Men Living With HIV Experiencing Sexual Difficulties Had Lower Quality of Life

Men who have sex with men (MSM) and living with HIV had a lower health-related quality of life (HRQOL) when they had sexual difficulties, according to a new study published in Sexual Medicine.¹ Worsening mental health was just one of the factors associated with the lower HRQOL.

An increasing focus has been put on HRQOL in people living with HIV (PLHIV) due to antiretroviral therapy prolonging the lives of PLHIV to that of normal life expectancy. However, these patients still often have a worse overall QOL compared with the general population.² A factor in QOL and mental health can be sexual difficulties, due to the reported number of sexual difficulties being higher in PLHIV. This study aimed to report on the association between sexual function, HRQOL, and psychological status in MSM who are living with HIV.

Men who have sex with men living with HIV could have a worse quality of life if they have sexual difficulties | Image credit: Krakenimages.com - stock.adobe.com

All patients were recruited from a perspective cohort study and were followed up with between January 2017 and December 2021. MSM diagnosed with HIV and patients without other severe diseases were eligible for the study; patients were excluded if they had incomplete information, had psychological symptoms before their diagnosis of HIV, or had a severe underlying disease. All participants were interviewed to collect data on their lifestyle habits and demographic information. Case management records held clinical data for all patients. Participants were asked about their frequency of exercise, income, sleep duration, alcohol consumption, and circadian disruption.

The Symptom Checklist-90-Revised (SCL-90) was used to measure psychopathology and the Arizona Sexual Experience Scale was used to assess sexual function. HRQOL was assessed using the 36-Item Short Form Health Survey (SF-36).

There were 391 MSM enrolled in the control group and 84 MSM enrolled in the sexual difficulties group, all of whom were diagnosed with HIV. Participants in the sexual difficulties group had lower regular exercise and higher alcohol consumption compared with the control group.

The control group had significantly higher mean (SD) physical HRQOL compared with the sexual difficulties group (323.0 [39.6] vs 335 [35.2]). The sexual difficulties group had lower blood pressure and general health scores compared with the control group and sexual function scores were negatively correlated with physical HRQOL score (r, –0.140; P = .003). Overall HRQOL was lower in the sexual difficulties group compared with the control group (293.5 [56.8] vs 305.6 [48.6]). However, sexual difficulties score and mental HRQOL score had no significant correlation. Similarly, there was no association between SCL-90 scores and sexual function scores. SCL-90 was found to negatively correlate with total (r, –0.416), physical (r, –0.347), and mental (r, –0.344) HRQOL scores (all P < .001).

A multivariate analysis found that regular exercise (OR, 0.553; 95% CI, 0.331-0.926; P = .024) and alcohol consumption (OR, 1.780; 95% CI, 1.046-3.028; P = .033) were independent factors of sexual difficulties. The multivariate analysis also found that body mass index (OR, 1.067; 95% CI, 1.004-1.133; P = .037) and sexual function score (OR, 0.941; 95% CI, 0.888-0.998; P = .041) were independent risk factors associated with HRQoL. The only independent factor associated with psychological symptoms was the SF-36 score (OR, 1.012; 95% CI, 1.009-1.016; P < .001).

There were some limitations to this study. A single medical center was used for all data, and this was a cross-sectional study, which doesn’t account for causality. The researchers also couldn’t confirm the amount of alcohol consumed by the patients, and the cohort had a low average level of exercise, which could have affected the correlation between the exercise and HRQOL.

SCL-90 and HRQoL scores were higher and lower, respectively, in MSM living with HIV who have sexual difficulties. Assessment of HRQOL in MSM who are diagnosed with HIV should include sexual function and psychiatric health to give a full picture on QOL for the patient, as well as provide methods of giving targeted interventions for this population.

References

1. Xu Y, Lin X, Wu X, et al. Sexual difficulties in men who have sex with men living with HIV: their mental health and health-related quality of life. Sex Med. 2024;12(4):qfae060. doi:10.1093/sexmed/qfae060

2. Aging with HIV. HIV.gov. Updated June 4, 2024. Accessed September 26, 2024. https://www.hiv.gov/hiv-basics/living-well-with-hiv/taking-care-of-yourself/aging-with-hiv