A total of 2783 men accessed the survey website; 1769 (63%) completing all portions of the questionnaire related to sexual function and HIV status. This initial cohort had a mean age of 38.8 years old; range, 18–79. After exclusion of men younger than 30 years, 1361 (49%) men constituted the final study cohort with mean age 42.6±9.47 years. Of these men, 1125 (82.7%) were HIV-negative, 110 (8.1%) were HIV-positive/AIDS-positive and 126 (9.2%) were HIV-positive/AIDS-positive. Ethnodemographic data are summarized in . There was a trend toward greater prevalence of hyperlipidemia, neurologic dysfunction, severe LUTS, depression, and use of both illicit drugs and PDE5 inhibitors with progressively more advanced HIV status.
Demographic Information (n=1347)
Information on sexual activity is presented in , stratified by HIV serostatus. Test for trend indicated that HIV-positive men were significantly less likely to report a regular partner and more likely to report higher risk sexual activity and/or history of higher risk sexual behavior (more lifetime partners, sex with strangers, condom usage with anal sex fewer than 75% of occasions).
Sexual Practices as Reported, Stratified by HIV/AIDS Status
The mean IIEF-EF scores with standard deviation were 26.1±5.2, 25.3±6.1, and 25.3±7.3 for men in the HIV-negative, HIV-positive/AIDS-negative, and HIV-positive/AIDS-positive cohorts, respectively. Test for trend indicated significantly (p<0.001) progressively lower mean IIEF-EF scores with progression of HIV status. The percentage of men who reported moderate/severe ED (IIEF-EF<16) is presented in , stratified by age and HIV status. In men 40–59 years of age, there was a significant trend toward greater incidence of ED when stratified by progressively more advanced HIV/AIDS status. Although there appeared also to be a trend towards greater incidence of ED with advanced HIV-positive status in subjects younger than 40 and older than 60 years, this trend was not statistically significant (p>0.05).
Percentage of population with erectile dysfunction (ED).
Bivariate and multiple logistic regression models for odds of reporting ED are presented in . Before adjustment for other variables (), HIV infection was a risk factor for moderate/severe ED (odds ratio [OR]=2.24). When HIV-positive men were subdivided into HIV-positive/AIDS- and HIV-positive/AIDS-positive groups (), the odds of ED in men reporting HIV infection alone were no longer significantly different from HIV-negative men (OR 1.63). On the other hand, men with HIV and AIDS had significantly increased odds of reporting ED relative to HIV-negative men (OR 2.84). After multivariate adjustment (), men in the HIV-positive/AIDS-positive group had greater odds of ED (OR=2.80). Ten-year incremental increase in age, diabetes, and severe LUTS were also significantly associated with greater odds of ED after multivariate adjustment (). Men with a regular sexual partner had lower odds of ED (OR=0.42). No other variables were associated with significantly different odds of moderate/severe ED after multiple variable adjustment (data not shown).
Logistic Regression for Odds of Moderate/Severe Erectile Dysfunction
The mean PEDT scores with standard deviation were 4.2±4.2, 4.5±4.4, and 4.5±4.2 for men in the HIV-negative, HIV-positive/AIDS-negative, and HIV-positive/AIDS-positive cohorts, respectively. Test for trend did not indicate significantly (p=0.112) progressively higher mean PEDT scores with progression of HIV status. The age-adjusted percentage of men who met criteria for risk of PE (PEDT ≥9) is presented in , stratified by HIV status. Test for trend indicated a significantly greater incidence of PE with advanced HIV-positive status in the 30–39 age range. Although the incidence of PE was highest in men with HIV and AIDS for all age cohorts, this trend was not statistically significant in any group older than 40 years.
Percentage of population with premature ejaculation (PE).
Bivariate and multiple logistic regression models for odds of reporting PE are presented in . Before adjustment for other variables (), HIV-infection was a risk factor for PE (OR=1.44). Men with HIV and AIDS had significantly increased odds of reporting PE compared to HIV-negative men (OR 1.58). However, after multivariable adjustment (), HIV/AIDS status was no longer significantly associated with odds of PE. Severe LUTS was independently associated with an increased risk of PE, whereas a 10-year incremental increase in age was associated with lower odds of PE (). No other variables were associated with significantly different odds of PE after multiple variable adjustment (data not shown).
Logistic Regression for Odds of Premature Ejaculation
The percentage of men (categorized by age) who had sought help from a health care provider for problems with sexual function is depicted in . HIV-positive men younger than 60 years were significantly more likely to have sought help for sexual problems compared to HIV-negative men; the difference in help-seeking behavior based on HIV status in men over the age of 60 did not attain strict statistical significance (p=0.084). Use of PDE5 inhibitor drugs was much more common in HIV-infected men in our cohort (31.8%, 53.6%, 57.9% for HIV-negative, HIV-positive/AIDS-negative, HIV-positive/AIDS-positive, respectively).
Percentage of men who have sought medical help for sexual problems, stratified by age and HIV status.