Sexuality and Intimacy Among Older Women Living with HIV: a Systematic Review

  • Amelia M. StantonEmail author
  • Georgia Goodman
  • Sara E. Looby
  • Gregory K. Robbins
  • Christina Psaros
Female Sexual Dysfunction and Disorders (T Lorenz and R Nappi, Section Editors)
Part of the following topical collections:
  1. Topical Collection on Female Sexual Dysfunction and Disorders


Purpose of Review

Sexual well-being and intimacy are critical to overall quality of life and retain a high degree of significance for aging individuals, even though these considerations are often overlooked in older populations. Sexual health may be particularly impacted in older individuals living with HIV, especially women, as a result of both physical and psychosocial disease-specific factors. Despite this, sexuality research related to HIV has traditionally focused on risk reduction, rather than on other elements of sexual wellness. In this review, we examine several aspects of sexual well-being that may be important to older women living with HIV (OWLH).

Recent Findings

This review summarizes existing literature on sexuality in OWLH over the age of 50 and explores five themes related to sexual health: physical and emotional intimacy, desire/interest, satisfaction/pleasure, frequency of sexual activity, and abstinence. Reduced intimacy among OWLH was reported across most studies, due to stigma and disclosure concerns, lack of opportunity for relationships, and difficulty communicating sexual preferences. Data on sexual desire/interest and satisfaction/pleasure among OWLH were mixed. Frequency of sexual activity varied widely across studies, and abstinence emerged as both an intentional and inadvertent decision for OWLH. Factors related to menopause as it relates to sexuality and HIV are also discussed.


Sexual health and well-being are important to women living with HIV over 50, though key components such as intimacy, desire, and pleasure remain poorly understood. As this population continues to grow, comprehensive and age-specific interventions are needed to examine positive aspects of sexuality and promote sexual wellness among OWLH.


Sexuality Intimacy Sexual function Older women HIV 


Funding Information

This work was supported by a T32 training grant (5T32MH116140-02).

Compliance with Ethical Standards

Conflict of Interest

Dr. Stanton, Dr. Looby, and Dr. Goodman each declare no conflicts of interest.

Dr. Robbins declares grants from Gilead, Emergent Solutions, Citius Pharmaceuticals, Inc., and Pfizer, outside of the submitted work.

