Sexual dissatisfaction and associated factors in a sample of patients on antiretroviral treatment in KwaZulu-Natal, South Africa

Sexual expression affects physical, mental and social well-being. There is a lack of understanding on sexual dissatisfaction among patients on antiretroviral treatment in Africa. Using systematic sampling, HIV-positive patients were selected from outpatient departments from three hospitals before commencing antiretroviral therapy (ART), followed up for 20 months (N=495) and interviewed with a questionnaire. Rates of self-reported sexual dissatisfaction were high (32.6%), but reduced significantly from before starting ART (56.1%) to 20 months on ART (32.6%) (p=0.006). Sexual dissatisfaction increased among sexually active compared with sexually inactive participants over the 20-month assessment period. In multivariate analysis, not being formally employed (odds ratio (OR) 0.4, 95% confidence interval (CI) 0.2 - 0.9), having had sexual intercourse in the past 3 months (OR 5.8, 95% CI 1.7 - 19.8), taking medications for HIV-related opportunistic infections (OR 2.5, 95% CI 1.1 - 5.7), internalised stigma (OR 1.4, 95% CI 1.2 - 1.6), lack of social support (OR 0.4, 95% CI 0.3 - 0.6) and low depressive symptoms (OR 0.9, 95% CI 0.8 - 1.0) were found to be associated with sexual dissatisfaction. This prospective study of a large sample of persons on ART showed evidence of reduction of overall sexual dissatisfaction over time and a number of factors influencing sexual dissatisfaction that should be addressed in health care provider interventions.