HSCI 431 Lecture Notes - Lecture 4: Intrauterine Device, Combined Oral Contraceptive Pill, Seroconversion
31 May 2018
School
Department
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Professor
Week 4: “eual ad Reproductive Health & HIV
guest lecture
Sexual Health: State of physical, mental and social well-being in relation to sexuality
• Requires positive and respectful approach to sexuality and sexual relationships
• Possibility of having pleasure and safe sexual experiences, free of coercion, discrimination and violence
NEGATIVE CONNOTATIONS (DANGERS; FEAR; CONSEQUENCES)
POSITIVE CONNOTATIONS
• Avoidance of unintended pregnancy
• Avoidance of sexually transmitted infections (syphilis)
• Absence of sexual dysfunctions
• Avoidance of coercion, violence
• Equitable relationships
• Sexual fulfillment
• Sexual rights (responsibilities)
• Pleasure
SEXUAL HEALTH AND HIV
• ‘eseah foused o edued tasissio hethe to othe seual pates o a
• Increased call for sex-positive approach to supporting PLWH and their sexual lives
• Desexualisation and potential stigmatization of sex lives for PLWH
o Fear of rejection, discloser; not viewed as a sexual person
Fear-mongering in media
• Exposed to images to portray a negative image of addressing sexual health through images that repel people
from sexual relationships (poor portrayal of HIV)
HIV Risk
BIOLOGICAL
SOCIAL
STRUCTURAL
Receptive vs. penetrative
Anal vs. vaginal vs. oral
Condom or other barrier methods
Viral load of sexual partner
Lube
Gender
Sexual orientation
Substance use history
Social-economic status
Education
Criminalization
Systemic racism, sexism
Poverty
Economic structure
• Transmission of HIV is eliminated if viral load is low
• People living with HIV on antiretroviral therapy (ART) and can maintain low levels of the virus can eliminate the
risk of transmitted HIV to sexual partners
Example: HPTN 052 Study, PARTNERS study
U=U Campaign → mass campaign that gets out the word that if your virus is below the threshold in the body →
relatively not infectious and not transmittable (virtually eliminated risk)
PLWH Having Sex in TasP era
• Study considered perceived impact of HIV on sexual practices and relationships of in-care HIV-positive individuals
• Themes related to risk behaviour categorized from struggles for intimacy and fear of isolation after diagnosis
a) Fear of infecting sex partner
b) Guilt about sex
c) Sexual communication difficulty
find more resources at oneclass.com
find more resources at oneclass.com
d) HIV-stigma
• Universal experience for people after diagnosis (losing human experience) → reduction in sexual activity
Secondary Sexual Abstinence
• Woe liig ith HIV pefe to aoid se altogethe o epost lost o daaged seualit
• Canadian CHIWOS study →
o 82% participants taking ART
o 77% report undetectable viral load
o 49% sexually inactive
• women said in cohort that they had negative experiences and there was HIV-stigma associated after diagnosis
Sexual function (dysfunction)
• HIV infection associated with sexual dysfunction
• HIV infection associated with decline in sexual activity
• Ex. Study with over 13,000 MSM living with HIV
o Greater prevalence of erectile dysfunction (ED) in men with progressive HIV infection (40-49 years of age)
o In addition to general health conditions, depression, fear of passing on HIV, direct effects of HIV on physiologic
systems responsible for penile erection contributes to ED
o Fear and guilt affects sexual function
o Mind and thought process creates a negative environment for people and impacts ability to respond
Access to Sexual Health Services
• Among SMS
o Massive gaps in health services
o Discrimination occurs
o Gaps in how we can support sexual health of key populations
• Subset of MSM
o Only 54% reported easy access to HIV treatment
o Sexual stigma, criminalization of homosexual behaviour and low country investment in HIV services associated
with reduced access to all basic HIV services
How does treatment impact sexual health outcomes?
• If there are massive gaps in supportive care for HIV treatment, we cannot capitalize on advances in support of
care
• Give back reproductive health power
• Obligation to de-stigmatize and de-iialize HIV as ell as oes odies ad seualit
• Affi oes sexual desires and normalize their experiences of sex and intimacy (support in leading a
satisfying, pleasurable and fulfilling sexual life)
REPRODUCTIVE HEALTH:
Women living with HIV (WLWH) and Reproductive Health
• 1.4 million women living with HIV become pregnant
• risk of vertical transmission drops to <1% with ART therapy
• number of children born annually with HIV has almost halved since 2009 (400,00 to 240,000)
• advantages of ART extend from sexual partners to vertical transmission (reduce infectious)
find more resources at oneclass.com
find more resources at oneclass.com
Document Summary
Week 4: e(cid:454)ual a(cid:374)d reproductive health & hiv (cid:894)guest lecture(cid:895) Sexual health: state of physical, mental and social well-being in relation to sexuality: requires positive and respectful approach to sexuality and sexual relationships, possibility of having pleasure and safe sexual experiences, free of coercion, discrimination and violence. Negative connotations (dangers; fear; consequences: avoidance of unintended pregnancy, avoidance of sexually transmitted infections (syphilis, absence of sexual dysfunctions, avoidance of coercion, violence. Positive connotations: equitable relationships, sexual fulfillment, sexual rights (responsibilities, pleasure. Fear-mongering in media: exposed to images to portray a negative image of addressing sexual health through images that repel people from sexual relationships (poor portrayal of hiv) Economic structure: transmission of hiv is eliminated if viral load is low, people living with hiv on antiretroviral therapy (art) and can maintain low levels of the virus can eliminate the risk of transmitted hiv to sexual partners.
