Sexual Activity, Sexual Function, and Sexual Satisfaction Among Women Living with HIV: A Feminist Scoping Review of 20 Years of Global Epidemiological Research
Bibliographic record
Abstract
Utilizing critical feminist theory, we conducted a scoping review of two decades worth of epidemiological research on sexual activity, function, and satisfaction among women living with HIV (WLWH). Studies in English from all geographic locations from 1996 onwards, where WLWH made up all or part of the sample, were considered. Our approach involved five stages: selecting articles; charting information; comparing studies; synthesizing data; and engaging stakeholders including WLWH. Twenty-nine studies involving 10,035 WLWH were found. Forty-eight percent were mixed-gendered studies that generally overlooked the different sexual realities of women and men. While samples were diverse with respect to age, ethnicity, and socio-economic status, studies provided a largely North American and Euro-centric, heterosexual, cis-gender picture of sexuality, with multiple underlying assumptions (e.g., sex-as-penetration, sex-as-mandatory). The reviewed studies suggest that women experience declines in sexual activity, function, and satisfaction following HIV diagnosis. The extent of such declines; however, is varied, with numerous contextual forces shaping women’s sexual well-being. While studies are frequently framed through a medical lens of individual “disease”, findings revealed little evidence that clinical markers of HIV, including viral load and CD4 cell count, predict sexual outcomes. Rather, women’s experiences of sexuality are primarily influenced by the effects of HIV-related stigma (e.g., shame, fear) intersecting with other social, economic, and life-course factors, including romantic relationships, violence and mental health, poverty and addiction, and aging and menopause. These factors; however, remain under-researched in favour of biological determinants. Moreover, women who deviated from heteronormative expectations of ‘healthy’ sexuality (i.e., high levels of desire, arousal, penetrative sex, orgasm) were pathologized as dysfunctional and in need of fixing.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.014 | 0.038 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.003 | 0.003 |
| Bibliometrics | 0.029 | 0.024 |
| Science and technology studies | 0.002 | 0.002 |
| Scholarly communication | 0.004 | 0.004 |
| Open science | 0.001 | 0.002 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".