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“The Pleasure Is Better as I’ve Gotten Older”: Sexual Health, Sexuality, and Sexual Risk Behaviors Among Older Women Living With HIV

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Abstract

There is limited research examining the sexual health and well-being of older women living with HIV (OWLH). Most studies focus on sexual dysfunction, leaving aside the richer context of sexuality and sexual health, including the effect of age-related psychosocial and interpersonal changes on sexual health behaviors. Guided by the integrative biopsychosocial model and the sexual health model, this study explored the importance of sex and sexuality among OWLH to identify their sexual health and HIV prevention needs for program planning. A purposive sample (n = 50) of OWLH was selected from a parent study (n = 2052). We conducted 8 focus groups and 41 in-depth interviews with 50 African American and Latina OWLH aged 50–69 years old in three U.S. cities. The triangulation approach was used to synthesize the data. Six salient themes emerged: sexual pleasure changes due to age, sexual freedom as women age, the role of relationships in sexual pleasure, changes in sexual ability and sexual health needs, sexual risk behaviors, and ageist assumptions about older women’s sexuality. We found that sexual pleasure and the need for intimacy continue to be important for OWLH, but that changing sexual abilities and sexual health needs, such as the reduction of sexual desire, as well as increased painful intercourse due to menopause-associated vaginal drying, were persistent barriers to sexual fulfillment and satisfaction. Particular interpersonal dynamics, including low perceptions of the risk of HIV transmission as related to gender, viral suppression, and habitual condomless sex with long-term partners without HIV transmission have resulted in abandoning safer sex practices with serodiscordant partners. These findings suggest that HIV prevention for OWLH should focus on how sexual function and satisfaction intersect with sexual risk. HIV prevention for OWLH should promote ways to maintain satisfying and safe sex lives among aging women.

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Notes

  1. “Booty call”: a person with whom one has sex at random times outside of a relationship; the act of calling said person; the term used to refer to said phone call.

  2. “All in all” the object of one's attention or interest (http://www.collinsdictionary.com/dictionary/english/all-in-all)

  3. “Come too fast”: premature ejaculation (http://www.netdoctor.co.uk/sex_relationships/facts/prematureejaculation.htm)

  4. “Wet”: when a women's vagina is fully lubricated and ready

  5. “Knocking boots”: to have sexual intercourse (http://www.urbandictionary.com/define.php?term=knocking+boots)

  6. “Flip the switch”: To have a change of heart or contrary approach. (http://www.urbandictionary.com/define.php?term=flip+the+switch).

  7. “Jump”: to want to have sex with someone (http://www.urbandictionary.com/define.php?term=jump)

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Acknowledgments

This work was supported by the National Institute of Mental Health (1 KO1 MH095670, Taylor, PI). Data in this manuscript were collected by the Women’s Interagency HIV Study (WIHS). The contents of this publication are solely the responsibility of the authors and do not represent the official views of the National Institutes of Health (NIH). WIHS (Principal Investigators) sites included in this study are Bronx WIHS (Kathryn Anastos), U01-AI-035004; Brooklyn WIHS (Howard Minkoff and Deborah Gustafson), U01-AI-031834; and Chicago WIHS (Mardge Cohen and Audrey French), U01-AI-034993. The WIHS is funded primarily by the National Institute of Allergy and Infectious Diseases (NIAID), with additional co-funding from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), the National Cancer Institute (NCI), the National Institute on Drug Abuse (NIDA), and the National Institute on Mental Health (NIMH). Targeted supplemental funding for specific projects is also provided by the National Institute of Dental and Craniofacial Research (NIDCR), the National Institute on Alcohol Abuse and Alcoholism (NIAAA), the National Institute on Deafness and other Communication Disorders (NIDCD), and the NIH Office of Research on Women’s Health. WIHS data collection is also supported by UL1-TR000004 (UCSF CTSA) and UL1-TR000454 (Atlanta CTSA). The contents of this publication are solely the responsibility of the authors and do not necessarily represent the official views of the National Institutes of Health.

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Authors and Affiliations

  1. College of Medicine, Division of Infectious Disease and the Special Treatment and Research Program, SUNY Downstate Medical Center, 450 Clarkson Avenue, Box 1240, Brooklyn, NY, 11203, USA

    Tonya N. Taylor, Susan Holman, Rebecca Gonsalves, Tiffany Bryan, Nina Connors & Gabrielle Schechter

  2. CMPconsulting, Santa Monica, CA, USA

    Corrine E. Munoz-Plaza

  3. Department of Medicine, Georgetown University Medical Center, Washington, DC, USA

    Lakshmi Goparaju

  4. College of Public Health, Temple University, Philadelphia, PA, USA

    Omar Martinez

  5. Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, NY, USA

    Howard L. Minkoff

  6. AIDS Community Research Initiative of America, New York, NY, USA

    Stephen E. Karpiak

  7. School of Nursing, New York University, New York, NY, USA

    Stephen E. Karpiak

  8. School of Medicine, University of California, San Francisco, San Francisco, CA, USA

    Monica Gandhi

  9. Department of Medicine, Cook County Health and Hospital System and Rush University, Chicago, IL, USA

    Mardge H. Cohen

  10. Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

    Elizabeth T. Golub

  11. City of Hope National Medical Center, Los Angeles, CA, USA

    Alexandra M. Levine

  12. Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA

    Adebola A. Adedimeji

  13. School of Public Health, SUNY Downstate Medical Center, Brooklyn, NY, USA

    Tracey E. Wilson

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  1. Tonya N. Taylor
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  2. Corrine E. Munoz-Plaza
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  8. Monica Gandhi
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  9. Mardge H. Cohen
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Correspondence to Tonya N. Taylor.

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Taylor, T.N., Munoz-Plaza, C.E., Goparaju, L. et al. “The Pleasure Is Better as I’ve Gotten Older”: Sexual Health, Sexuality, and Sexual Risk Behaviors Among Older Women Living With HIV. Arch Sex Behav 46, 1137–1150 (2017). https://doi.org/10.1007/s10508-016-0751-1

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