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Women naturally produce small quantities of testosterone, released by the adrenal glands and ovaries.

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Emotional Brain is also developing a sister pill to Lybrido called Lybridos, which contains buspirone, an anti-anxiety drug. The buspirone is intended to lower inhibition—the feeling that puts the brakes on sex or distracts from desire—by causing the short-term suppression of seratonin levels. Brotto helped develop the new criteria for defining SIAD formerly called HSDD, or hypoactive sexual desire disorder in the DSM-5, the latest edition of the medical reference book, and says that clinicians will first ask women whether their lack of lust is affecting their lives negatively.

There are six other criteria see sidebar belowand three are required for diagnosis. For a clinical diagnosis of sexual interest arousal disorder SIADwomen must meet three of the following criteria for at least six months: The after-work rush of daycare, dance, soccer, dinner, homework and bedtime can be downright draining for those of us who barely have time to take off our coats, let alone pull out the lacy lingerie.

Often, says Brotto, the role of lover falls to the bottom of the list. When Cross gets home from her job running a media company, she just wants to be left alone. Once the kids were in bed I just wanted my own space without little hands all over me. Sometimes talking or arguing about not having sex takes up the same amount of time as actually doing it, she says. And it adds to the feeling of never having time. She has significant concerns about the long-term safety of taking any amount of testosterone, and says she would be hesitant to prescribe Lybrido until more extended studies have been conducted.

She waits to prescribe any medication until large-scale randomized trials have proved that it works, without side effects. There are so many factors involved: Hormonal birth control including traditional oral contraceptives can hamper desire for some women, as can antidepressants.

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Some studies have linked oral contraceptives to decreased levels of androgens, the group of hormones that includes testosterone. For women who are breastfeeding, sex can become uncomfortable due to lowered estrogen levels, which can cause vaginal dryness. Like Gunter, Lori Brotto, the Vancouver psychologist, has her doubts.

But women need to address their different issues and have discussions about their expectations and their needs.

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Lybrido and Lybridos may only help the small subset of women who cannot become physically aroused, she says. While she loves her husband, she describes their sex life, after 12 years together, as dismal. The resentment toward me for not meeting his needs is a gigantic problem in our marriage.

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All relationships—especially long-term ones—go through highs and lows when it comes to passion. Remember that intimacy can come in all forms, and simple or even sappy displays of affection, such as holding hands or stealing a quick kiss, can help partners who are having sexual issues.

Hold hands and cuddle on the couch watching TV. If even this kind of affection feels like work, then it may be time to seek professional help. In addition to their concerns, they were still physically weak and had lots of physical signs of the illness. They talked about their desire to advise partners to go for tests before they decided to have sex with them and also using condoms with partners all the time.

This was however, not the case for many of them as they improved health and engaged in sexual relationships without disclosing their own status or knowing the HIV status of their partners. Ever since I started taking these drugs, I have never had sex again I no longer like sexual relationships because of what happened to me; I gave up all about sex.

Many had children prior to falling ill and some had been forced to send their children to live with relatives when they were unable to take care of them. They also talked about their fears of bearing children who were HIV positive and the burden they would leave their relatives taking care of their children and therefore felt that having any more children was not a good idea: I have taken a long time without having sex I am still seeking for health I can't engage myself in such issues now.

I told you that I have children and I don't stay with them. Now if I get a partner she has to deliver more children and it will be a problem again on my side. Some still talked about sex as something that 'hurt' their health and should be avoided while others reported that they still had vivid memories of the counselling sessions they had received concerning sexual activity.

They also talked about being focused on bringing up their children now that they were feeling better while others reported a diminished sexual desire as a result of ageing.

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I do not think I will change [decision to abstain] because I don't have it in mind For the sake of my health, I cannot involve myself in that It is something that hurt my health that is why for me I decided to give up on that. Ah aha, according to what I have seen I don't still have that time, the things that I am thinking are very different I am thinking about what my children are going to eat at lunch.

According to many participants their desire for sex was reversed by ART and hence with continued use, they reported that their desire had increased markedly. While women were likely to mention their motivations to resume sexual activity as being desire for children and material support, men mentioned reasons such as: They said that their main reason for resuming sex at three months on ART was mainly for the sake of their partners.

A male participant separated with his wife: For me I didn't have energy for having sex but I could force myself in order not to lose the marriage. Now that I am alone, I am just thinking about my life. They said that they hoped that in addition to catering for their sexual needs, such partners would provide them with support in taking medications as they too would have experienced what it is to be on ART.

