PLOS ONE · 6 authors, 5 centres
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This qualitative study explored the exercise experiences of 10 women living with HIV in Toronto, Canada. Six intersecting components—culture, gender, HIV-related stigma, the episodic nature of HIV, sense of belonging, and perceptions of exercise—shaped their engagement. Findings highlight the need for tailored, multi-level strategies (social support, online classes, financial assistance, education) to improve exercise uptake and health outcomes in this population.
**Background:** As life expectancy for people with HIV increases, many face multidimensional health challenges related to aging and multimorbidity, often experienced as episodic disability. Exercise can improve body composition, muscular strength, cardiorespiratory fitness, functional capacity, mental health, and quality of life in adults living with HIV. However, only about 51% of people with HIV meet weekly physical activity guidelines, and women with HIV have lower exercise engagement than men. Women comprise only 22% of the systematic review exercise literature, highlighting a need to better understand their exercise experiences.
**Methods:** This qualitative descriptive study recruited women living with HIV from a specialty hospital (Casey House), a community-based organization (AIDS Committee of Toronto), and a medical clinic (Maple Leaf Medical Clinic) in Toronto, Canada. Eligibility criteria: women (cis, trans, and gender-diverse) aged ≥18 with access to technology for online interviews. Purposive and snowball sampling were used. Ten women participated in online semi-structured interviews (60–90 minutes each) via Zoom. A demographic questionnaire was administered electronically via Qualtrics. Interview data were analyzed using descriptive thematic analysis informed by Braun and Clarke; questionnaire data were analyzed descriptively (medians, frequencies, percentages). Participants were classified as 'exercisers' or 'non-exercisers' based on Canadian Society of Exercise Physiology (CSEP) guidelines (≥150 minutes of moderate-to-vigorous aerobic activity per week).
**Key Results:** Of 16 women who showed interest, 10 were eligible and participated. Median age was 54 years (25th, 75th percentile: 49, 57). Racial/ethnic background: 40% Black or African, 20% White, 20% Indigenous, 10% White and Indigenous, 10% South Asian. 70% were single, 60% had children, 40% lived alone. 40% had completed college; 30% had annual income <$20,000 CAD; 30% received Ontario Disability Support Program. Median year of HIV diagnosis was 1999 (1993, 2010). 90% were on antiretroviral therapy; 90% had undetectable viral load (<50 copies/mL). 80% were living with at least one other concurrent health condition; 50% had a mental health condition, 40% had lung disease, 30% had gastrointestinal conditions, 30% had high cholesterol. Based on self-reported questionnaire, 50% met aerobic activity guidelines (exercisers) and 40% did not. Based on interview data, 3 were classified as exercisers and 7 as non-exercisers (of whom 3 exercised but did not meet guidelines, 2 had met guidelines in the past, and 2 currently did not exercise). The most common exercise was walking (n=6); frequency ranged from no exercise in >5 years (n=1) to daily exercise (n=2). 60% reported exercising less during the COVID-19 pandemic.
Six intersecting components characterized exercise experiences: (1) culture (cultural expectations, intersectionality of social identities, exposure to exercise, food diversity); (2) gender (caregiving roles, objectification of women, social norms around body image); (3) HIV-related stigma (as both a barrier and, for one participant, a motivator); (4) episodic nature of HIV (symptoms/treatments causing fatigue, lipodystrophy, uncertainty; concurrent health conditions like asthma, diabetes, COPD); (5) sense of belonging (lack of community, racial divide in gym spaces, support networks as motivators); and (6) perceptions of exercise (as a luxury vs. priority, as health promotion, and variable understanding of 'exercise' vs. 'physical activity' terminology).
aspirations to achieve a healthy lifestyle; using exercise as a mental diversion from stressors; having an exercise companion; and receiving financial support from community-based organizations (e.g., 50% reimbursement on gym memberships). Barriers included: limited resources (lack of mental-health support and fitness classes/groups for women with HIV); financial limitations; time and gym restrictions (work, caregiving, limited gym hours); and cold winter weather conditions.
creating social interactions (exercise buddies, support groups that exercise together); provision of online exercise classes (convenience, accessibility, comfort of home); raising awareness and education (healthcare providers discussing exercise, pamphlets in clinics, emphasizing benefits in women's groups); and offering practical support (childcare, free gym memberships, financial honoraria).
**Clinical Implications:** These findings underscore that exercise interventions for women living with HIV must address intersecting personal and environmental factors. Tailored strategies should include stigma-reduction efforts, flexible online options, social support structures, financial assistance, and integration of mental health resources. Healthcare providers should routinely discuss exercise with women living with HIV and provide concrete referrals. Community-based organizations can play a key role by subsidizing memberships and offering women-only, culturally safe exercise spaces. The results may help inform implementation of exercise rehabilitation programs to enhance uptake and health outcomes among women living with HIV.