BACKGROUND Life expectancy of people living with HIV (PLWH) is increasing. Effective biomedical prevention methods (treatment as prevention and preexposure prophylaxis) are being widely implemented in high-income nations. Therefore, research into quality of life, including sexual adjustment, is of increasing importance to HIV care. Yet, sexual adjustment of PLWH has been neglected in past research. We propose a new model of sexual adjustment to HIV which explores the dynamic process, facilitators and barriers characterising sexual life of PLWH overtime. METHOD Thirty PLWH (19 male, 11 female) recruited from two HIV treatment centres as well as community groups, completed semi-structured interviews which were audio-recorded and transcribed verbatim for analysis using grounded theory. RESULTS The model of sexual adjustment to HIV is the first to establish how undue fears of transmission of HIV during sex and/or fear of rejection by sexual partners determine initial sexual behaviour after diagnosis and also sexual adjustment over time. Within the model, sexual adjustment to HIV is facilitated by factors which assist PLWH to overcome such fears, including: partner acceptance, peer, community and health professional support, and accurate knowledge of risk of transmission including of undetectable viral load and pre-exposure prophylaxis. Adjustment is inhibited when undue fears of transmission and of rejection persist long term, resulting in maladaptive behaviours to cope with such fears including avoidance of sex and problematic drug and alcohol use. CONCLUSION This model offers clear directions for promoting sexual adjustment to HIV. Health professionals should: (a) assess and intervene for sexual quality of life (not just risk) among PLWH; (b) be aware that serosorting facilitates adjustment in the short to medium term, but may interfere with adjustment long-term, (c) promote opportunities for positive connection between PLWH, and (d) intervene directly with PLWH and HIV negative sexual partners to promote accurate risk of transmission knowledge, including how this applies to their own sexual practices, and whether they are experiencing undue fear of transmission over time.

中文翻译：

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艾滋病毒性调整的新扎根理论模型：性调整的促进者和临床实践的建议。

背景技术 HIV 感染者 (PLWH) 的预期寿命正在延长。高收入国家正在广泛实施有效的生物医学预防方法（治疗即预防和暴露前预防）。因此，对生活质量（包括性调整）的研究对于艾滋病毒护理变得越来越重要。然而，过去的研究却忽视了感染者的性适应。我们提出了一种针对艾滋病毒的性调整的新模型，该模型探讨了感染者超时性生活的动态过程、促进因素和障碍。方法 从两个艾滋病毒治疗中心和社区团体招募了 30 名感染者（19 名男性，11 名女性），完成了半结构化访谈，访谈内容被录音并逐字转录，以便使用扎根理论进行分析。结果艾滋病毒的性调整模型首次确定了对性行为过程中艾滋病毒传播的过度恐惧和/或对性伴侣拒绝的恐惧如何决定诊断后的初始性行为以及随着时间的推移进行的性调整。在该模型中，艾滋病毒感染者的性适应是通过帮助感染者克服此类恐惧的因素来促进的，这些因素包括：伴侣的接受、同伴、社区和卫生专业人员的支持，以及对传播风险的准确了解，包括不可检测的病毒载量和暴露前预防。当对传播和排斥的过度恐惧长期持续存在时，调整就会受到抑制，从而导致应对此类恐惧的适应不良行为，包括避免性行为以及有问题的药物和酒精使用。结论 该模型为促进艾滋病毒的性调整提供了明确的方向。卫生专业人员应： (a) 评估和干预感染者的性生活质量（而不仅仅是风险）；(b) 请注意，血清分类有助于中短期调整，但可能会干扰长期调整，(c) 促进感染者和艾滋病病毒感染者之间建立积极联系的机会，以及 (d) 直接干预感染者和艾滋病毒阴性性伴侣，以宣传传播风险的准确知识，包括这如何适用于他们自己的性行为，以及他们是否随着时间的推移对传播产生过度的恐惧。