Sexual difficulties in men who have sex with men living with HIV: their mental health and health-related quality of life

Abstract

Background: Health-related quality of life (HRQoL) is gaining significance for people living with human immunodeficiency virus (HIV), with sexual difficulties being a crucial yet frequently neglected component of HRQoL, especially in HIV-positive men who have sex with men (MSM).

Aim: The study sought to assess the levels of sexual difficulties and explore the associations between sexual difficulties, mental health, and HRQoL in HIV-positive MSM.

Methods: A cohort of 475 HIV-positive MSM was studied from January 2017 to December 2021. Sociodemographic, clinical, and lifestyle data were collected. Participants were divided based on Arizona Sexual Experience Scale (ASEX) scores into 2 groups: those with sexual difficulties and a control group without difficulties.

Outcomes: Psychological symptoms were evaluated by the Symptom Checklist-90 (SCL-90), HRQoL was accessed via 36-item Short Form Health Survey, and sexual function was assessed using the ASEX. We also employed path analysis to unveil latent mechanisms, alongside multivariate analysis to identify independent factors, and aimed to elucidate the interplay among sexual function, HRQoL, and mental health in HIV-positive MSM.

Results: A total of 391 HIV-positive MSM were enrolled in the control group and 84 in the sexual difficulties group. The control group had significantly higher physical HRQoL (P = .004) and mental HRQoL (P = .045). In addition, SCL-90 scores were higher in the sexual difficulties group (P = .001). Multivariate analyses that indicated regular exercise (odds ratio, 0.553; P = .024) and alcohol consumption (odds ratio, 1.780; P = .033) were independent factors associated with sexual difficulties. The proportion of alcohol consumption in the sexual difficulties group was significantly higher (P = .003). ASEX scores increased gradually with increasing frequency of alcohol consumption (P = .031). Results from structural equation model showed a negative association between HRQoL and ASEX scores (β = -0.13, P < .001) and SCL-90 scores (β = -0.40, P < .001).

Clinical implications: HIV-positive MSM experiencing sexual difficulties exhibited lower HRQoL and worse mental health, with independent associations identified for regular exercise and alcohol consumption in relation to sexual difficulties.

Strengths and limitations: Our research has pioneered in demonstrating that HRQoL mediates the relationship between sexual difficulties and psychological symptoms among HIV-positive MSM undergoing highly active antiretroviral therapy. We found the protective factor associated with sexual difficulties was regular exercise while the risk factor was alcohol consumption. However, the data were collected only from China, and it is still unclear how HRQoL changes after intervention.

Conclusion: Routine follow-up for people living with HIV should encompass an investigation into sexual function, emphasizing the need for timely assessment and intervention, particularly in HIV-positive MSM with identified risk factors.

Keywords: HIV/AIDS; alcohol consumption; health-related quality of life; psychological symptom; sexual difficulties.

Figure 1

The health-related quality-of-life (HRQoL) scores in the control and sexual difficulties groups in men who have sex with men (MSM) with human immunodeficiency virus (HIV). (A) Physical HRQoL scores in the control and sexual difficulties groups. (B) Physical HRQoL dimensions scores in the control and sexual difficulties groups. (C) Correlation between physical HRQoL scores and Arizona Sexual Experience Scale (ASEX) scores. (D) Mental HRQoL scores in the control and sexual difficulties groups. (E) Mental HRQoL dimensions scores in the control and sexual difficulties groups. (F) Correlation between mental HRQoL scores and ASEX scores. BP, bodily pain; GH, general health; MH, mental health; PF, physical functioning; RE, role-emotional; RP, role-physical; SF, social functioning; VT, vitality.

Figure 2

The Symptom Checklist-90 (SCL-90) in the control and sexual difficulties groups in men who have sex with men (MSM) with human immunodeficiency virus (HIV). (A) SCL-90 scores in the control and sexual difficulties groups. (B) SCL-90 dimensions scores in the control and sexual difficulties groups. (C) Correlation between SCL-90 scores and Arizona Sexual Experience Scale (ASEX) scores. (D) the proportion of SCL-90 dimension positive levels in the control and sexual difficulties groups. ANX, anxiety; DEP, depression; HOS, hostility; IS, interpersonal sensibility; OS, obsessive-compulsive; PAR, paranoid ideation; PHO, phobic anxiety; PSY, psychoticism; SOM, somatization.

