FUNDING AND ETHICS: This work is funded by the National Institute of Health Research (PDF-2014-07-071). It has Research Ethical Approval from the South East Coast-Surrey Research Ethics Committee on behalf of all NHS sites (REF 15/0735).

REFERENCES: 1. Z Yin (Public Health England), personal communication; 2. S Tariq et al. Maturitas. 2016; 88:76-83; 3. KR Mitchell KR et al. Eur J Epidemiol. 2012;27(6):409-18.

Association of HIV status with sexual function in women aged 45-60Nasreen Toorabally1, Catherine H Mercer1, Kirstin Mitchell2, Fiona Burns1, Richard Gilson1, Caroline Sabin1, Shema Tariq1 (on behalf of the PRIME Study Group)1Institute for Global Health, University College London, UK; 2Institute of Health & Wellbeing, University of Glasgow, UK

PRIME EXPERT ADVISORY GROUP: Comfort Adams, Jane Anderson, Mwenza Blell, Jonathan Elford, Janine McGregor-Read, Fiona Pettitt, Janice Rymer, Jane Shepherd, Lorraine Sherr, Emily Wandolo

s.tariq@ucl.ac.uk

PRIME STUDY SITES: Barking Community Hospital (Rageshri Dhairyawan, Emma Macfarlane, Sharmin Obeyesekra, Cecelia Theodore); Brighton and Sussex University Hospital (Yvonne Gilleece, Alyson Knott, Celia Richardson); Chelsea and Westminster Hospital (Mimi Chirwa, Ann Sullivan, Mini Thankachen, Sathya Visvendra); City of Coventry Health Centre (Sris Allen, Kerry Flahive); Guy’s and St Thomas’ Hospital (Julie Fox, Julianne Iwanga, Annemiek DeRuiter, Mark Taylor); 10 Hammersmith Broadway (Sophie Hobday, Rachael Jones, Clare Turvey); Homerton University Hospital (Monica James, Sambasivarao Pelluri, Iain Reeves); Kings College Hospital (Sarah Barber, Priya Bhagwandin, Lucy Campbell, Leigh McQueen, Frank Post, Selin Yurdakul, Beverley White); Lewisham and Greenwich NHS Trust (Tarik Moussaoui, Melanie Rosenvinge, Judith Russell); Mortimer Market Centre (Tuhina Bhattacharya, Alexandra Rolland, Shema Tariq); New Cross Hospital Wolverhampton (Sarah Milgate, Anjum Tariq); North Manchester General Hospital (Claire Fox, Gabriella Lindergard, Andrew Ustianowski); Royal Free Hospital NHS Trust (Fiona Burns, Nargis Hemat, Nnenna Ngwu, Rimi Shah); Southend Hospital (Sabri Abubakar, John Day, Laura Hilton, Henna Jaleel, Tina Penn); St Mary’s Hospital (Angela Bailey, Nicola Mackie); University Hospital Birmingham (Reka Drotosne-Szatmari, Jan Harding, Satwant Kaur, Tessa Lawrence, Monika Oriak, Jonathan Ross); West Middlesex Hospital (Kimberley Forbes, Ursula Kirwan, Shamela De Silva, Marie-Louise Svensson, Rebecca Wilkins).

Most of all we thank all PRIME study participants for sharing their time and experiences so generously.

• In 2016 ~ 10,350 women of potentially menopausal age (45-56 years) attended for HIV care in the UK, a 5-fold increase over 10 years1.

• Reproductive aging is associated with declines in sexual function in women across several domains including desire, arousal and lubrication, often as a result of vulvovaginal atrophy.

• However, there remains limited data on the sexual health and wellbeing of women ageing with HIV2.

• We explore the association of HIV status with sexual function in midlife women in England.

BACKGROUND

METHODS

• An analysis of cross-sectional data of sexually active women aged 45-60 from two national datasets from England:

– The 3rd National Survey of Sexual Attitudes & Lifestyles, a national probability sample survey (HIV-negative women, N=1699)

– The PRIME Study (Positive Transitions Through the Menopause), a convenience survey of midlife women living with HIV (WLWH, N=336) attending HIV clinics across England.

• We captured self-reported sexual function in both surveys using the Natsal sexual function measure (Natsal-SF) in those sexually active in the past year, with the highest quintile defined as having low sexual function.

• Natsal-SF is a validated measure comprising a brief 16-item multidimensional measure of sexual function in the last year including assessment of sexual problems, sexual partnership-specific issues and help sought3.

• Postmenopausal status was defined as self-reported amenorrhea ≥12 months.