Dr. Psaros reports personal fees in consultation with collaborators at Brown University. In this role, she supervises interventionists on an HIV medication adherence trial.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Bouman WP, Arcelus J, Benbow SM. Nottingham study of sexuality & ageing (NoSSA I). Attitudes regarding sexuality and older people: a review of the literature. Sex Relation Ther. 2006;21:149–61.CrossRefGoogle Scholar
  2. 2.
    Lee D, Nazroo J, O’Connor D, et al. Sexual health and well-being among older men and women in England: findings from the English Longitudinal Study of Ageing. Arch Sex Behav. 2016;45:133–44.PubMedCrossRefGoogle Scholar
  3. 3.
    Delamater J. Sexual expression in later life: a review and synthesis. J Sex Res. 2012;49:125–41.PubMedCrossRefGoogle Scholar
  4. 4.
    Syme ML. The evolving concept of older adult sexual behaviour and its benefits. Generations. 2014;38:35–41.Google Scholar
  5. 5.
    Wang V, Depp CA, Ceglowski J, et al. Sexual health and function in later life: a population-based study of 606 older adults with a partner. Am J Geriatr Psychiatry. 2015;23:227–33.PubMedCrossRefGoogle Scholar
  6. 6.
    Negin J, Cumming R. HIV infection in older adults in sub-Saharan Africa: extrapolating prevalence from existing data. Bull World Health Organ. 2010;88:847–53.PubMedPubMedCentralCrossRefGoogle Scholar
  7. 7.
    Gott M, Galena E, Hinchliff S, et al. ‘Opening a can of worms’: GP and practice nurse barriers to talking about sexual health in primary care. Fam Pract. 2004;21:528.PubMedCrossRefGoogle Scholar
  8. 8.
    Gott M, Hinchliff S, Galena E. General practitioner attitudes to discussing sexual health issues with older people. Soc Sci Med. 2004;58:2093–103.PubMedCrossRefGoogle Scholar
  9. 9.
    Politi M, Clark M, Armstrong G, McGarry K, Sciamanna CN. Patient-provider communication about sexual health among unmarried middle-aged and older women. J Gen Intern Med. 2009;24:511–6.PubMedPubMedCentralCrossRefGoogle Scholar
  10. 10.
    Brooks JT, Buchacz K, Gebo KA, et al. HIV infection and older Americans: the public health perspective. (Author abstract). Am J Public Health. 2012;102:1516.PubMedPubMedCentralCrossRefGoogle Scholar
  11. 11.
    Schick V, Herbenick D, Reece M, et al. Sexual behaviors, condom use, and sexual health of Americans over 50: implications for sexual health promotion for older adults. J Sex Med. 2010;7:315–29.PubMedCrossRefPubMedCentralGoogle Scholar
  12. 12.
    Taylor A, Gosney MA. Sexuality in older age: essential considerations for healthcare professionals. Age Ageing. 2011;40:538–43.PubMedCrossRefGoogle Scholar
  13. 13.
    Tietz D.. Older Americans: the changing face of HIV/AIDS in America. 2013. Accesssed 01 Jul 2019.
  14. 14.
    Administration on Aging. HIV: know the RISKS. Get the FACTS. 2016. Accesssed 01 Jul 2019.
  15. 15.
    Hogg RS, Yip B, Chan KJ, Wood E, Craib KJ, O'Shaughnessy MV, et al. Rates of disease progression by baseline CD4 cell count and viral load after initiating triple-drug therapy. JAMA. 2001;286:2568–77.PubMedCrossRefGoogle Scholar
  16. 16.
    Patterson S, Cescon A, Samji H, Chan K, Zhang W, Raboud J, et al. Life expectancy of HIV-positive individuals on combination antiretroviral therapy in Canada. BMC Infect Dis. 2015;15:1–10. Scholar
  17. 17.
    •• Samji H, Cescon A, Hogg RS, et al. Closing the gap: increases in life expectancy among treated HIV-positive individuals in the United States and Canada. PLoS ONE. 2013;8. This study estimates changes in life expectancy among individuals living with HIV and on antiretroviral therapies (ART) from 2000–2007. The authors determined that a 20-year-old individual on ART in the USA or Canada could expect to live into their early 70s, a life expectancy that approaches that of the general population in these two countries. PubMedPubMedCentralCrossRefGoogle Scholar
  18. 18.
    Centers for Disease Control and Prevention. HIV surveillance report. 2014. Accesssed 01 Jul 2019.
  19. 19.
    • Brennan D, Emlet C, Eady A. HIV, sexual health, and psychosocial issues among older adults living with HIV in North America. Ageing Int. 2011;36:313–33 This paper describes some of the epidemiological trends among older adults living with or at risk for HIV in North America. The authors also review the current and emerging sexual health needs of this population.CrossRefGoogle Scholar
  20. 20.