Figure 3

Correlation of health-related quality of life (HRQoL) dimension scores and Symptom Checklist-90 (SCL-90) dimension scores in men who have sex with men (MSM) with human immunodeficiency virus (HIV). (A) Correlation between somatization scores and HRQoL scores. (B) Correlation between obsessive compulsive scores and HRQoL scores. (C) Correlation between interpersonal sensitively scores and HRQoL scores. (D) Correlation between depression scores and HRQoL scores. (E) Correlation between anxiety scores and HRQoL scores. (F) Correlation between hostility scores and HRQoL scores. (G) Correlation between phobic anxiety scores and HRQoL scores. (H) Correlation between paranoid ideation scores and HRQoL scores. (I) Correlation between psychoticism scores and HRQoL scores. (J) Correlation between SCL-90 scores and HRQoL scores. (K) Correlation between SCL-90 scores and physical HRQoL scores. (L) Correlation between SCL-90 scores and mental HRQoL scores.

Figure 4

Univariate and multivariate analyses associated with sexual difficulties, health-related quality of life (HRQoL), and psychological symptoms in men who have sex with men (MSM) with human immunodeficiency virus (HIV). (A) Forest plot of univariate regression analysis associated with sexual difficulties. (B) Forest plot of multivariate regression analysis associated with sexual difficulties. (C) Forest plot of univariate regression analysis associated with HRQoL. (D) Forest plot of multivariate regression analysis associated with HRQoL. (E) Forest plot of univariate regression analysis associated with psychological symptom. (F) Forest plot of multivariate regression analysis associated with psychological symptom.

Figure 5

Structural equation model for the mediation mechanism of health-related quality of life (HRQoL) with standardized beta weights and significant level. ^***P < .001; the model reflected a good model fit: (χ²: 266.922; degrees of freedom: 52; χ²/degrees of freedom: 5.133; goodness-of-fit index: 0.913; normed fit index: 0.942; incremental fit index: 0.953; Tucker-Lewis index: 0.940; comparative fit index: 0.953; root mean square error of approximation: 0.094).

Figure 6

The role of regular exercise in sexual difficulties, health-related quality of life (HRQoL), and psychological symptom in men who have sex with men (MSM) with human immunodeficiency virus (HIV). (A) Proportion of regular exercise in the control and sexual difficulties groups. (B) Proportion of different regular exercise frequency in the control and sexual difficulties groups. (C) Arizona Sexual Experience Scale (ASEX) scores in MSM with HIV with or without regular exercise. (D) Physical HRQoL scores and mental HRQoL scores according to different regular exercise frequency. (E) Total HRQoL scores according to different regular exercise frequency. (F) HRQoL dimensions scores according to different regular exercise frequency. (G) Symptom Checklist-90 (SCL-90) dimension scores according to different regular exercise frequency. (H) the proportion of SCL-90 dimension positive levels in different regular exercise. ANX, anxiety; DEP, depression; HOS, hostility; IS, interpersonal sensibility; OS, obsessive-compulsive; PAR, paranoid ideation; PHO, phobic anxiety; PSY, psychoticism; SOM, somatization.

Figure 7

The role of alcohol consumption in sexual difficulties, health-related quality of life (HRQoL), and psychological symptoms in the men who have sex with men (MSM) with human immunodeficiency virus (HIV). (A) Proportion of different alcohol consumption frequency in the control and sexual difficulties groups. (B) Arizona Sexual Experience Scale (ASEX) scores according to different regular exercise frequency. (C) Proportion of alcohol consumption frequency in positive or negative Symptom Checklist-90 (SCL-90) dimensions. (D) SCL-90 dimension scores according to different alcohol consumption frequency. ANX, anxiety; BP, bodily pain; DEP, depression; GH, general health; HOS, hostility; IS, interpersonal sensibility; MH, mental health; OS, obsessive-compulsive; PAR, paranoid ideation; PF, physical functioning; PHO, phobic anxiety; PSY, psychoticism; RE, role-emotional; RP, role-physical; SF, social functioning; SOM, somatization; VT, vitality.