Sex and Relationships Newsletter
February 6, 2017
When we are no longer able to change a situation, we are challenged to change ourselves.
                                                            -- Viktor Frankl
In this Issue
• Obese Couples May Take Longer to Conceive
• Black Americans Still Undertreated for HIV
• Better Sleep Could Mean Better Sex for Older Women
• Gay Man Infected With HIV Despite Using Preventive Drugs



Obese Couples May Take Longer to Conceive

His weight appears to affect pregnancy success, too, study finds

FRIDAY, Feb. 3, 2017 (HealthDay News) -- It's not just a woman's weight that matters when couples are trying to conceive, a new study suggests.

When a woman and her partner are both obese, their chances for pregnancy during any menstrual cycle are about half that of a normal-weight couple, according to the analysis from the U.S. National Institutes of Health.

"It translates to maybe a longer time to get pregnant," said lead study author Rajeshwari Sundaram. She is a senior investigator at the U.S. National Institute of Child Health and Human Development, a unit of NIH.

Prior studies show an association between female obesity and reduced odds for pregnancy in a single menstrual cycle, as well as a link between men's increased body weight and lower sperm count, the researchers noted.

This study breaks new ground because it enrolled couples hoping to get pregnant, not couples undergoing fertility treatment. Measurements of body fat were taken before they conceived, and the researchers followed each couple for a year or until a pregnancy occurred.

Lauren Wise, professor of epidemiology at Boston University School of Public Health, said, "This study represents an important contribution to the literature on couples' body size and fertility."

Wise, who was not involved in the study, said its strengths include use of more than one measure of body composition and fertility over multiple menstrual cycles. The researchers also controlled for physical activity, a key factor, she added. However, they did not take couples' diets into account.

The findings, Sundaram said, are representative of reproductive-age couples in the United States.

A total of 501 couples from Michigan and Texas joined the study from 2005 to 2009, as they were ready to try to get pregnant. Infertile couples were excluded. The women ranged in age from 18 to 40 and the men were over 18.

The researchers interviewed each partner to gather data on lifestyle, habits, and medical and reproductive history. Couples completed daily journals on lovemaking, and women recorded their menstrual cycles and pregnancy test results.

Nurses weighed each participant and measured their height as well as their waist and hip circumference.

Height and weight were used to calculate body mass index (BMI), an estimate of body fat. People with a BMI of 30 or higher are considered obese. Researchers divided the obese couples into two groups: BMIs of 30 to 34.9, and BMIs of 35 and over.

Overall, 27 percent of the women and 41 percent of the men were obese, the findings showed. In addition, the majority of men and women engaged in physical activity less than once a week.

It took couples with the highest BMIs (35 and over) 55 percent longer to get pregnant compared with normal-weight couples. When researchers accounted for other factors that might affect fertility -- including age, smoking status, exercise and cholesterol levels -- it took these obese couples 59 percent longer to get pregnant.

Larger women's waistlines -- roughly 35 or more inches -- was also associated with longer time to achieve pregnancy. But that finding didn't hold up when researchers adjusted for other factors.

The study doesn't say why couples' obesity may reduce their chances of conception. Sundaram said weight loss improves many health outcomes. "And since it takes two to make a baby, it also requires two to have a healthy weight," she reasoned.

The study can't prove a direct cause-and-effect relationship. But the research team concluded that couples' weight may be something that should be considered during preconception counseling -- and not just to reduce their odds for type 2 diabetes, cancer and heart disease.

"A little weight loss from both of them should be beneficial for a quicker time to pregnancy," Sundaram said.

The study was published online Feb. 3 in the journal Human Reproduction.

More information

The American College of Obstetricians and Gynecologists has more on obesity and pregnancy.

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Black Americans Still Undertreated for HIV

Nearly 1 in 4 had progressed to AIDS at time of diagnosis: CDC

FRIDAY, Feb. 3, 2017 (HealthDay News) -- Although progress has been made, blacks in America are still being hit harder by HIV/AIDS, a new report from the U.S. Centers for Disease Control and Prevention says.

The CDC study found that of more than 12,200 black men and women diagnosed with HIV in 2014, nearly 22 percent had progressed to AIDS by the time they were diagnosed. That means diagnosis and treatment is often coming too late.

Moreover, among all black Americans with HIV in 2013, only about 54 percent were receiving continuous medical care. Of those getting care, less than half had effectively suppressed the virus. This is far below the National HIV/AIDS Strategy goals of 90 percent of HIV patients in treatment and 80 percent with undetectable HIV by 2020, the study authors noted.

