Sexual compulsion and HIV transmission: a case report

Compulsão sexual e transmissão do HIV: um relato de caso

CARTAS AOS EDITORES

Sexual compulsion and HIV transmission: a case report

Compulsão sexual e transmissão do HIV: um relato de caso

Dear Editor,

We report on a case drawing attention to sexual compulsion (SC) as a risk factor for HIV transmission.

P., 37 year-old, male, Caucasian, single, retired physics teacher, born and resident in São Paulo, Brazil, homosexual and HIV positive was referred from Hospital Emílio Ribas to the Sexuality Project of Institute of Psychiatry, Hospital das Clínicas, Universidade de São Paulo Medical School, due to risk of transmission as he had exacerbated sexual behavior. P. started going to saunas, cinemas and public restrooms on a daily basis in search of sex since the age of 18. He had unprotected homosexual intercourses with multiple partners, sometimes ten or more on the same day. He rarely had more than one sexual intercourse with the same person. P. spent a lot of money on sex. He frequently abandoned his professional routine to look for sex, compromising his career. He never earned a university degree. The patient did not have emotional feelings for his partners. He did not waste time with foreplay (hugs, kisses, caresses), focusing on contact with erogenous zones. When he felt the "uncontrollable desire of having sex", he only followed his impulse and rarely used a condom. In 1993, he had syphilis and anal and genital herpes. He has had HIV since 1996. In 2003, he was hospitalized due to pneumocystosis and, since then, has been taking antiretrovirals. His family relationship is extremely poor and he has no friends. He has no leisure activities. The patient had no previous history of drug use and was not sexually abused in childhood. He did not meet criteria for personality disorder. He met six out of seven criteria proposed by Goodman¹ for sexual addiction (Table 1). His score on the Sexual Addiction Screening Scale² was 15 (cases should score 6 or higher) and he scored 26 (moderate to severe depression) on the Beck Depression Inventory.³ Treatment consisted of psychiatric follow-up, when paroxetine was started. He had partial reduction in sexual desire at a daily dose of 40mg. In the second month, psychodynamic psychotherapy was associated. After a 1-year follow-up, the patient had improvements in all clinical parameters, developing higher control over his sexual impulses and no longer searching for sex in cinemas and saunas. He began to use condoms in almost every sexual intercourse. Single individuals exclusively with occasional partners account for 15% of the sexually active population in Brazil. Use of condom in the last intercourse was reported by 79.5% of this group.⁴ In Brazil, transmission in homosexual and bisexual intercourses accounts for 20.7 and 12.2%, respectively, of all cases of AIDS in men.⁵ Therefore, our patient's vulnerability to HIV/AIDS seems to be less associated with homosexual orientation and multiplicity of partners and more associated with the clinical outcome of SC: lack of control over sexual impulses, impairment of affective, social, and occupational areas of life. The patient had no previous history of depression. The depressive episode is recent and may be secondary to psychosocial difficulties. SC has not received proper emphasis in scientific publications as to its potential for higher risk of HIV transmission and its prevalence is estimated to be between 3 to 6%.¹

Marco de T. Scanavino, Roberta R. A. Torres, Carmita H. N. Abdo

Sexuality Project (ProSex), Department and Institute of Psychiatry,

School of Medicine, Universidade de São Paulo (USP),

São Paulo (SP), Brazil

Maria Antonia S. Rego, Fabiana M. A. O. Fernandez

School of Medicine, Universidade de São Paulo (USP),

São Paulo (SP), Brazil

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• 1. Goodman A. Sexual addiction: nosology, diagnosis, etiology, and treatment. In: Lowinson JH, Ruiz P, Millman RB, Langrod JG. Substance abuse Philadelphia: Lippincott Williams & Wilkins; 2005. p.505-39.
• 2. Silveira DX, Vieira AC, Palomo V, Silveira ED. Criteria validity and reliability of the Brazilian version of a sexual addiction screening scale. Rev Bras Psiquiatr. 2000;22(1):4-10.
• 3. Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh G. An inventory for measuring depression. Arch Gen Psychiatry. 1961;4(1):53-63.
• 4. Brazil. Department of Health. National Program of STD and AIDS. Behavior of the sexually active Brazilian population [cited 2005 Feb 24]. Available from: http://www.aids.gov.br/final/biblioteca/ibope_2003/briefing2.doc
• ⁵
  5. Epidemiological Bulletin 2008. Department of Health. National Program of STD and AIDS. Brasília: Department of Health; 2008. [cited 2008 Jan 29]. Available from: http://www.aids.gov.br/data/documents/storedDocuments/%7BB8EF5DAF-23AE-4891AD36-1903553A3174%7D/%7BF880504B-B87C-4155-8C31EDFE337DB4C6%7D/Boletim2008_jornalistas.pdf
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Publication Dates

• Publication in this collection
  25 June 2009
• Date of issue
  June 2009