    Grov C, Golub S, Parsons J, Brennan M, Karpiak SE. Loneliness and HIV-related stigma explain depression among older HIV-positive adults. AIDS Care. 2010;22:630–9.PubMedPubMedCentralCrossRefGoogle Scholar
  21. 21.
    Kalichman SC, Heckman T, Kochman A, Sikkema K, Bergholte J. Depression and thoughts of suicide among middle-aged and older persons living with HIV-AIDS. Psychiatr Serv. 2000;51:903–7.PubMedCrossRefGoogle Scholar
  22. 22.
    Shippy RA, Karpiak SE. The aging HIV/AIDS population: fragile social networks. Aging Ment Health. 2005;9:246–54.PubMedCrossRefGoogle Scholar
  23. 23.
    Dykstra PA, Fokkema T. Social and emotional loneliness among divorced and married men and women: comparing the deficit and cognitive perspectives. Basic Appl Soc Psych. 2007;29:1–12.CrossRefGoogle Scholar
  24. 24.
    Pinquart M. Loneliness in married, widowed, divorced, and never-married older adults. J Soc Pers Relat. 2003;20:31–53.CrossRefGoogle Scholar
  25. 25.
    Gurevich M, Mathieson CM, Bower J, et al. Disciplining bodies, desires and subjectivities: sexuality and HIV-positive women. Fem Psychol. 2007;17:9–38.CrossRefGoogle Scholar
  26. 26.
    •• Gay J, Hardee K, Croce-Galis M, et al. What works to meet the sexual and reproductive health needs of women living with HIV/AIDS. J Int AIDS Soc. 2011;14:56–56. This review identifies sexual and reproductive health interventions that have been effectively employed in resource-limited countries to address the needs of women living with HIV. The authors emphasize that there are a number of promising interventions, but they note that operationalizing these programs has been challenging. PubMedPubMedCentralCrossRefGoogle Scholar
  27. 27.
    Kennedy CE, Spaulding AB, Brickley DB, et al. Linking sexual and reproductive health and HIV interventions: a systematic review. J Int AIDS Soc. 2010;13:26–26.PubMedPubMedCentralCrossRefGoogle Scholar
  28. 28.
    Nunes S, Azevedo F, Lisboa C. Sexually transmitted infections in older adults – raising awareness for better screening and prevention strategies. J Eur Acad Dermatol Venereol. 2016;30:1202–4.PubMedCrossRefPubMedCentralGoogle Scholar
  29. 29.
    Jarman M, Walsh S, De Lacey G. Keeping safe, keeping connected: a qualitative study of HIV-positive women’s experiences of partner relationships. Psychol Health. 2005;20:533–51.CrossRefGoogle Scholar
  30. 30.
    •• Stevens PE, Galvao L. ‘He won’t use condoms’: HIV-infected women’s struggles in primary relationships with serodiscordant partners. Am J Public Health. 2007, 97:1015–22 In this longitudinal qualitative study, women living with HIV described their sexual behavior over time. Women who reported engaging in sexual activity without using a condom highlighted challenges negotiating condom use with their partners.PubMedPubMedCentralCrossRefGoogle Scholar
  31. 31.
    Von Elm E, Altman DG, Egger M, et al. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet. 2007;370:1453.CrossRefGoogle Scholar
  32. 32.
    Russell CK, Gregory DM. Evaluation of qualitative research studies. Evid Based Nurs. 2003;6:36–40.PubMedCrossRefGoogle Scholar
  33. 33.
    Boonyanurak P, Bunupuradah T, Wilawan K, Lueanyod A, Thongpaeng P, Chatvong D, et al. Age at menopause and menopause-related symptoms in human immunodeficiency virus–infected Thai women. Menopause. 2012;19:820–4.PubMedCrossRefGoogle Scholar
  34. 34.
    Chirinda W, Zungu N. Health status and years of sexually active life among older men and women in South Africa. Reprod Health Matters. 2016;24:14–24.PubMedCrossRefGoogle Scholar
  35. 35.
    Denis A, Hong S-M. Sexual functioning of women with HIV: a comparison with non-HIV women. Can J Hum Sex. 2003;12:97.Google Scholar
  36. 36.
    • Grodensky C, Golin C, Jones C, et al. ‘I should know better’: the roles of relationships, spirituality, disclosure, stigma, and shame for older women living with HIV seeking support in the South. J Assoc Nurses AIDS Care. 2015;26:12 This qualitative study examines the specific stressors faced by older women living with HIV in the Southeastern USA, where HIV-related stigma is particularly high. Some women reported that spirituality provided some support. PubMedCrossRefGoogle Scholar
  37. 37.