• We compared WLWH to HIV-negative women using multivariable logistic regression.

RESULTS

• WLWH aged 45-60 were more likely to have low sexual function than their HIV-negative counterparts.

• Although we cannot eliminate the possibility of residual confounding and reporting bias, this analysis highlights the burden of sexual problems among midlife WLWH.

• We recommend that assessment of sexual function be integrated into routine care for WLWH of all ages.

CONCLUSIONS

• We present participant characteristics in Table 1.

• Both HIV-negative women and WLHIV commonly reported having experienced ≥1 sexual problem lasting ≥3 months in the past year (54.3% and 68.9% respectively, Table 2), but WLWH had an adjusted odds ratio (AOR) of 2.61 of reporting a problem.

• WLWH were also more likely to report almost all of the specific sexual problems the surveys asked about (Table 2), with an AOR of 3.87 of reporting low overall sexual function.

• Low sexual function was more common in post-menopausal WLWH (only), although of borderline statistical significance (AOR:1.78 [0.94-3.38]; p=0.08).

• Among those reporting ≥1 sexual problem, WLWH were more likely than HIV-negative women to seek help for sexual problems from ≥1 source (29.9% vs. 17.1%, p<0.001, Figure).

Natsal-3 (HIV-)N=1228a, 1677b

n (%)

PRIME (HIV+)N=312N (%)

Adjusted odds ratioc

(95% CI)

p-value

Overall sexual functiond

Low sexual function 342 (20.4) 133 (42.6) 3.87 (2.35-6.38) < .001

Lacked interest in sex 642 (38.3) 163 (52.2) 2.79 (1.50-5.16) .001

Lacked enjoyment in sex 217 (13.1) 102 (32.7) 4.19 (2.08-8.41) < .001

Felt anxious during sex 59 (3.5) 54 (17.3) 4.90 (2.55-9.42) < .001Physical pain due to sex 126 (7.5) 52 (16.7) 2.92 (1.91-4.46) < .001

No arousal during sex 146 (8.7) 90 (28.8) 3.42 (1.98-5.91) < .001

No orgasm/took long time to reach orgasm 25 (14.9) 97 (31.1) 2.92 (1.78-4.75) < .001

Reached orgasm too quickly 40 (2.4) 23 (7.4) 1.79 (0.33-9.66) .50

Vaginal dryness 288 (17.2) 86 (27.6) 2.27 (1.37-3.77) .002

Experienced ≥1 problem 911 (54.3) 215 (68.9) 2.61 (1.54-4.45) < .001

TABLE 2: ASSOCIATIONS BETWEEN SEXUAL FUNCTION AND HIV STATUS (REFERENCE GROUP HIV-)

aUnweighted denominator; bWeighted denominator; cAdjusted for ethnicity, age, number of chronic conditions, depression and ongoing relationship status; dUsing Natsal-SF

FIGURE: HELP-SEEKING SOURCE (%) IN WOMEN REPORTING ≥1 SEXUAL PROBLEM BY HIV STATUS

Abstract 1073

www.natsal.ac.ukwww.ucl.ac.uk/prime-ucl

TABLE 1: PARTICIPANT CHARACTERISTICS

Natsal-3 (HIV-)N=1228a, 1677b

n (%)

PRIME (HIV+)N=312 n (%)

p-value

Median age in years, IQR 51 (48-55) 49 (47-52) < 0.001

Ethnicity White BritishBlack African

Other

1464 (87.5)21 (1.4)

186 (11.1)

25 (8.3)211 (69.6)

67 (13.1) <0.1Ongoing relationship No

Yes189 (82.3)

1488 (88.7)48 (15.5)

262 (84.5) <0.001

Menopausal status Pre-menopausalPost-menopausal

727 (43.7)936 (56.3)

223 (71.1)88 (28.3) <0.001

Chronic conditions (other than HIV) 01

≥2

1165 (70.0)404 (24.2)

97 (5.8)

160 (52.1)108 (35.2)

39 (12.7) <0.001Depression (PHQ-2) No (score <3)

Yes (score ≥3)1496 (89.2)

181 (10.8)

226 (76.1)

71 (23.9) <0.1

Most recent CD4 (cells/mm3) >500200-500

<200

-

-

-

193 (71.7)

63 (23.4)

13 (4.8) 0.92

Most recent HIV viral load UndetectableDetectable

-

-

262 (90.3)

28 (9.7) 0.74aUnweighted denominator; bWeighted denominator (to account for study design)

Help from ≥1 source