"While we have made great progress in HIV prevention among African Americans in recent years, it is clear that we need to increase the proportion of African Americans living with HIV who are aware of their status and are receiving treatment," said lead researcher Andre Dailey. He's an epidemiologist in the CDC's division of HIV/AIDS prevention.

According to the report, from 2010 to 2014, the annual HIV diagnosis rate decreased for blacks by 16 percent.

Yet, in 2015, black people still accounted for 45 percent of new HIV diagnoses. Among black women, the annual rate of HIV diagnosis was about 16 times greater than the rate among white women, the CDC reported.

The findings also indicated that many black men may be infected with HIV for years without knowing it, Dailey said.

"Newly diagnosed HIV-positive persons who start treatment immediately live longer, healthier lives and dramatically reduce their risk of passing the virus to another person," he noted.

The results of the analysis underscore the importance of directing prevention and care efforts to populations that are most affected by HIV, Dailey added.

"CDC is pursuing an approach that focuses resources on programs and initiatives that can have the biggest impact," he said. "This includes targeted focus on African Americans and in geographic areas of greatest need -- including the South."

For people living with HIV, getting diagnosed and starting treatment early is an essential first step toward long-term health, Dailey explained.

"Increasing HIV testing in health-care and non-health-care settings can improve the proportion of African Americans who know their status and ultimately drive down HIV infection in the black community," he said.

For the study, Dailey and his colleagues used data from the National HIV Surveillance System in 33 areas around the nation.

The report was published Feb. 3 in the CDC's Morbidity and Mortality Weekly Report (MMWR).

Greg Millett is vice president and director of public policy at amfAR, The Foundation for AIDS Research. He said, "The good news is that HIV diagnosis has been decreasing all over the United States over the last 10 years, and it's also decreasing among African Americans."

Millett said that "this shows that prevention efforts are working, as well as efforts to increase HIV treatment in the African-American community."

The bad news is that blacks fare poorly on HIV outcomes and access to care compared with white Americans and others, he said.

"This is not something that's specific to HIV. There are other diseases where blacks are more likely to die or have worse outcomes than other groups," Millett added.

"It's really more symptomatic of marginalization in society -- issues of poverty, not having access to health insurance, and homelessness, which is associated with not taking HIV medications and not having the virus suppressed," he said.

More access to care -- particularly in rural areas -- is needed, he said.

"The other good news is that we are seeing a decrease in HIV diagnoses among African-American women as well as a decrease in disparities between African-American women and other women," Millett said.

A second report in the same issue of the MMWR looks at this reduction and shows that HIV has significantly decreased among black women in the United States. From 2005 to 2014, HIV infection rates among black women dropped 42 percent, according to the researchers.

But in 2015, black women still accounted for almost two-thirds of women living with HIV in the United States.

These findings are more evidence that, although progress has been made, disparities in the prevalence of HIV still exist between black and white women, according to Donna McCree and colleagues at the CDC's division of HIV/AIDS prevention.

More information

For more information on HIV/AIDS, visit the U.S. Centers for Disease Control and Prevention.

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Better Sleep Could Mean Better Sex for Older Women

Study found links between too little shuteye and less sexual satisfaction, especially around menopause

WEDNESDAY, Feb. 1, 2017 (HealthDay News) -- A more satisfying sex life may be only a good night's sleep away for women over 50, new research finds.

Researchers led by Dr. Juliana Kling of the Mayo Clinic in Scottsdale, Ariz., tracked data from nearly 94,000 women aged 50 to 79.

The investigators found that 31 percent had insomnia, and a little more than half (56 percent) said they were somewhat or very satisfied with their sex life.

But too little sleep -- fewer than seven to eight hours a night -- was linked with a lower likelihood of sexual satisfaction, the findings showed.

"This is a very important study since it examines a question which has tremendous potential impact on women's lives," said Dr. Jill Rabin, who reviewed the findings. She's co-chief of the Women's Health Program at Northwell Health in New Hyde Park, N.Y.

Age played a key role in outcomes. For example, the study found that older women were less likely than younger women to be sexually active if they slept fewer than seven to eight hours per night.

Among women older than 70, those who slept fewer than five hours a night were 30 percent less likely to be sexually active than women sleeping seven to eight hours, Kling's team found.

The findings highlight how crucial sleep is to many aspects of women's health, medical experts said.

"Seven hours of sleep per night will improve sexual satisfaction and has been shown to increase sexual responsiveness," said Dr. JoAnn Pinkerton, executive director of The North American Menopause Society.