    • Kaida A, Carter A, De Pokomandy A, et al. Sexual inactivity and sexual satisfaction among women living with HIV in Canada in the context of growing social, legal and public health surveillance. J Int AIDS Soc. 2015; 18: n/a–n/a. This study investigates the influence of legal and public health surveillance of HIV on the sexual activity and well-being of women living with HIV. The authors suggest that some women may be choosing to abstain from sexual activity to resist surveillance by the state and avoid criminalization for non-disclosure. Google Scholar
  38. 38.
    Lovejoy TI, Heckman TG, Sikkema KJ, Hansen NB, Kochman A, Suhr JA, et al. Patterns and correlates of sexual activity and condom use behavior in persons 50-plus years of age living with HIV/AIDS. AIDS Behav. 2008;12:943–56.PubMedPubMedCentralCrossRefGoogle Scholar
  39. 39.
    Negin J, Geddes L, Brennan-Ing M, Kuteesa M, Karpiak S, Seeley J. Sexual behavior of older adults living with HIV in Uganda. Arch Sex Behav. 2016;45:441–9.PubMedCrossRefPubMedCentralGoogle Scholar
  40. 40.
    Nevedal A, Sankar A. The significance of sexuality and intimacy in the lives of older african americans with HIV/AIDS. Gerontologist. 2016;56:762–71.PubMedCrossRefGoogle Scholar
  41. 41.
    Psaros C, Barinas J, Robbins GK, Bedoya CA, Safren SA, Park ER. Intimacy and sexual decision making: exploring the perspective of HIV positive women over 50. AIDS Patient Care STDS. 2012;26:755–60.PubMedPubMedCentralCrossRefGoogle Scholar
  42. 42.
    Siegel K, Schrimshaw EW. Reasons for the adoption of celibacy among older men and women living with HIV/AIDS. J Sex Res. 2003;40:189–200.PubMedCrossRefGoogle Scholar
  43. 43.
    • Taylor TN, Munoz-Plaza CE, 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. 2017;46:1137 In this qualitative study of older women living with HIV in three US cities, some participants reported an increase in sexual pleasure and sexual freedom with age.PubMedCrossRefGoogle Scholar
  44. 44.
    Whyte J, Whyte MD, Cormier E. Down low sex, older African American women, and HIV infection. J Assoc Nurses AIDS Care. 2008;19:423–31.PubMedCrossRefPubMedCentralGoogle Scholar
  45. 45.
    Syrjala KL, Schroeder TC, Abrams JR, et al. Sexual function measurement and outcomes in cancer survivors and matched controls. J Sex Res. 2000;37:213–25.CrossRefGoogle Scholar
  46. 46.
    Vyavaharkar M, Moneyham L, Corwin S, Saunders R, Annang L, Tavakoli A. Relationships between stigma, social support, and depression in HIV-infected African American women living in the rural Southeastern United States. J Assoc Nurses AIDS Care. 2010;21:144–52.PubMedCrossRefPubMedCentralGoogle Scholar
  47. 47.
    Althof SE, Meston CM, Perelman MA, Handy AB, Kilimnik CD, Stanton AM. Opinion paper: on the diagnosis/classification of sexual arousal concerns in women. J Sex Med. 2017;14:1365–71.PubMedCrossRefPubMedCentralGoogle Scholar
  48. 48.
    Addis IB, Van Den Eeden SK, Wassel-Fyr CL, et al. Sexual activity and function in middle-aged and older women. Obstet Gynecol. 2006;107:755–64.PubMedPubMedCentralCrossRefGoogle Scholar
  49. 49.
    • de Pommerol M, Hessamfar M, Lawson-Ayayi S, Neau D, Geffard S, Farbos S, et al. Menopause and HIV infection: age at onset and associated factors, ANRS CO3 Aquitaine cohort. Int J STD AIDS. 2011;22:67–72 This paper demonstrates increased risk of early menopause among women living with HIV.PubMedCrossRefGoogle Scholar
  50. 50.
    Ferreira CE, Pinto-Neto AM, Conde DM, Costa-Paiva L, Morais SS, Magalhães J. Menopause symptoms in women infected with HIV: prevalence and associated factors. Gynecol Endocrinol. 2007;23:198–205.PubMedCrossRefPubMedCentralGoogle Scholar
  51. 51.
    Melissa WJ, Pamela OM, Pamela SM, et al. Early menopause predicts future coronary heart disease and stroke: the Multi-Ethnic Study of Atherosclerosis. Menopause. 2012;19:1081–7.CrossRefGoogle Scholar
  52. 52.
    Walter RA, Brandon GR, Virginia MM, et al. Premature menopause or early menopause and risk of ischemic stroke. Menopause. 2012;19:272–7.CrossRefGoogle Scholar
  53. 53.
    Svejme O, Ahlborg H, Nilsson J, Karlsson MK. Early menopause and risk of osteoporosis, fracture and mortality: a 34-year prospective observational study in 390 women. BJOG. 2012;119:810–6.PubMedCrossRefGoogle Scholar
  54. 54.
    Kanapathipillai R, Hickey M, Giles M. Human immunodeficiency virus and menopause. Menopause. 2013;20:983–90.PubMedCrossRefGoogle Scholar
  55. 55.
    Triant VA, Lee H, Hadigan C, Grinspoon SK. Increased acute myocardial infarction rates and cardiovascular risk factors among patients with human immunodeficiency virus disease. J Clin Endocrinol Metab. 2007;92:2506–12.PubMedPubMedCentralCrossRefGoogle Scholar
