Sexual desire and associated factors among older adults living with HIV: a cross-sectional study

With the widespread availability of antiretroviral therapy (ART), HIV infection has become a manageable chronic condition, leading to a significant increase in the population of older adults living with HIV (OALHIV). Sexual health is a crucial yet often neglected dimension of comprehensive care for this group, as their sexual desire is rarely proactively assessed. Guided by the biopsychosocial model, this study aimed to identify factors associated with sexual desire among OALHIV.

A cross-sectional study was conducted at designated ART institutions in Luzhou, China, from May to November 2021. A total of 316 OALHIV (aged ≥ 50 years) were enrolled using convenience sampling. We designed a questionnaire to assess the sexual desire of OALHIV and the associated factors. Sexual desire was measured using a single binary item: "Do you currently have sexual desire?" (Yes/No). Chi-square test, t-test, and Fisher's exact test were used for univariate analysis of sexual desire, and variables with statistical significance were included in binary logistic regression analysis to determine the factors associated with sexual desire.

Among the 316 participants, 31.6% reported having sexual desire. Multivariate logistic regression analysis revealed that younger age (OR = 0.907, 95% CI: 0.872-0.943), male gender (OR = 3.395, 95% CI: 1.665-6.924), and higher life satisfaction (OR = 1.561, 95% CI: 1.268-1.923) were significantly associated with increased odds of reporting sexual desire. Compared with the lowest income group (< 1000 RMB), middle-income groups (1001-3000 RMB) had significantly higher odds of reporting sexual desire, suggesting an inverted U-shaped association.

Sexual desire is prevalent among over 30% of OALHIV, challenging societal stereotypes of "asexual aging". Younger age, male gender, higher life satisfaction, and a middle-income level (in an inverted U-shaped pattern) are significantly associated factors. The biopsychosocial model offers a comprehensive framework for understanding these multifaceted factors. These findings underscore the importance of integrating sexual health assessment into routine geriatric HIV care and developing gender-sensitive, age-specific interventions to improve overall well-being in this growing population. However, the single-item measure may not capture the full multidimensional nature of sexual desire, and this limitation should be considered when interpreting the findings.