Menopausal status, age and management among women living with HIV in the UK.

BACKGROUND: There is currently little evidence exploring menopausal status, age at last menstrual period (LMP) and management of menopause among women living with HIV aged 45-60 years in England. METHODS: Socio-demographic, lifestyle and clinical data were collected through a self-completed cross-sectional survey. Longitudinal CD4 count and viral load data were available from linkage to clinical records, if consent was provided. Women were categorised as pre-, peri- or post-menopausal. Factors associated with menopausal stage were examined using ordinal logistic regression adjusting for age. Age at LMP was estimated using Kaplan-Meier survival analysis. RESULTS: The 847 women had a median age of 49 [interquartile range (IQR): 47-52] years. Most were of black ethnicity (81.3%), were born outside the UK (85.0%) and had completed secondary education (88.7%); 177 (20.4%), 373 (43.0%) and 297 (34.2%) were pre-, peri- or post-menopausal, respectively. After adjusting for age, associations of menopausal status with non-cohabiting relationship [adjusted odds ratio = 0.63 (95% confidence interval: 0.43-0.91)], baseline viral load ≥ 100 000 copies/mL [2.67 (1.20-5.94)] and unemployment [1.34 (0.97-1.84)] remained significant. Median (IQR) age at LMP was 54 (51-55) years in the group. In total, 27.9% (233/836) of women reported severe menopausal symptoms; 45.6% of those with somatic symptoms had heard of hormone replacement therapy and 8.7% had used it. Only 5.6% of women with urogenital symptoms had used topical oestrogen. CONCLUSIONS: Our findings highlight the importance of educating both women and their healthcare providers about menopausal symptoms and management options.

The association between severe menopausal symptoms and engagement with HIV care and treatment in women living with HIV.

Using data from the PRIME Study, an observational study of the menopause in women living with HIV in England, we explored the association between menopausal symptoms and: (i) antiretroviral therapy (ART) adherence and (ii) HIV clinic attendance. We measured menopausal symptom severity with the Menopause Rating Scale (MRS, score ≥17 indicating severe symptoms), adherence with the CPCRA Antiretroviral Medication Adherence Self-Report Form, and ascertained HIV clinic attendance via self-report. Odds ratios were obtained using logistic regression. Women who reported severe menopausal symptoms had greater odds of suboptimal ART adherence (adjusted odds ratio (AOR) 2.22; 95% CI 1.13, 4.35) and suboptimal clinic attendance (AOR 1.52; 95% CI 1.01, 2.29). When psychological, somatic and urogenital domains of the MRS were analysed individually there was no association between adherence and severe symptoms (all p > 0.1), however there was an association between suboptimal HIV clinic attendance and severe somatic (AOR 1.98; 95% CI 1.24, 3.16) and psychological (AOR 1.76; 95% CI 1.17, 2.65) symptoms. Severe menopausal symptoms were significantly associated with sub-optimal ART adherence and HIV clinic attendance, however we cannot infer causality, highlighting the need for longitudinal data.

'We can't be perfect all the time': Life with HIV before antiretrovirals: A narrative analysis of early published stories by women with HIV in the United Kingdom.

OBJECTIVES: The experiences of women like me, diagnosed with HIV before the development of effective antiretrovirals, tend to be neglected and overlooked. Research, policy and services can better serve us if our lived experiences are known and understood within a contextual framework. This small study revisited published personal experience stories by women diagnosed with HIV before 1992 in order to examine what the women said and why. METHODS: Due to limited data, a single published collection of 12 stories was chosen, Positively Women: Living with AIDS. Narrative analysis was used to make some overarching sense of identified themes, plots and genres within the women's accounts. This method allows for a deep contextual reading. I adopted an inductive and reflexive approach using my lived experience to weave in contextual detail and analysis. FINDINGS: In their search for sense-making, the women often expressed their life with HIV as transformative. Speaking out and peer support helped women construct a more positive identity and develop strategies for survival that were influenced by ideas contextually situated in an emerging public health crisis. However, women also felt defined and confined by their status, and others spoke of a conflict in living up to an emerging HIV subjecthood that was adherent to wellness regimes, self-improvement and positive thinking. CONCLUSION: The analysis brings to light some of the contradictions and conflicts within these early HIV narratives. Contextually examining women's narratives from the perspective of lived experience offers new readings and fresh insights into wider cultural narratives that may resonate with today's stories of living with HIV.