The Sexuality of Women Living With HIV: Care Demands and Implications for Practice.

ObjectiveTo understand perceptions of sexuality and care needs from the perspective of women living with human immunodeficiency virus (HIV) and health professionals.MethodThis exploratory qualitative study was conducted in 2 specialized secondary-care services in Brazil. Participants included women living with HIV (WLHIV) aged ≥18 years receiving ongoing follow-up and healthcare professionals involved in their care for at least 6 months. Semistructured interviews were conducted between September and November 2024. Data were analyzed using inductive thematic content analysis, and interpretation was informed by Bronfenbrenner's ecological model to integrate individual, relational, and structural dimensions. The final sample comprised 13 WLHIV and 9 healthcare professionals, with recruitment completed upon theoretical saturation.Resultstwo themes were identified. The first indicated that WLHIV frequently experience sexuality as a domain marked by fear, guilt, and anticipated judgment rooted in HIV-related stigma and strained intimate relationships. Concerns related to transmission, rejection, and disclosure limited sexual activity, generated emotional distress, and hindered new partnerships. Some women, however, described processes of reframing sexuality through emotional support, strengthened self-care, and renewed trust in partners. The second theme highlighted insufficient professional preparedness, including limited training, discomfort discussing sexual health, and reliance on biomedical and preventive guidance. Conversations about sexuality were typically patient-initiated and constrained by time pressures, cultural norms, and generational differences.Final considerationsFindings underscore the need to integrate sexuality into HIV care for WLHIV, addressing the impacts of stigma and gaps in professional training. Advancing sexual health in this population requires public policies and ongoing capacity-building to support comprehensive, humanized, and nonjudgmental care.