They talked about finding such partners through the HIV clinics they attended: I told you that I stopped that and I sealed it but you never know if God recovers me well, maybe I will get one [partner] but I must get one who is already infected. I will go to the office and enquire from my counsellor whether there is a person who is HIV positive like me.

I want to get a person who knows my problem and I know her problem so that we can remind each other to take the drugs. They attributed their renewed sexual desire to the use of the ART and a sign that their health was improving.

I am regaining the desire for sex unlike before when I had no interest in having it It is not like before when I had lost appetite and I couldn't eat anything.

At 18 months, some of the participants especially men who reported that they had resumed sex had started arguing that sex was something made by God and should not be neglected. Although many of the participants reported that they had resumed sex, their sexual encounters were less frequent compared to before they fell ill and started ART. Well, that one is not compulsory that I have to be with a sexual partner but as you know things which were made by God [meaning things like sex] you cannot reject because of having AIDS.

When I feel like having it [sex], I can get one but not frequenting it I don't deny I get one. My friend as I told you that you never know, it is what happened to me when I took these drugs, my life improved and even the desire for sex restarted and I got a sexual partner and I found myself being pregnant. Love is blind and it is worse with alcohol, you can suspect someone to be HIV positive before taking it [alcohol] and after taking it you become blind. After having sex for sometime the mind forgets all about the sickness and you remove the condom.

They recounted what they had reported in the interviews in the earlier rounds about never engaging in sex, but as their health got better it became difficult to keep their word. Hence, at 30 months on ART, many participants considered themselves as "normal" and said that as "normal people" one of the healthy functions was to have sexual desires.

They also reported that drugs had increased their desire for sex, contrary to what many had mentioned at three and six months about the drugs having diminished their sexual desire: After taking drugs for six months the desire started. Let me tell you [interviewer], "when there is health there is life". I had thought that I would never work. These thoughts were similar to ever having a relationship. I tried very much to be single but when I couldn't hold on any longer I got someone who was also with TASO and is on medication.

They reported that they had requested the counsellor to help them to find a suitable person God helped me [ The problem was solved and I am now okay. Some had plans of getting married to their partners but feared disclosing their HIV serostatus as this could risk being abandoned. One woman who had thought she would never find a partner talked about her experience at 18 months on ART as follows: It is difficult to get a partner unless he is also of the same status.

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What helped me was that my partner came here [village] to work [ He continued coming here to make calls and that is when our relationship started. I think he had already developed an interest in me I am known to be HIV positive and if I stand with a man who is not my relative and people see me, they quickly warn him about me being infected. They must warn him [ Most of them also reported that they did not talk about their HIV status with new partners.

They however, expected other people to inform their partners: I didn't know his status but what I think is that he knows about my health status because the people he stays with at that home know very well about my status. Sometimes the motorcycles with a TASO label find him here. This shows that it comes from TASO. They reported that with such partners they did not need to take their medications discretely: This is because if you go out with someone that doesn't know your status or who knows nothing about these things you will start hiding the tablets from her not to see you swallowing them.

Some participants thought that so long as they were protecting their partners from HIV infection by using condoms, they did not see the need to disclose their HIV status to them. Moreover, men interpreted that their partners agreeing to have sex with them meant that they were also HIV positive and hence did not need to disclose their HIV status to their partners when they first met: That lady is a resident of this village and she very well knows me because she has seen me for a long time.

By the time I fell seriously sick, she used to come and pay me visits She was among those paying me visits and saw how I suffered but when I asked her for love she didn't hesitate which indicated to me that she might also be HIV positive. Whenever they approached women, they could easily consent to their sexual advances without asking them about their HIV serostatus.

It is not hard to find a partner These days I am a nice looking guy and admirable, whoever I talk to has to accept [agree to his sexual proposal] I started having sex and I have asked the doctor to provide me condoms. I can't hide it from you, I have a partner now. Several women reported that although they had now agreed to have sex with fellow HIV positive people after refusing for some time, the relationship was mainly shaped by their wishes.

He [new partner] had to promise me that he would abide by my terms and conditions of love using condoms all the time and avoiding pregnancies and any other sexual diseases. Among some of these things were having a spouse and children and material property such as a house. In as much as resumption of sexual activity could help meet some of the desired goals such as having a companion and for a few, children, some talked about it as a way to achieve developments such as affording to build a house or revive their petty trade that had collapsed when they succumbed to illness.

