Sexual Activity, Pleasure, and Testosterone: A Biopsychosocial Analysis of Women Living With and Without HIV in British Columbia, Canada

Sexual health research comparing women with and without human immunodeficiency virus (HIV) often pathologizes women living with HIV, overlooking biopsychosocial factors that may drive differences between groups. Low testosterone levels have been reported among women living with HIV; however, how this may impact sexual health outcomes remains unclear. We compared the prevalence of sexual activity and sexual pleasure between women with and without HIV in British Columbia and examined associations with psychosocial variables and testosterone. There were no significant differences in the prevalence of partnered sexual activity (45.7% vs. 52.8%) or sexual pleasure (64.1% vs. 70.4%) between women with and without HIV, respectively. Women with HIV reported less masturbation (43.2%) compared to women without HIV (64.6%). In multivariable logistic regression models, both HIV and testosterone were independently associated with masturbation, but not with partnered sexual activity or sexual pleasure. Several psychosocial factors were associated with sexual outcomes including age, relationship status, income, substance use, physical health, and children. In HIV-stratified analyses, knowledge of Undetectable=Untransmittable (U=U), having an undetectable HIV-RNA viral load and a CD4 count > 500 cells/μl showed significant associations. This work highlights positive aspects of sexuality and the confluence of social norms, internalized perceptions, and biology in shaping women's sexual well-being.