  56. 56.
    Michael YT, Chiyuan ZA, Donald MJ, et al. Higher rates of bone loss in postmenopausal HIV-infected women: a longitudinal study. J Clin Endocrinol Metab. 2012;97:554–62.CrossRefGoogle Scholar
  57. 57.
    Tariq S, Burns FM, Gilson R, et al. PRIME (Positive Transitions Through the Menopause) Study: a protocol for a mixed-methods study investigating the impact of the menopause on the health and well-being of women living with HIV in England. BMJ Open. 2019, 9. Scholar
  58. 58.
    De Villiers TJ, Gass MLS, Haines CJ, et al. Global consensus statement on menopausal hormone therapy. Climacteric. 2013;16:203–4.PubMedCrossRefGoogle Scholar
  59. 59.
    Zona S, Guaraldi G, Luzi K, Beggi M, Santi D, Stentarelli C, et al. Erectile dysfunction is more common in young to middle-aged HIV-infected men than in HIV-uninfected men. J Sex Med. 2012;9:1923–30.PubMedCrossRefGoogle Scholar
  60. 60.
    Brotto LA, Basson R. Group mindfulness-based therapy significantly improves sexual desire in women. Behav Res Ther. 2014;57:43–54.PubMedCrossRefGoogle Scholar
  61. 61.
    Freeman E, Anglewicz P. HIV prevalence and sexual behaviour at older ages in rural Malawi. Int J STD AIDS. 2012;23:490–6.PubMedPubMedCentralCrossRefGoogle Scholar
  62. 62.
    Freeman EK, Coast E. Sex in older age in rural Malawi. Ageing Soc. 2014;34:1118–41.CrossRefGoogle Scholar
  63. 63.
    •• Houle B, Mojola SA, Angotti N, Schatz E, Gómez-Olivé FX, Clark SJ, et al. Sexual behavior and HIV risk across the life course in rural South Africa: trends and comparisons. AIDS Care. 2018;30:1435–43 This population-based survey reveals similarities and differences in sexual risk and protective behaviors among young, middle-aged, and older adults in South Africa. Notably, the findings demonstrate risk for acquiring HIV among older adults, stemming from cross-generational sex and low condom use. PubMedPubMedCentralCrossRefGoogle Scholar
  64. 64.
    Todd J, Cremin I, Mcgrath N, et al. Reported number of sexual partners: comparison of data from four African longitudinal studies. Sex Transm Infect. 2009;85. Scholar
  65. 65.
    Marston M, Slaymaker E, Cremin I, et al. Trends in marriage and time spent single in sub-Saharan Africa: a comparative analysis of six population-based cohort studies and nine demographic and health surveys. Sex Transm Infect. 2009;85:1. i64–71.CrossRefGoogle Scholar
  66. 66.
    Jones GW, Gubhaju B. Factors influencing changes in mean age at first marriage and proportions never marrying in the low-fertility countries of East and Southeast Asia. Asian Popul Stud. 2009;5:237–65.CrossRefGoogle Scholar
  67. 67.
    Techasrivichien T, Darawuttimaprakorn N, Punpuing S, Musumari PM, Lukhele BW, el-Saaidi C, et al. Changes in sexual behavior and attitudes across generations and gender among a population-based probability sample from an urbanizing province in Thailand. Arch Sex Behav. 2016;45:367–82.PubMedCrossRefGoogle Scholar
  68. 68.
    •• Calabrese SK, Mayer KH. Providers should discuss U=U with all patients living with HIV. Lancet HIV. 2019;6:e211–3 The authors of this paper call for providers to communicate to their patients that, if their HIV viral load is suppressed, they cannot transmit the virus sexually. Awareness of this relationship may contribute to improved sexual health and well-being. PubMedCrossRefGoogle Scholar
  69. 69.
    Robinson B‘B’E, Bockting WO, Simon Rosser BR, et al. The Sexual Health Model: application of a sexological approach to HIV prevention. Health Educ Res. 2002;17:43–57.PubMedCrossRefGoogle Scholar
  70. 70.
    UNAIDS, Global Network of People Living with HIV. Positive health, digity, and prevention: a policy framework. 2011. Accesssed 01 Jul 2019.

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Amelia M. Stanton
    • 1
    • 2
    Email author
  • Georgia Goodman
    • 1
    • 2
  • Sara E. Looby
    • 3
    • 4
  • Gregory K. Robbins
    • 5
  • Christina Psaros
    • 1
  1. 1.Department of PsychiatryMassachusetts General Hospital/Harvard Medical SchoolBostonUSA
  2. 2.The Fenway InstituteFenway HealthBostonUSA
  3. 3.Program in Nutritional MetabolismMassachusetts General HospitalBostonUSA
  4. 4.Yvonne L. Munn Center for Nursing ResearchMassachusetts General HospitalBostonUSA
  5. 5.Division of Infectious DiseasesMassachusetts General Hospital/Harvard Medical SchoolBostonUSA

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