I had just come back from the island and I had worries, they had burnt down my fishing net, my money had got finished. So my uncle told me to go back home. I then came back.

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At that time, in order to have a rest from my worries, I would most of the time be taking alcohol. And I was taking too much booze. Ha, and it's at that time that he proposed to me. I first refused but I then later said but I have a lot of worries!


Maybe this man would give me a rest from the worries. Ha, we then fell in love and he told me to look for a house and he paid the rent. At 18 and 30 months on ART, most of the participants reported that they would like to have partners who were interested in marriage rather than just sex. I am now looking for a partner to get married to because I have a house Fear of infecting one's spouse was common among the participants who reported their spouses to be HIV sero-negative.

A married man with a sero-discordant wife talked about his experience in the following: What should I hide from you my sister, the sexual desire came back and we had sex for sometime but recently my wife refused completely saying that I want to kill her leaving the children alone. Then I got stress for that action because I was strong and my wife never wanted me to disturb her [have sex with her].

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She says that though we use condoms, she doesn't have the appetite [interest] for sex. We got some misunderstandings and she went to report me to our counsellor, so I also gave up with it [sex] She says that if possible I can get another person but for me I don't like to get a new one. Many had also a previous dislike for them. All that time, which I have spent on drugs, I have not had that feeling [sexual desire] until recently when I started getting it.

Since I have it now, we have to use condoms in order not to infect ourselves I remember once I told you that I had got a partner but I failed to continue with her because she had many sexual partners. Fearing that I might acquire other viruses which I didn't have, I left her and got this one so that I also get that enjoyment.

Some may engage in unprotected sex despite counselling and availability of condoms. Similar findings have been noted by others pointing to many people diagnosed with HIV claiming to have a loss of sexual interest and their plan to remain abstinent at ART initiation [ 14 ].

As observed by Seeley et al. Our findings show that as many people regained their health due to continued use of ART, they resumed sexual activity usually with new partners.

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Although many participants reported reduced numbers of partners, the ART users in this study found it challenging to consistently adopt safer sexual behaviours such as using condoms. As noted in other studies [ 15 ], a new cadre of patients is emerging-'those who expected to die but are now getting better'.

With renewed health and hopes, this group may facilitate the further spread of the epidemic or control it. As also observed elsewhere [ 8 ], counselling and free condoms, did not lead to long-term consistent condom use. Therefore, knowledge about HIV and how to avoid the disease does not automatically translate into less risky sexual behaviours and much more prevention efforts might be necessary.

It was encouraging to note, that ART use seemed to have empowered some women to discuss their sexual and reproductive health issues such as condom use and sometimes their fertility intentions with their partners. The motivation behind all this was to preserve their health after experiencing severe illness and near death signs that they could not believe that they would ever get better. As many people regain health and report increased sexual desire, it is a challenge for couples to consistently use condoms.

Besides, in relationships where the women totally refused sex for fear of infection, their partners may engage in extramarital sex in a bid to satisfy their desires and in the course place other people at risk. The challenge therefore, is how we can ensure that people on ART satisfy their sexual desires and other sexual and reproductive needs, one of their fundamental human rights [ 16 ] but at the same time ensuring that their behaviour does not place them and others at risk.

Participants talked about finding partners who were also HIV positive like themselves. Their partner selection strategies were mainly motivated by their desire to find someone who could support them in their drug taking but also driven by a desire not to infect others. While many participants' desire to have partners of the same HIV status was encouraging, it is important to point that while in theory selecting sex partners of the same HIV status could offer protection against transmission, in practice the value of serosorting may be questionable [ 17 ].

Since the HIV serostatus of partners was often assumed rather than openly discussed, this might mean that many of the partners were placed at risk. Eaton [ 17 ] observed that for the HIV positive persons who can be certain about their HIV status, serosorting can provide benefits. However, unprotected sex between HIV sero-positive persons carries risks such as superinfection, sexually transmitted infections and unplanned pregnancy that should be considered when making sexual and reproductive health decisions.

It is apparent that many couples should be encouraged to go for frequent testing to ascertain their status and that of their partners instead of assuming that they might be infected because they once had a sexual relationship with someone who had been tested and found to be HIV-sero-positive. It is also crucial for interventions to focus their messages on the potential risks of having unprotected sex, even with someone of a similar HIV status.