Cove Jeff, Petrak Jenny
Infection and Immunity, MED, Barts and the London NHS UK, Royal London Hospital, Whitechapel, London E1 1BB, UK.
Int J STD AIDS. 2004 Nov;15(11):732-6. doi: 10.1258/0956462042395221.
Our objective was to determine factors associated with sexual problems in a sample of HIV-seropositive gay male clinic patients. Using a cross-sectional survey design a volunteer sample of 78 outpatient HIV-seropositive gay male service users completed a self-report questionnaire. This examined sexual problems, their perceived causes and associated factors including demographics, health status, sexual behaviour, self-justifications for sexual risk-taking and mood state (Hospital Anxiety and Depression Scale). Fifty (69%) of 78 HIV-positive gay men reported one or more sexual problems. Erectile dysfunction (ED) was reported by 38% rising to 51% in the context of trying to use condoms. Loss of interest in sex was reported by 41% and 24% experienced delayed ejaculation. The presence of sexual problems affected condom use in that 33 (90%) of the 37 gay men who had ED associated with condom use were inconsistent condom users in insertive sex compared to 28% of those not having this type of ED (P < 0.001). The presence of ED did not reduce the frequency of anal intercourse but those with ED associated with condoms were significantly more likely to have had receptive anal sex in the past three months (62%) compared to men without ED with condoms (38%) (P = 0.05). Risk cognitions such as wanting to lose oneself in sex, leaving responsibility for condom use to the active partner and perceptions that condoms interfere with pleasure were significantly more likely to be endorsed by those who report ED with condoms. Other factors associated with sexual problems included low T-cell counts (i.e. < 200). Psychological explanations were the most frequently cited causes of sexual problems, whether alone or in interaction with HIV disease itself, and combination therapy. A high incidence of sexual problems was found amongst this sample of HIV-positive gay men. Untreated sexual dysfunctions may contribute to sexual risk-taking and therefore HIV clinics need to address both issues. Further research is required to better understand the role of psychological factors, HIV disease itself and combination therapy in the incidence and treatment of sexual problems.
我们的目标是确定在一组HIV血清反应呈阳性的男同性恋门诊患者样本中，与性问题相关的因素。采用横断面调查设计，78名门诊HIV血清反应呈阳性的男同性恋服务使用者组成的志愿者样本完成了一份自我报告问卷。该问卷调查了性问题、其感知到的原因及相关因素，包括人口统计学特征、健康状况、性行为、对性行为冒险的自我辩解以及情绪状态（医院焦虑抑郁量表）。78名HIV阳性男同性恋者中有50名（69%）报告了一个或多个性问题。38%的人报告有勃起功能障碍（ED），在尝试使用避孕套的情况下这一比例升至51%。41%的人报告对性失去兴趣，24%的人经历射精延迟。性问题的存在影响了避孕套的使用，在37名因使用避孕套而出现ED的男同性恋者中，有33名（90%）在插入式性行为中使用避孕套不规律，相比之下，没有这种类型ED的人这一比例为28%（P<0.001）。ED的存在并没有降低肛交的频率，但与使用避孕套相关的ED患者在过去三个月中进行接受性肛交的可能性显著高于未患ED的使用避孕套的男性（分别为62%和38%）（P=0.05）。诸如想在性行为中迷失自我、将使用避孕套的责任留给主动方以及认为避孕套会干扰快感等风险认知，在报告因使用避孕套而出现ED的人群中更有可能得到认同。与性问题相关的其他因素包括低T细胞计数（即<200）。心理因素被认为是性问题最常见的原因，无论是单独存在还是与HIV疾病本身及联合治疗相互作用。在这个HIV阳性男同性恋者样本中发现性问题的发生率很高。未治疗的性功能障碍可能导致性行为冒险，因此HIV诊所需要同时解决这两个问题。需要进一步研究以更好地理解心理因素、HIV疾病本身及联合治疗在性问题的发生率和治疗中的作用。
