Sexual Quality of Life and Association With HIV and Sexually Transmitted Infections Among a Cohort of Heterosexual Couples in Kenya
Sexual Quality of Life and Association With HIV and Sexually Transmitted Infections Among a Cohort of Heterosexual Couples in Kenya
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DOI：
10.1016/j.jsxm.2018.08.007
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发表时间：
2018-10-01
影响因子：
3.5
通讯作者：
Bailey, Robert C.
中科院分区：
文献类型：
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作者：
Mehta, Supriya D.;Nordgren, Rachel K.;Bailey, Robert C.
性生活质量（SQoL）是性健康的一个重要组成部分，在撒哈拉以南非洲地区流行艾滋病毒和性传播感染（STI）的环境中尚未得到充分研究。目的：我们试图评估肯尼亚基苏木异性恋夫妇的SQoL，以及这与艾滋病毒状况、性传播感染和性行为之间的关系。方法：这是一项社区招募夫妇的前瞻性队列研究。在基线、6个月和12个月时测量SQoL、HIV状态、单纯疱疹病毒(HSV)-2状态、细菌性阴道病（BV）、性行为和社会人口统计学。考虑伴侣特征，对女性和男性分别进行随机截距多变量线性回归拟合。主要观察指标：采用女性问卷调查18项，男性问卷调查11项的方式评估生活质量。结果：从2014年4月到2016年7月，252对夫妇入组，并随访至2017年9月。基线时，女性的中位年龄为23岁，10%的HIV阳性，53%的HSV-2血清阳性，22%的BV阳性。基线时，男性的中位年龄为26岁，12% HIV阳性，47% HSV-2血清阳性，56%包皮环切。男性的平均质量满意度（88）高于女性（78），随着时间的推移，得分保持一致。在多变量分析中（各P < 0.05）， SQoL问卷女性（SQoL- f）得分降低：男性伴侣报告性生活感觉比他希望的更粗糙（下降9.5分），女性HSV-2血清阳性（下降5.15分），女性报告阴道干燥（下降5.27分）；在BV女性中，SQoL-F得分随着近期性行为（下降8.27分）和年龄的增加（每增加1年年龄下降0.75分）而下降。年龄和近期性别不影响无BV女性的SQoL-F。男性有工作的男性得分下降4.99分，最近有多个性伴侣的男性得分下降4.52分，女性伴侣在心情不好时发生性行为的HIV阳性男性得分下降29.5分。女性伴侣的身体质量指数每增加1 u，男性的SQoL就会增加0.84分，而女性伴侣最近有过性行为的艾滋病毒阳性男性的SQoL则会增加17.6分。临床意义：在性伙伴关系中，男性的生活质量高于女性，而细菌性阴道炎和性传播感染对生活质量的不利影响女性大于男性。优势和局限性：需要进行研究，以确保在sql测量尚未验证的环境中测量相关领域，以及生理和心理相关的可靠测量。结论：重视性服务质量，可以加强预防艾滋病毒和性传播感染的干预措施，全面改善性健康状况。版权所有，作者2018年由爱思唯尔公司代表国际性医学学会出版。
Introduction: Sexual quality of life (SQoL) is a critical component of sexual health and is understudied in Sub-Saharan African settings with endemic HIV and sexually transmitted infection (STI).Aim: We sought to assess SQoL among heterosexual couples in Kisumu, Kenya, and how this was associated with HIV status, STIs, and sexual practices.Methods: This was a prospective cohort study of community-recruited couples. SQoL, HIV status, herpes simplex virus (HSV)-2 status, bacterial vaginosis (BV), sexual practices, and sociodemographics were measured at baseline, 6 months, and 12 months. Multivariable linear regression with random intercept was fitted separately for females and males, accounting for partner characteristics.Main Outcome Measure: SQoL was assessed with an 18-item female and 11-item male survey.Results: From April 2014 through July 2016, 252 couples were enrolled, and followed up through September 2017. At baseline, women were median age 23 years, 10% HIV positive, 53% HSV-2 seropositive, and 22% with BV. At baseline men were median age 26 years, 12% HIV positive, 47% HSV-2 seropositive, and 56% circumcised. Mean SQoL was higher for men (88) than women (78), with consistent scores over time. In multivariable analysis (P < .05 each), SQoL Questionnaire Female (SQoL-F) score was reduced with: male partner report that sex felt rougher than he would have liked (9.5-point decrease), female HSV-2 seropositivity (5.15-point decrease), female reported having dry vaginal sex (5.27-point decrease); among women with BV, SQoL-F score declined with recent sexual activity (8.27-point decrease) and increasing age (0.75-point decrease per 1 year increase in age). Age and recent sex did not affect SQoL-F for women without BV. SQoL Questionnaire Male score was decreased 4.99 points if male was employed, 4.52 points if male reported multiple recent sex partners, and 29.5 points for HIV positive men whose female partner reported having sex when not in the mood. Men's SQoL increased by 0.84 points for each 1-U increase in female partner body mass index and 17.6 points for HIV positive men whose female partner reported recent sex with him.Clinical Implications: Within sexual partnerships, men had greater SQoL than women, and the adverse impact of BV and STIs on SQoL was greater for women than men.Strength & Limitations: Research is needed to ensure relevant domains are measured in settings where measure of SQoL has not been validated, along with robust measures of physiologic and psychologic correlates.Conclusion: More attention to SQoL as an outcome may strengthen interventions aimed at preventing HIV and STIs and improving sexual health holistically. Copyright (C) 2018, The Authors. Published by Elsevier Inc. on behalf of the International Society for Sexual Medicine.