Besides putting a damper on sex lives, she said, poor sleep is also tied to an array of health issues, such as "sleep apnea, restless legs syndrome, stress and anxiety." Other health problems linked to insomnia include "heart disease, hypertension [high blood pressure], arthritis, fibromyalgia, diabetes, depression and neurological disorders," Pinkerton added.

Dr. Steven Feinsilver directs sleep medicine at Lenox Hill Hospital in New York City. He reviewed the new findings and stressed that they can't prove cause and effect. "It certainly could be possible that many underlying problems -- for example, illness, depression -- could be causing both worsened sleep and worsened sex," he noted.

Rabin agreed, but said there's been "a paucity of studies" looking into links between sleep and sexual health, especially during menopause.

"We know that obstructive sleep apnea and sexual dysfunction are positively correlated," she said. "Other factors which may lead to a decreased sleep quality include: a woman's general health; various life events, which may contribute to her stress; chronic disease; medication; and degree and presence of social supports, just to name a few," Rabin explained.

And, "in menopause, and due to the hormonal transition, women may experience various symptoms which may impact the duration and quality of their sleep patterns," Rabin added.

"We and our patients need to know that quality sleep is necessary for overall optimum functioning and health, including sexual satisfaction, and that there are effective treatment options -- including hormone therapy -- which are available for symptomatic women," she said.

The study was published online Feb. 1 in the journal Menopause.

More information

The U.S. National Institute on Aging has more about sexuality later in life.

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Gay Man Infected With HIV Despite Using Preventive Drugs

But cases of drug-resistant strains of AIDS virus are still rare, doctors say

WEDNESDAY, Feb. 1, 2017 (HealthDay News) -- Doctors report that a gay Canadian man contracted HIV even though he had been taking daily medication to ward off infection.

Based on a genetic analysis of the virus, it was determined that the 43-year-old Toronto resident was infected with a strain of HIV that had become resistant to the anti-HIV drug Truvada, said report author Dr. David Knox. He is a doctor with the Maple Leaf Medical Clinic in Toronto.

However, HIV experts say this does not mean a completely drug-resistant strain of the virus is on its way, leading to a return of the AIDS crisis of the 1980s and 1990s.

"The number of highly resistant strains for Truvada is still very low," said Greg Millett, vice president and director of public policy for amfAR, The Foundation for AIDS Research.

"Less than 1 percent of people living with HIV have a highly resistant strain. I do not have a concern that this is the beginning of a huge wave of multidrug-resistant HIV," Millett added.

Truvada contains two drugs that both work to inhibit HIV from replicating. In 2012, the U.S. Food and Drug Administration approved its use in uninfected adults to prevent the spread of HIV.

The strategy of taking an oral daily dose of Truvada to ward off HIV infection is called pre-exposure prophylaxis (PrEP). Daily PrEP reduces the risk of acquiring HIV from sex by as much as 99 percent, Millett said.

The Toronto man began taking oral Truvada in April 2013, according to the report published in the Feb. 2 issue of the New England Journal of Medicine.

Pharmacy records show he had been taking the drug as prescribed, Knox and colleagues noted.

But after two years of successful PrEP, a screening test revealed that the man had contracted HIV, Knox said.

"We looked at the genetics of this particular strain of HIV and proved there were mutations to counter both medications used in PrEP meant to stop the infection," he said.

The man was not using condoms during sex, Knox noted, which is recommended for complete protection against HIV, even for people taking PrEP.

"Condoms plus PrEP equals our best protection against HIV infection," Knox stated.

However, the man also did not have any other sexually transmitted diseases, which can increase risk of HIV infection, the researcher added.

Both Knox and Millett said the case shows that doctors need to keep an eye on the evolution of HIV.

"We should be monitoring the rates of these mutations that are occurring in individuals with HIV, and we should be vigilant for unique cases in PrEP users," Knox said.

Millett added that the case also highlights the need for more anti-HIV drugs that can be used in PrEP.

"It's an argument for us to have a range of PrEP products and agents to be developed in the future," Millett said.

In the meantime, people at high risk for HIV infection should continue to take PrEP drugs to protect themselves, Knox and Millett advised.

"There's tens of thousands of people who are believed to be on HIV PrEP, and there have been only two documented cases of people who were infected with drug-resistant strains of HIV," Knox said. "I wouldn't use this case as a reason to stop taking PrEP or to dissuade anybody from initiating PrEP if they are at high risk for HIV."

More information

For more about pre-exposure prophylaxis (PrEP), visit the U.S. Centers for Disease Control and Prevention.

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