those with HIV disease in certain segments of the population. The findings support the inclusion of spirituality as a variable when examining mental well-being and physical health. Finally, given the limitations of the design, more rigorous methods should be employed to understand further the contribution of spirituality to the health status of African-Americans living with HIV, because of its social importance to this particular community.

Personal and psychosocial characteristics associated with psychiatric conditions among women with human immunodeficiency virus

This study presents information on correlates of mental health and substance abuse problems among women with human immunodeficiency virus (HIV), a particularly vulnerable, poor and minority population. Data are from 847 women in the HIV Cost and Services Utilization Study, a national probability sample of adults with known human immunodeficiency virus infection. Fifty-five percent of women manifested a probable psychiatric condition. Results indicated that increased risk for psychiatric conditions among these women was associated with younger age, having acquired immunodeficiency virus (rather than asymptomatic), using avoidant coping strategies, reporting increased conflict with others, and prior physical abuse, needing income assistance, and putting off going to the doctor because of caring for someone else. Findings suggest we need to address women's need for safety from assaultive partners and that we may need special programs for women burdened with having to care for others.

Quality of life among women living with HIV: the importance violence, social support, and self care behaviors

This paper describes the relationship between psychosocial factors and health related quality of life among 287 HIV-positive women using items from the Medical Outcomes Study HIV Health Survey to measure physical functioning, mental health and overall quality of life. Multivariate models tested the relative importance of sociodemographic characteristics, HIV-related factors and psychosocial variables in explaining these quality of life outcomes. A history of child sexual abuse and adult abuse, social support and health promoting self-care behaviors were the psychosocial factors studied. Women in the sample were on average 33 years old and had known they were HIV-positive for 41 months; 39% had been hospitalized at least once due to their HIV; 83% had children; 19% had a main sex partner who was also HIV-positive. More than one-half of the women (55%) had a history of injection drug use and 63% reported having been physically or sexually assaulted at least once as an adult. A history of childhood sexual abuse. reported by 41% of the sample, was significantly related to mental health after controlling for sociodemographic and HIV-related characteristics. Women with larger social support networks reported better mental health and overall quality of life. Women who practiced more self-care behaviors (healthy diet and vitamins, adequate sleep and exercise, and stress management) reported better physical and mental health and overall quality of life. The high prevalence of physical abuse and child sexual abuse reported by this sample underscores the importance of screening for domestic violence when providing services to HIV-positive women. That such potentially modifiable factors as social support and self care behaviors are strongly associated with health-related quality of life suggests a new opportunity to improve the lives of women living with HIV.

Double-blind comparison of fluoxetine and desipramine in the treatment of depressed women with advanced HIV disease: a pilot study

A double-blind, placebo-controlled study was conducted to assess the relative efficacy and tolerability of fluoxetine and desipramine in depressed, human immunodeficiency virus (HIV)-positive women. Although difficulty in the recruitment and retention of participants led to insufficient power to detect differences between treatment groups, results indicated that participants experienced improvement in their depression. However, for most women, significant depressive symptoms remained after 6 weeks of treatment. In addition, although most participants reported at least one adverse event after treatment began, most of the side effects, regardless of treatment condition, were mild to moderate in severity. Important barriers to study participation and completion are discussed, as well as suggestions for increasing the involvement of depressed, HIV-positive women in future treatment studies.

HIV-positive people, risk and sexual behaviour

For a long time, the sexual behaviour of HIV-infected persons did not receive any serious attention for a variety of reasons. Initially, diagnosis of HIV-infection appeared to imply a death sentence. In this context, the sex life of those infected seemed a secondary issue making prevention focused on sexual behaviour hard to imagine. Furthermore, the conviction that stigmatisation should be avoided also precluded an interest in the sexual behaviour of HIV-infected persons. From an epidemiological perspective and in the context of the developments in the medical treatment of AIDS it is important to address the sexuality of HIV-infected people. The scarce research done until now shows that there are various ways in which an HIV-infection affects people's sexuality. It seems that the sexuality of HIV-infected people can be compromised by their infection, inducing various sexual problems. Research also shows that there are HIV-infected people who do engage in unprotected sex, just as there are HIV-negative people or people with unknown serostatus who do so. Studies into the determinants of unsafe sex in HIV-infected people suggest that to some extent the same determinants are operative as among people in general. These include intention and self-efficacy regarding safe sex. Recreational drug use also affects safe sex regardless of serostatus. However, safe sex as well as sex in general is different for seropositive persons than for people who are seronegative or have an unknown serostatus. Among seropositive people, sex is also related to dilemma's involving disclosing their serostatus to potential sex partners, and their motivation to protect their partners as well as themselves against surinfection and STD. Furthermore, having to cope with a serious disease induces negative mood states (particularly depression) and may compromise sexual functioning. Comprehensive prevention aimed at HIV infected persons should address these various issues and should be an integrated part of general HIV-prevention.