How gay, bisexual and other men who have sex with men living with HIV experience sexual dysfunction: a thematic analysis of interviews in Montreal, Canada.

BACKGROUND

Sexual dysfunction (SD) is prevalent, yet underaddressed, among gay, bisexual and other men who have sex with men (GBM) living with HIV. We aimed at exploring the perceived causes and effects of SD from the perspective of Montreal-based GBM with HIV.

METHODS

During 2024, semi-structured interviews were conducted with 31 Montreal-based GBM with HIV who experienced SD (reduced libido, erectile dysfunction, premature/delayed ejaculation or pain during sex) in the past 5 years, asking about perceived causes and impacts. Data were analyzed using reflexive thematic analysis.

RESULTS

Participants' median age was 46 years (range 27-74 years). The most common SDs were reduced libido (n = 26; 84%) and erectile dysfunction (n = 25; 81%). Participants reported a median of three concurrent SDs. Themes regarding the perceived causes of SD were: (1) biopsychosocial challenges across the lifespan, including aging, physical health (e.g. hormonal/cardiovascular problems), adverse life events and mental health problems; (2) living with HIV (in terms of HIV diagnosis and stigma) and concerns about antiretroviral therapy side-effects; and (3) gay sexual culture, which encompassed challenges in navigating expectations, relational/sexual ambivalence, and combining sex and drugs. Themes related to the impacts of SD included: (1) negative emotions (e.g. frustration, low self-esteem); (2) relational strain; and (3) adaptation (e.g. prioritizing intimacy over sex alone).

CONCLUSIONS

Findings highlight the multifaceted experience of SD among GBM with HIV. Participants perceived that biopsychosocial challenges across the lifespan, living with HIV and gay sexual culture contributed to SD. Although SD led to emotional and relational distress, participants indicated strategies to manage it.